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de Almeida Pinho I, Pimentel MJ, Oliveira C, Matos MI, Vale C, Matias P, Pereira J, Marques P, Leite-Moreira A, Friões F, Vasques-Nóvoa F, Ferreira JP. Office- versus home-based evaluation of quality of life in heart failure with reduced ejection fraction: A randomized study. Int J Cardiol 2024; 413:132341. [PMID: 38971536 DOI: 10.1016/j.ijcard.2024.132341] [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] [Received: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Heart failure (HF) patients often experience poor health-related quality-of-life (HR-QoL). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is frequently used for assessing HR-QoL in HF. Whether KCCQ scores vary in a clinical meaningful manner according to the setting (home vs office) where patients respond to the questionnaire is currently unknown. AIMS Assess the differences in the responses to KCCQ-23 questionnaire when completed at home or office. METHODS Randomized parallel-group study, including patients with HF with reduced ejection fraction (HFrEF). Primary outcome was home vs office comparison of overall summary score (KCCQ-OSS). Main secondary outcomes were clinical summary score (KCCQ-CSS) and total symptom score (KCCQ-TSS). RESULTS A total of 100 patients were included in the study: 50 home vs 50 office. Mean age was 71 yrs. Most baseline characteristics were well balanced between groups, except male sex, MRA use, and prior HF hospitalizations which were more frequent in the home group. No statistically-significant between-group differences were found regarding KCCQ-OSS (median [percentile25-75]) scores: home 69.1 (42.0-86.5) vs office 63.1 (44.3-82.3) points, P-value = 0.59, or main secondary outcomes: KCCQ-CSS home 62.2 (46.5-79.9) vs office 68.1 (51.9-79.2) points, P-value = 0.69, and KCCQ-TSS home 84.7 (59.7-97.2) vs office 76.4 (66.7-94.4) points, P-value = 0.85. Results remained similar after adjustment for differences in baseline characteristics and using non-parametric regressions. CONCLUSIONS No major differences were found in KCCQ-23 scores regardless of whether the questionnaire was completed at home or office. These findings can be useful to make HR-QoL more accessible, allowing patients to respond at home using email or cell-phone applications.
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Affiliation(s)
- Inês de Almeida Pinho
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Pimentel
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Cristina Oliveira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria Inês Matos
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Vale
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Matias
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Pereira
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Marques
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Friões
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Institut National de la Santé et de la Recherche Médicale U1116, Centre Hospitalier Régional Universitaire, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nancy, France.
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Salehi N, Heydarpour P, Salimi Y, Ziapour A, Majzoobi MR, Geravand S, Janjani P. Comparison of quality of life in patients with mitral valve replacement and mitral valve repair in Imam Ali Hospital during 2014 to 2020: a cross-sectional study. J Cardiothorac Surg 2024; 19:299. [PMID: 38789973 PMCID: PMC11127294 DOI: 10.1186/s13019-024-02780-1] [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: 11/13/2023] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients. Therefore, the present study was conducted to compare the quality of life in patients with mitral valve replacement and those who underwent mitral valve repair. METHODS In this cross-sectional study, we considered all cardiac patients with ischemic mitral insufficiency who underwent mitral valve repair and patients with a history of valve replacement in Imam Ali Hospital of Kermanshah between 2014 and 2020. Two Minnesota and general quality of life questionnaires along with a checklist for demographic variables were used for data collection. Data analysis was performed using SPSS version 21 software. RESULTS The mean quality of life score based on the general quality of life scale in the valve repair group was 32.33 (SD = 2.29) and in the valve replacement group 32.89(SD = 2.60), (p = 0.917). Also, mean quality of life, as measured by the Minnesota MLHFQ was 60.89(SD = 17.67) in the valve repair group and 63.42 (SD = 12.13) in the valve replacement group (p = 0.308). The results showed that the average general quality of life was different in study groups regarding education. Tukey's post hoc test showed that the average general quality of life in illiterate people is significantly lower than in people with academic degrees (P-value = 0.001). CONCLUSION The quality of life of the patients in both the valve repair and replacement groups was at an average level. There was no significant difference between the general quality of life and the Minnesota scales, suggesting that both tools can be effectively used to measure patients' quality of life. The study's findings can be valuable for monitoring patients, screening for conditions, and enhancing communication between doctors and patients.
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Affiliation(s)
- Nahid Salehi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pouria Heydarpour
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Majzoobi
- Developmental Psychology and Clinical Psychology of the Lifespan, University of Siegen, Siegen, Germany
| | - Sahand Geravand
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Hosseini SA, Karampourian A, Shamsizadeh M, Mohammadi Y. Application of Haddon strategy training on self-care behavior and disease consequences in heart failure. JOURNAL OF VASCULAR NURSING 2023. [DOI: 10.1016/j.jvn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Habibzadeh H, Shariati A, Mohammadi F, Babayi S. The effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure: an experimental study. BMC Cardiovasc Disord 2021; 21:478. [PMID: 34610821 PMCID: PMC8491755 DOI: 10.1186/s12872-021-02294-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Heart failure is a common and chronic heart condition with high prevalence and mortality rates. This debilitating disease as an important predictor of health outcomes is directly related to patients' quality of life. Given that one of the main goals of heart failure treatment is to promote patients' quality of life and health status, conducting effective nursing interventions seems to be necessary in this regard. Therefore, the present study aimed to determine the effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure. METHODS This is an experimental study in which a total of 80 patients with heart failure were recruited and randomly allocated to two groups of intervention and control (n = 40 in each group). The educational program was designed based on Pender's health promotion model and then provided for the patients in the intervention four subgroups (10 person in each group) during six sessions. Data were collected at three time-points of before, immediately after, and three months after the intervention using a demographic questionnaire, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Health-Promoting Lifestyle Profile II (HPLP-II). Data were then analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA) and p value less than 0.05 was taken as statistically significant. RESULTS Based on the results of the present study, no statistically significant difference was shown in terms of demographic characteristics between the two groups. It was also indicated that there was a statistically significant difference in the mean scores of all dimensions of quality of life (except in the physical dimension) between the two groups so that the overall mean score of quality of life increased significantly in the intervention group after the intervention (p < .05). Moreover, there were significant increases in the mean scores of health-promoting behaviors (except in the domain of physical activity) in the intervention group compared to the control group (p < .05) after intervention. CONCLUSIONS This study demonstrates a trend that Pender's health promotion model is effective in improving the quality of life of patients with heart failure except of the physical dimension, and strengthening their health-promoting behaviors in all dimensions except of the physical activity dimension.
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Affiliation(s)
- Hossein Habibzadeh
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Akram Shariati
- Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Farshad Mohammadi
- Student's Research Committee of Nursing and Midwifery Faculty, School of Nursing and Midwifery, Urmia University of Medical Sciences, P.O Box: 575611- 5111, Urmia, Iran.
| | - Salman Babayi
- Department of Mathematics, Faculty of Science, Urmia University, Urmia, Iran
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Abstract
Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, 'value' refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley's "agential flourishing" theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations.
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Bundgaard JS, Thune JJ, Torp-Pedersen C, Nielsen JC, Haarbo J, Rørth R, Videbæk L, Melchior T, Pedersen SS, Køber L, Mogensen UM. Self-reported health status and the associated risk of mortality in heart failure: The DANISH trial. J Psychosom Res 2020; 137:110220. [PMID: 32836103 DOI: 10.1016/j.jpsychores.2020.110220] [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: 05/10/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the gradual association between self-reported health status and mortality in patients with heart failure (HF) as current research has focused on poor health status and increased risk of mortality. METHOD This is a substudy of the DANISH (Defibrillator Implantation in Patients with Nonischemic Systolic HF) trial in which 1116 patients were randomized to receive or not receive an implantable cardioverter-defibrillator. Health status was assessed by a single question of the Short-Form 36. Patients were classified as having excellent/very good, good, fair (reference) or poor health status. We assessed the association between health status and mortality using multivariable Cox proportional hazard models. RESULTS Self-reported health status was completed by 943 (84%) patients at randomization with a median follow-up of 67 months and a health status distribution of; excellent/very good (n = 79, 8%), good (n = 369, 39%), fair (n = 409, 43%), and poor (n = 86, 9%). All-cause mortality (death events/ 100 person-years) occurred with gradual differences according to health status from excellent/ very good (2.14), good (3.74), fair (5.21) to poor health status (5.57). The gradual difference yielded a crude hazard ratio (HR) of 0.40, 95% CI 0.20-0.80 (adjusted HR 0.47 (95% CI 0.23-0.95) for excellent/ very good health status, HR 0.71, 95% CI 0.52-0.97 (adjusted HR 0.78 (95% CI 0.56-1.08) for good health status. Poor being worse than fair health status yielded a crude HR of 1.07, 95% CI 0.67-1.69. CONCLUSION Excellent/very good self-reported health status as assessed by a single question was associated with lower long-term mortality in patients with HF.
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Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jens J Thune
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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Stein G, Teng THK, Tay WT, Richards AM, Doughty R, Dong Y, Sim D, Yeo PSD, Jaufeerally F, Leong G, Soon D, Ling LH, Lam CSP. Ethnic differences in quality of life and its association with survival in patients with heart failure. Clin Cardiol 2020; 43:976-985. [PMID: 32562317 PMCID: PMC7462190 DOI: 10.1002/clc.23394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Optimizing quality of life (QoL) is a key priority in the management of heart failure (HF). Hypothesis To investigate ethnic differences in QoL and its association with 1‐year survival among patients with HF. Methods A prospective nationwide cohort (n = 1070, mean age: 62 years, 24.5% women) of Chinese (62.3%), Malay (26.7%) and Indian (10.9%) ethnicities from Singapore, QoL was assessed using the Minnesota Living with HF Questionnaire (MLHFQ) at baseline and 6 months. Patients were followed for all‐cause mortality. Results At baseline, Chinese had a lower (better) mean MLHFQ total score (29.1 ± 21.6) vs Malays (38.5 ± 23.9) and Indians (41.7 ± 24.5); P < .001. NYHA class was the strongest independent predictor of MLHFQ scores (12.7 increment for class III/IV vs I/II; P < .001). After multivariable adjustment (including NT‐proBNP levels, medications), ethnicity remained an independent predictor of QoL (P < .001). Crude 1‐year mortality in the overall cohort was 16.5%. A 10‐point increase of the physical component (of MLHFQ) was associated with a hazard (HR 1.22, 95% 1.03‐1.43) of 1‐year mortality (P = .018) in the overall cohort. An interaction between MLHFQ and ethnicity was found (P = .019), where poor MLHFQ score (per 10‐point increase) predicted higher adjusted mortality only in Chinese (total score: HR 1.18 [95% CI 1.07‐1.30]; physical: HR 1.44 [95% CI 1.17‐1.75]; emotional score: HR 1.45 [95% CI 1.05‐2.00]). Conclusions Ethnicity is an independent determinant of QoL in HF. Despite better baseline QoL in Chinese, QoL was more strongly related to survival in Chinese vs Malays and Indians. These findings have implications for HF trials that use patient‐reported outcomes as endpoints.
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Affiliation(s)
- Gillian Stein
- NYU Grossman School of Medicine, New York, New York, USA
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,School of Population & Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Wan T Tay
- National Heart Centre Singapore, Singapore, Singapore
| | | | | | - YanHong Dong
- National University Health System, Singapore, Singapore
| | - David Sim
- Singapore General Hospital, Singapore, Singapore
| | - Poh S D Yeo
- Gleneagles Medical Centre, Singapore, Singapore
| | | | | | - Dinna Soon
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lieng H Ling
- National University Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Khalili Y, Hamediseresht M, Asghari R, Taghavi S, Amin A, Naderi N. Evaluation of the reliability and validity of the Iranian caregiver burden questionnaire for heart failure. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moshki M, Khajavi A, Vakilian F, Minaee S, Hashemizadeh H. The content comparison of health-related quality of life measures in heart failure based on the international classification of functioning, disability, and health: a systematic review. J Cardiovasc Thorac Res 2019; 11:167-175. [PMID: 31579455 PMCID: PMC6759616 DOI: 10.15171/jcvtr.2019.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 08/02/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: Due to the necessity of assessing the health-related quality of life (HRQOL) in heart failure (HF) and the increased use of the International Classification of Functioning, Disability, and Health (ICF) for making a content comparison of measurement instruments, the present study aimed to evaluate the relationship between the instruments and ICF. To this aim, the disease-specific HRQOL instruments in HF were identified, and then psychometric properties and content comparison of included instruments were conducted by linking to ICF. Methods: Disease-specific HRQOL instruments in HF were identified through a comprehensive and systematic search strategy. Then, the psychometric properties of included instruments were determined, and their contents were analyzed and compared based on the ICF coding system. In addition, each instrument was independently linked to ICF by two researchers based on standardized linking rules, and finally their degree of agreement was assessed by the Cohen's kappa coefficient. Results: Ten instruments including a total of 247 items and 417 concepts were linked to 124 different ICF categories. Further, 39 (31.5%), 65 (52.5%), 13 (10.4%), and 7 (5.6%) categories were linked to body function, activity and participation, environmental factors, and body structure, respectively. According to the content analysis approach and psychometric properties, the appropriate measurement instruments were Kansas City Cardiomyopathy and Minnesota living with HF questionnaires, respectively. Conclusion: Content comparison provides researchers with valuable information on the instrument heterogeneity and overlapping, which results in selecting the most appropriate measurement instrument based on a specific clinical context.
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Affiliation(s)
- Mahdi Moshki
- Department of Health Education and Promotion, School of Health; Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Abdoljavad Khajavi
- Department of Community Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Farveh Vakilian
- Department of Cardiology, Preventive Atherosclerotic Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Minaee
- Department of Cardiovascular Diseases, Razavi Hospital, Mashhad, Iran
| | - Haydeh Hashemizadeh
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Mozenska O, Bil J, Segiet A, Kosior DA. The influence of calcium-phosphate metabolism abnormalities on the quality of life in patients with hemodynamically significant mitral regurgitation. BMC Cardiovasc Disord 2019; 19:116. [PMID: 31096915 PMCID: PMC6521542 DOI: 10.1186/s12872-019-1094-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background In recent years, studies have indicated that vitamin D [25(OH)D3] and other calcium-phosphate (Ca-P) metabolism parameters and their disturbances might be potential new factors that may influence health-related quality of life (HRQoL). The aim of our study was to assess the extent of Ca-P metabolism abnormalities in patients with significant mitral regurgitation (MR) and their effect on patients’ HRQoL. Methods We included 99 patients with significant MR (median age, 75 years [Q1–Q3, 66.0–81.5], 35.4% females). Hemodynamically significant MR was assessed using transthoracic echocardiography (vena contracta > 3 mm, effective orifice area > 0.2 cm2, and MR volume > 30 mL/s). HRQoL was evaluated using a cardiac-specific (MacNew) tool. Results A significant negative correlation between parathormone (PTH) levels and HRQoL was demonstrated (r = − 0.242, − 0.243, and − 0.255; p = 0.018, 0.018, and 0.013 for Global Scores, and physical and social domains, respectively). Additionally, we confirmed that patients with higher NT-proBNP levels, NYHA heart failure (HF) class, and larger left ventricles had poorer HRQoL. Moreover, patients with poorer HRQoL walked a shorter distance in a 6-min walking test. Conclusions To the best of our knowledge, this report is the first to show that Ca-P abnormalities resulted in significantly worse HRQoL, especially in the physical domain, in a population of patients with hemodynamically significant MR.
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Affiliation(s)
- Olga Mozenska
- Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior and Administration, Woloska Street 137, 02-507, Warsaw, Poland. .,Department of Internal Medicine, Hypertension and Vascular Diseases, Warsaw Medical University, Banacha Street 1a, 02-097, Warsaw, Poland.
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of the Interior and Administration, Woloska Street 137, 02-507, Warsaw, Poland
| | - Agnieszka Segiet
- Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior and Administration, Woloska Street 137, 02-507, Warsaw, Poland
| | - Dariusz A Kosior
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawinskiego Street 5, 02-106, Warsaw, Poland
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11
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Mohamed NF, Ghazali SR, Yaacob NA, Rahim AAA, Maskon O. Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire. Sultan Qaboos Univ Med J 2019; 18:e494-e500. [PMID: 30988969 DOI: 10.18295/squmj.2018.18.04.011] [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: 04/02/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient's quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument's construct validity. Cronbach's alpha coefficients were used to determine internal consistency. Results A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors-psychological, physical-social and spiritual wellbeing-resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450-0.718 for psychological wellbeing (12 items), 0.394-0.740 for physical-social wellbeing (14 items) and 0.449-0.727 for spiritual wellbeing (seven items). The overall Cronbach's alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF.
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Affiliation(s)
- Nor F Mohamed
- Department of Psychology & Counselling, Faculty of Human Development, Sultan Idris Education University, Tanjung Malim, Malaysia
| | - Siti R Ghazali
- Department of Psychological Medicine, University Malaysia Sarawak, Sarawak, Malaysia
| | - Nor A Yaacob
- Department of Community Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aizai A A Rahim
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Oteh Maskon
- Department of Cardiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Jalali D, Abdolazimi M, Alaei Z, Solati K. Effectiveness of mindfulness-based stress reduction program on quality of life in cardiovascular disease patients. IJC HEART & VASCULATURE 2019; 23:100356. [PMID: 31011624 PMCID: PMC6465573 DOI: 10.1016/j.ijcha.2019.100356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/09/2019] [Accepted: 03/25/2019] [Indexed: 01/03/2023]
Abstract
Introduction Cardiovascular disease is one of the most fatal physical illnesses that impose many financial losses on societies every year. Aim This study was to investigate the effectiveness of a mindfulness-based stress reduction (MBSR) program on self-efficacy and quality of life in patients with cardiovascular disease. Material and methods The samples of this clinical trial were 60 patients who were selected by convenience sampling from patients were diagnosed, clinically interviewed by a cardiologist and randomized to two groups; experimental and control, and then completed Sherer et al. General Self-Efficacy Scale and 36-item Short Form Survey three times; pre-test, post-test, and after 3 months of follow-up. MBSR Program includes the methods that patients learn to calm their minds and body to help them cope with disease that was based on self-efficacy and quality of life. Data analysis was performed by the SPSS v22 using t-test and ANOVA. Results The results show that the mean pre-test scores of self-efficacy and quality of life of patients were not significantly different between the experimental and control groups (P > 0.05). However, the mean scores of the two variables were found to be significantly different between the experimental group and the control group on the post-test and follow-up as the research hypotheses were examined (P < 0.01). So that the means of self-efficacy were 60.80 ± 5.91 and 60.40 ± 7.03 and quality of life were 103.80 ± 9.35 and 101.10 ± 9.13 at post-test and 3 months later respectively in experimental group. Conclusion Self-efficacy and quality of life of cardiovascular patients could be improved by providing an MBSR program.
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Affiliation(s)
- Darioush Jalali
- Department of Psychology, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
| | - Mohammad Abdolazimi
- Department of Cardiovascular Cancer Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Alaei
- Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Kamal Solati
- Department of Psychiatry, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Kernick LA, Hogg KJ, Millerick Y, Murtagh FEM, Djahit A, Johnson M. Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis. Palliat Med 2018; 32:1539-1551. [PMID: 30234421 DOI: 10.1177/0269216318801162] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. AIM To evaluate the literature regarding advance care planning in heart failure. DESIGN Systematic review and narrative analysis (PROSPERO CRD42017059190). DATA SOURCES Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies. RESULTS Out of the 1713 articles, 8 were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised controlled trial assessed planning in addition to usual cardiology care; one randomised controlled trial and one observational study assessed planning in an integrated cardiology-palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning: (1) reduced hospitalisation (5/7 studies); (2) increased referral/use of palliative services (4/4 studies); and (3) supported deaths in the patient-preferred place (2/2 studies). CONCLUSION Advance care planning as part of specialist palliative care reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising.
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Affiliation(s)
- Lucy A Kernick
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Karen J Hogg
- 2 Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Yvonne Millerick
- 3 Glasgow Royal Infirmary, Glasgow Caledonian University, Glasgow, UK
| | - Fliss E M Murtagh
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ayse Djahit
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam Johnson
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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14
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Katarina PL, Sussanne B, Gunilla HF, Henrik H, Marika W. The quality of care questionnaire: development of a valid measure for persons with inflammatory bowel disease. Scand J Gastroenterol 2018; 53:1043-1050. [PMID: 30299173 DOI: 10.1080/00365521.2018.1495759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Quality of care is important in lifelong illnesses such as inflammatory bowel disease (IBD). Valid, reliable and short questionnaires to measure quality of care among persons with IBD are needed. The aim of this study was to develop a patient-derived questionnaire measuring quality of care in persons with IBD. METHODS AND RESULTS The development of the questionnaire The Quality of Care -Questionnaire (QoC-Q) was based on a literature review of studies measuring quality of care, and the results of two qualitative studies aiming to identify the knowledge need and perception of health care among persons with IBD. Further development and evaluation was done by focus groups, individual testing and cognitive interviews with persons with IBD, as well as evaluation by a group of professionals. After the development, the questionnaire was tested for validity and test-retest reliability in 294 persons with IBD. CONCLUSIONS The QoC-Q is showing promising validity and reliability for measuring the subjective perception of quality of care. Further testing in clinical practice is suggested to assess if the QoC-Q can be used to evaluate care and areas of improvement in health care for persons living with IBD.
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Affiliation(s)
- Pihl Lesnovska Katarina
- a Departments of Gastroenterology and Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Börjeson Sussanne
- b Department of Medical and Health Sciences, Faculty of Medicine , Linköping University , Linköping , Sweden
| | - Hollman Frisman Gunilla
- c Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences , Linkoping University , Linkoping , Sweden
| | - Hjortswang Henrik
- d Departments of Gastroenterology and Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Wenemark Marika
- e Department of Medical and Health Sciences, Centre for Organizational support and Development , Linköping University , Linköping , Sweden
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15
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Lugo LH, Navas CM, Plata JA, Ortiz SD, Caraballo D, Henao AC, García HI, Sénior JM. Ensayo clínico aleatorizado para evaluar el efecto de un programa de rehabilitación cardiaca supervisado con ejercicio en el consumo de oxígeno, la función y calidad de vida de pacientes con falla cardiaca crónica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Du H, Newton PJ, Budhathoki C, Everett B, Salamonson Y, Macdonald PS, Davidson PM. The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behaviour in people with stable chronic heart failure: A randomized controlled trial. Eur J Cardiovasc Nurs 2017; 17:235-245. [PMID: 28857618 DOI: 10.1177/1474515117729779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adherence to self-care recommendations is associated with improved patient outcomes and improved quality of life for people living with heart failure. The Home-Heart-Walk (HHW) is an intervention to promote physical activity adapting the elements of a six minute walk test, a reliable and valid measure. This adaptation was designed to support self-monitoring of physical functioning and promote the self-care of people with heart failure. The primary outcome of the Home-Heart-Walk was perceived physical functioning and the secondary outcomes were six-minute walk test distance, health related quality of life, self-care behaviour, self-efficacy and physical activity level. METHODS A multicentre randomized controlled trial. Participants ( N=132) were recruited from three academic hospitals in Sydney, Australia. Participants were randomized to either the Home-Heart-Walk group or the control group. Perceived physical functioning, health related quality of life, self-care behaviour, exercise self-efficacy and physical activity level were measured at baseline and at three- and six-month follow-up. RESULTS After adjusting for baseline scores, there were no statistically significant between-group differences in perceived physical functioning, six-minute walk test distance, health related quality of life and exercise self-efficacy at follow-up. The intervention group had improvement in self-care behaviour ( F(1,129) = 4.75, p = 0.031) and physical activity level ( U = 1713, z = -2.12, p = 0.034) at the six-month follow-up compared with the control group. CONCLUSION The Home-Heart-Walk did not improve the perceived physical functioning of the intervention group. Although the feasibility and acceptability of this strategy to support self-monitoring and improve self-care behaviour was demonstrated, self-reported adherence was unreliable; newer technologies may offer better assessment of adherence.
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Affiliation(s)
- Huiyun Du
- 1 College of Nursing and Health Science, Flinders University, Australia
| | - Phillip J Newton
- 2 Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia
| | | | - Bronwyn Everett
- 4 School of Nursing & Midwifery, University of Western Sydney, Australia.,5 Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Yenna Salamonson
- 4 School of Nursing & Midwifery, University of Western Sydney, Australia.,5 Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Peter S Macdonald
- 6 St Vincent's Hospital, Darlinghurst, & Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Patricia M Davidson
- 2 Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia.,3 School of Nursing, Johns Hopkins University, USA
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17
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Gundersen GH, Norekvål TM, Graven T, Haug HH, Skjetne K, Kleinau JO, Gustad LT, Dalen H. Patient-reported outcomes and associations with pleural effusion in outpatients with heart failure: an observational cohort study. BMJ Open 2017; 7:e013734. [PMID: 28320791 PMCID: PMC5372075 DOI: 10.1136/bmjopen-2016-013734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We aimed to study whether patient-reported outcomes, measured by quality of life (QoL) and functional class, are sensitive to pleural effusion (PLE) in patients with heart failure (HF), and to study changes in QoL and functional class during follow-up of PLE. METHODS A cohort of 62 patients from an outpatient HF clinic was included. The amount of PLE was quantified using a pocket-sized ultrasound imaging device. Self-reports of QoL and functional class were collected using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the New York Heart Association (NYHA) functional classification. RESULTS At baseline, 26 (42%) patients had PLE of which 19 (31%) patients had moderate to severe amounts of PLE. Patients with no to mild PLE had a lower MLHFQ score (mean 42, SD 21) compared with patients with a moderate to severe amount of PLE (mean 55, SD 24), p=0.03. For 28 patients (45%) with follow-up data, we observed a linear improvement of the MLHFQ-score (3.2, 95% CI 1.2 to 5.1) with each centimetre reduction of PLE. Correspondingly, patient-reported NYHA-class followed the same pattern as the MLHFQ-score. CONCLUSIONS Our study indicates that patient-reported outcome measures as MLHFQ may be sensitive tools to identify patients with HF at highest risk of symptomatic PLE and that treatment targeting reduction of PLE during follow-up is essential to improvement of QoL and functional capacity of outpatients with HF. TRIAL REGISTRATION NUMBER NCT01794715; Results.
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Affiliation(s)
- Guri H Gundersen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Torbjørn Graven
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hilde H Haug
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Kyrre Skjetne
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens O Kleinau
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Lise T Gustad
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Neuromedicine (INM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Håvard Dalen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, K.G. Jebsen Centre of Exercise in Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Cardiology, St. Olavs University Hospital, Trondheim, Norway
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18
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Kawauchi TS, Umeda IIK, Braga LM, Mansur ADP, Rossi-Neto JM, Guerra de Moraes Rego Sousa A, Hirata MH, Cahalin LP, Nakagawa NK. Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial. Clin Res Cardiol 2017; 106:676-685. [PMID: 28255812 DOI: 10.1007/s00392-017-1089-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inspiratory and peripheral muscle training improves muscle strength, exercise tolerance, and quality of life in patients with chronic heart failure (HF). However, studies investigating different workloads for these exercise modalities are still lacking. OBJECTIVE To examine the effects of low and moderate intensities on muscle strength, functional capacity, and quality of life. DESIGN A randomized controlled trial. METHODS Thirty-five patients with stable HF (aged >18 years, NYHA II/III, LVEF <40%) were randomized to: non-exercise control group (n = 9), low-intensity training group (LIPRT, n = 13, 15% maximal inspiratory workload, and 0.5 kg of peripheral muscle workload) or moderate-intensity training group (MIPRT, n = 13, 30% maximal inspiratory workload and 50% of one maximum repetition of peripheral muscle workload). The outcomes were: respiratory and peripheral muscle strength, pulmonary function, exercise tolerance by the 6-minute walk test, symptoms based on the NYHA functional class, and quality of life using the Minnesota Living with Heart Failure Questionnaire. RESULTS All groups showed similar quality-of-life improvements. Low and moderate intensities training programs improved inspiratory muscle strength, peripheral muscle strength, and walking distance. However, only moderate intensity improved expiratory muscle strength and NYHA functional class in HF patients. CONCLUSIONS The low-intensity inspiratory and peripheral resistance muscle training improved inspiratory and peripheral muscle strength and walking distance, demonstrating that LIPRT is an efficient rehabilitation method for debilitated HF patients. In addition, the moderate-intensity resistance training also improved expiratory muscle strength and NYHA functional class in HF patients.
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Affiliation(s)
- Tatiana Satie Kawauchi
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Iracema Ioco Kikuchi Umeda
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lays Magalhães Braga
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Antonio de Pádua Mansur
- Heart Institute - HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, Brazil
| | - João Manoel Rossi-Neto
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | | | - Mário Hiroyuki Hirata
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil.
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19
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Whitaker-Brown CD, Woods SJ, Cornelius JB, Southard E, Gulati SK. Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic. Heart Lung 2016; 46:79-84. [PMID: 28034562 DOI: 10.1016/j.hrtlng.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 11/01/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The purpose was to pilot the feasibility and impact of a 4-week transition-to-care program on quality of life for heart failure patients. BACKGROUND The transition from the acute care to the outpatient setting has been shown to be a critical time with heart failure patients. METHODS A pre- and post-test design was used. Quality of Life, measured by the Minnesota Living with Heart Failure Questionnaire, and hospital readmissions were the outcomes. A convenience sample of 50 persons was recruited into a multidisciplinary transition-to-care program for heart failure patients following hospitalization. Thirty-six (72%) completed the study. RESULTS There was a significant improvement in quality of life. Men reported greater improvement in physical symptoms and less emotional distress when compared to women. Only 2 participants were readmitted within 30 days. CONCLUSIONS Study findings support improved quality of life and decreased readmission rates following a multidisciplinary transition-to care program for heart failure patients.
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Affiliation(s)
- Charlene D Whitaker-Brown
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA; Sanger Heart & Vascular Institute's Heart Success Clinic, Carolinas Medical Center-Main, 1000 Blythe Blvd., Charlotte, NC 28203, USA.
| | - Stephanie J Woods
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA
| | - Judith B Cornelius
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA
| | - Erik Southard
- Indiana State University, College of Nursing, Health, & Human Services, Landsbaum Center 217, 200 North Seventh Street, Terre Haute, IN 47809, USA
| | - Sanjeev K Gulati
- Sanger Heart & Vascular Institute's Heart Success Clinic, Carolinas Medical Center-Main, 1000 Blythe Blvd., Charlotte, NC 28203, USA
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20
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Diop MS, Rudolph JL, Zimmerman KM, Richter MA, Skarf LM. Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis. J Palliat Med 2016; 20:84-92. [PMID: 27912043 DOI: 10.1089/jpm.2016.0330] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. BACKGROUND Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. METHODS A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. RESULTS The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). DISCUSSION Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
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Affiliation(s)
- Michelle S Diop
- 1 Primary Care and Population Medicine Program, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island
| | - James L Rudolph
- 2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island.,3 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,4 Center for Gerontology, Brown University School of Public Health , Providence, Rhode Island
| | - Kristin M Zimmerman
- 5 Department of Pharmacotherapy and Outcomes, Virginia Commonwealth University , Richmond, Virginia
| | - Mary A Richter
- 6 Department of Obstetrics and Gynecology, Tulane University School of Medicine , New Orleans, Louisiana
| | - L Michal Skarf
- 7 Division of Geriatrics and Palliative Care, VA Boston Healthcare System , Boston, Massachusetts.,8 Harvard Medical School , Boston, Massachusetts
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21
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Attitude towards knowledge of the disease and psychological characteristics of patients with systolic heart failure. HEALTH PSYCHOLOGY REPORT 2016. [DOI: 10.5114/hpr.2017.62748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
We aimed to investigate the relationships between selected psychological features of patients with chronic systolic heart failure (HF) and their attitude towards knowledge of the disease.<br />
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<b>Participants and procedure</b><br />
This prospective study among 75 patients with stable systolic HF consisted of 2 parts: a quantitative approach, conducted during the hospitalization (based on 4 psychological questionnaires: the Multidimensional Health Locus of Control Scale; the Coping Inventory for Stressful Situations; the Acceptance of Illness Scale; and the Patient’s Request Form) and a qualitative approach (phone interviews performed later).<br />
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<b>Results</b><br />
Fifty-nine percent of patients declared the need for possessing knowledge about their disease. Psychological questionnaires did not allow us to characterize groups of patients with extremely different attitudes towards knowledge about the disease. Patients who did not want to look for any information, although they admitted that their knowledge was poor, were characterized by the conviction that nobody has an influence on their health status. Patients who were likely to read drug labels were characterized by the active style of coping.<br />
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<b>Conclusions</b><br />
The attitude towards knowledge about the disease is diverse among patients with systolic HF, and it is not easy to explain these differences using their psychological features assessed in the present study. Further studies focused on assessing the patient’s willingness to acquire knowledge about HF, using more accurate measures, are needed, especially for healthcare professionals, who still look for an improvement in understanding the needs of their patients.
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22
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Bagheri H, Yaghmaei F, Ashktorab T, Zayeri F. Relationship between illness-related worries and social dignity in patients with heart failure. Nurs Ethics 2016; 25:618-627. [PMID: 27694547 DOI: 10.1177/0969733016664970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure is a major growing problem and affects not only patients but also their families and community networks and reduces the functional capacity of patients and impairs their social life. RESEARCH QUESTIONS This study was conducted to investigate relationship between illness-related worries and social dignity in patients with heart failure. DESIGN The study had a descriptive-analytic design, and data collection was carried out by means of two specific questionnaires. Participants and context: A total of 130 inpatients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. RESULTS The highest mean score of illness-related worries was attributed to the dimension of patient's worry of physical-mental complications, and the least mean score was related to the dimension of the worry about the future of disease. The highest mean score of social dignity was associated with the dimension of social communication and support, and the least is attributed to the dimension of burden to others (economic). Pearson's statistical test showed a significant correlation (r = 0.455, p < 0.05) between the score of illness-related worries and social dignity. DISCUSSION As the result of this study showed that reducing illness-related worries in patients with heart failure can improve their social dignity, using strategies to decrease worries and promote social dignity in these patients is recommended. CONCLUSION This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. We hope these results will help to promote actions by patient-care staff that honor and support patient dignity, resulting in benefits to patients and developing the quality of care based on human rights.
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Affiliation(s)
- Hossein Bagheri
- Shahroud University of Medical Sciences, Shahroud, Iran.,Shahid Beheshti University of Medical Sciences, Iran
| | | | | | - Farid Zayeri
- Shahid Beheshti University of Medical Sciences, Iran
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Floegel TA, Perez GA. An integrative review of physical activity/exercise intervention effects on function and health-related quality of life in older adults with heart failure. Geriatr Nurs 2016; 37:340-347. [PMID: 27189848 PMCID: PMC5108691 DOI: 10.1016/j.gerinurse.2016.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/16/2016] [Accepted: 04/16/2016] [Indexed: 11/24/2022]
Abstract
This paper reviews randomized, controlled trials (RCTs) that have used a physical activity/exercise intervention in older adults with heart failure and reported outcomes of physical function and/or health-related quality of life. An integrative review was necessary because a literature search indicated no reviews have been done regarding these outcomes which are deemed very important by the older adult population. Computerized database search strategies by authors between 2002 and 2015 resulted in 163 studies, with 12 meeting inclusion criteria. Interventions were performed in clinic and home-based, group and/or individual settings with durations from three to 12 months. Interventions were varied. Common methodological weaknesses of the studies include lack of theory guiding the intervention, small sample and low minority representation. Strengths included detailed intervention methods. There was a moderate effect of interventions with no reported adverse effects. Further work is essential to identify successful strategies to support older adults with heart failure to increase their physical activity levels.
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Affiliation(s)
- Theresa A Floegel
- University of North Carolina-Chapel Hill, School of Nursing, 5007 Carrington Hall, CB#7460, Chapel Hill, NC 27599, USA.
| | - G Adriana Perez
- University of Pennsylvania, School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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Abstract
BACKGROUND Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers. RESEARCH QUESTIONS This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model. DESIGN The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires. Participants and context: A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. FINDINGS Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9. DISCUSSION This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. CONCLUSION According to the results, the necessity of using appropriate tools to assess various aspects of patients' dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients' dignity, develop quality of care and treatment, and improve patients' satisfaction.
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Affiliation(s)
- Hossein Bagheri
- Shahroud University of Medical Sciences, Shahroud, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Farid Zayeri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kane PM, Murtagh FEM, Ryan K, Mahon NG, McAdam B, McQuillan R, Ellis-Smith C, Tracey C, Howley C, Raleigh C, O'Gara G, Higginson IJ, Daveson BA. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure. Heart Fail Rev 2016; 20:673-87. [PMID: 26435042 PMCID: PMC4608978 DOI: 10.1007/s10741-015-9508-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
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Affiliation(s)
- P M Kane
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - K Ryan
- St. Francis Hospice, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - N G Mahon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B McAdam
- Beaumont Hospital, Dublin, Ireland
| | - R McQuillan
- St. Francis Hospice, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - C Ellis-Smith
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - C Tracey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Howley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - G O'Gara
- Beaumont Hospital, Dublin, Ireland
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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Koutrolou-Sotiropoulou P, Lima FV, Stergiopoulos K. Quality of Life in Survivors of Peripartum Cardiomyopathy. Am J Cardiol 2016; 118:258-63. [PMID: 27239023 DOI: 10.1016/j.amjcard.2016.04.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
Little data exist with regard to the effect of peripartum cardiomyopathy (PPCM) on quality of life. The aim of this study was to determine the impact of PPCM on quality of life and emotional well-being. We sought to determine the feasibility of using social media to perform quality of life research. We conducted a study using a survey distributed to established members of "Peripartum Cardiomyopathy Survivors" support group on the social networking site Facebook. A total of 116 women completed the survey (age 36 ± 6.4 years; 91% white, 75% married, 46% college educated), with 4.9 ± 0.5 years (range 0.02 to 24 years) since the initial diagnosis. Most women (41%) never returned to their baseline level of activity, and 28% discontinued their job because of the diagnosis. Most respondents (56%) were not limited or only slightly limited by heart failure symptoms over the past 2 months. Most respondents (56%) never returned to their baseline emotionally after the diagnosis of PPCM, and most patients (73%) were dissatisfied with their current level of heart failure symptoms. Most patients (67%) felt discouraged frequently (more than several times per month) because of heart failure. Only 26% of women were satisfied with the counseling they received from their providers. The emotional and physical burden of PPCM on young mothers with PPCM years after the diagnosis is striking. Identifying strategies that promote better emotional health and potential treatment strategies may be required.
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Bloemen-Vrencken J, de Witte L, Post M, Pons C, van Asbeck F, van der Woude L, van den Heuvel W. Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care. Clin Rehabil 2016; 21:997-1006. [DOI: 10.1177/0269215507079835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate whether transmural care for people with spinal cord injury living in the community has more impact on health outcomes than traditional follow-up care within the Netherlands. Design: Quasi-experiment with 12 months of follow-up. Setting: Eight Dutch rehabilitation centres. Subjects: Thirty-one patients who received transmural care in two `experimental' rehabilitation centres were compared with a matched sample of 31 patients having received `usual follow-up care' in six other rehabilitation centres. Intervention: The core component of the transmural care consists of a transmural nurse, who `liaises' between former patients living in the community, primary care professionals and the rehabilitation team. The transmural care model provides activities to support patients and their family/partners and activities to promote continuity of care. Main measures: The prevalence of pressure sores and urinary tract infections; the number and duration of re-admissions to hospital and rehabilitation centre due to pressure sores, bladder and bowel problems; and the experienced quality of follow-up care. Results: The transmural care, as implemented, did not influence the health outcomes. The prevalence of pressure sores, urinary tract infections and the number of re-admissions (due to pressure sores, bladder and bowel problems) was respectively 13, 13 and 4 in the intervention group versus 14, 15 and 6 in the usual follow-up care group. Since the transmural care had been incompletely implemented and there were methodological and practical limitations, we formulated no final conclusions regarding its effectiveness. Conclusion: Implementing the transmural care model strictly according to protocol may improve its effectiveness.
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Affiliation(s)
| | - L.P. de Witte
- Institute for Rehabilitation Research, iRv, Hoensbroek, Maastricht University, Maastricht
| | - M.W.M. Post
- Rehabilitation Centre De Hoogstraat, Utrecht
| | - C. Pons
- Rehabilitation Centre Hoensbroeck, Hoensbroek
| | | | - L.H.V. van der Woude
- Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Rehabilitation Centre Amsterdam
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Pattenden JF, Roberts H, Lewin RJP. Living with Heart Failure; Patient and Carer Perspectives. Eur J Cardiovasc Nurs 2016; 6:273-9. [PMID: 17383236 DOI: 10.1016/j.ejcnurse.2007.01.097] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2007] [Accepted: 01/29/2007] [Indexed: 11/26/2022]
Abstract
Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome.
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Affiliation(s)
- J F Pattenden
- British Heart Foundation Care and Education Research Group, Department of Health Sciences, Seebohm Rowntree Building Area 4, University of York, York YO10 5DD, England, United Kingdom.
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Orszulak M, Mizia-Stec K, Siennicka A, Goscinska-Bis K, Waga K, Wojcik M, Blaszczyk R, Michalski B, Szymanski FM, Ptaszynska-Kopczynska K, Kopec G, Nadrowski P, Hrynkiewicz-Szymanska A, Krzych L, Jankowska EA. Differences of psychological features in patients with heart failure with regard to gender and aetiology - Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study. Int J Cardiol 2016; 219:380-6. [PMID: 27356026 DOI: 10.1016/j.ijcard.2016.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology. METHODS 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF. RESULTS There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status. CONCLUSIONS There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.
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Affiliation(s)
- Michal Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Siennicka
- Department of Physiology, Wroclaw Medical University, Wroclaw, Poland; Center for Heart Diseases, Department of Cardiology, Military Hospital in Wroclaw, Wroclaw, Poland;; Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Goscinska-Bis
- Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Medical Centre, Katowice, Poland
| | - Karolina Waga
- Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Medical Centre, Katowice, Poland
| | - Maciej Wojcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Blaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Filip M Szymanski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Grzegorz Kopec
- John Paul II Hospital, Department of Cardiac and Vascular Diseases of the Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Nadrowski
- Third Department of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Hrynkiewicz-Szymanska
- Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Krzych
- Department of Cardiac Anaestesiology and Intensive Care, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, Poland
| | - Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Wroclaw Medical University, Wroclaw, Poland; Department of Cardiology, Center for Heart Diseases, Military Hospital in Wroclaw, Wroclaw, Poland
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Blom JW, El Azzi M, Wopereis DM, Glynn L, Muth C, van Driel ML. Reporting of patient-centred outcomes in heart failure trials: are patient preferences being ignored? Heart Fail Rev 2016; 20:385-92. [PMID: 25690985 PMCID: PMC4464642 DOI: 10.1007/s10741-015-9476-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older people often suffer from multiple diseases. Therefore, universal cross-disease outcomes (e.g. functional status, quality of life, overall survival) are more relevant than disease-specific outcomes, and a range of potential outcomes are needed for medical decision-making. To assess how patient-relevant outcomes have penetrated randomized controlled trials (RCTs), reporting of these outcomes was reviewed in heart failure trials that included patients with multimorbidity. We systematically reviewed RCTs (Jan 2011–June 2012) and evaluated reported outcomes. Heart failure was chosen as condition of interest as this is common among older patients with multimorbidity. The main outcome was the proportion of RCTs reporting all-cause mortality, all-cause hospital admission, and outcomes in four domains of health, i.e. functional, signs and symptoms, psychological, and social domains. Of the 106 included RCTs, 50 (47 %) reported all-cause mortality and cardiovascular mortality and 29 (27 %) reported all-cause hospitalization and cardiovascular hospitalization. Of all trials, 68 (64 %) measured outcomes in the functional domain, 80 (75 %) in the domain of signs and symptoms, 65 (61 %) in the psychological domain, and 59 (56 %) in the social domain. Disease-specific instruments were more often used than non-disease-specific instruments. This review shows increasing attention for more patient-relevant outcomes; this is promising and indicates more awareness of the importance of a variety of outcomes desirable for patients. However, patients’ individual goal attainments were universally absent. For continued progress in patient-centred care, efforts are needed to develop these outcomes, study their merits and pitfalls, and intensify their use in research.
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Affiliation(s)
- Jeanet W Blom
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Postbox 9600, 2300 RC, Leiden, The Netherlands,
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Louredo ABD, Leite ALC, Salerno GRF, Fernandes M, Blascovi-Assis S. Instruments to assess quality of life in patients with heart failure. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction : Heart failure (HF) is a complex clinical syndrome representing the common final pathway of various heart diseases. It is characterized by low exercise tolerance, low survival rates and deteriorated quality of life. Several studies mention Quality of Life (QoL) as an important source of information on how disease truly affects patient's lives. In this context, the assessment of QoL is extremely important to provide data that support the choice of a therapeutic strategy and the assessment of the effectiveness of a treatment. Objectives : This study aimed to investigate and identify the most appropriate and widely used instrument for the assessment of quality of life in patients with HF. Methods : We searched the databases of Lilacs, Medline, Pubmed, Scielo and CAPES to identify relevant articles published in English and Portuguese between 2000 and 2010. Results : We found 25 papers that described, quoted or used instruments for the assessment of QoL in patients with HF. Conclusion : The MLHFQ is the most widely used instrument to assess QoL in patients with HF. Its good metric properties have been confirmed in a large number of studies. In addition, it has a simple structure and is easy to administer, which makes it the most recommended instrument for this purpose.
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Using a patient-generated mental-health measure 'PSYCHLOPS' to explore problems in patients with coronary heart disease. Br J Gen Pract 2014; 64:e354-63. [PMID: 24868073 DOI: 10.3399/bjgp14x680137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Patients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality. AIM To use a patient generated instrument (PSYCHLOPS) to define categories of concerns in patients with CHD. To define the psychometric characteristics of patients in each category. DESIGN AND SETTING Cross-sectional study set in general practices in south London. METHOD Of 3325 patients on the CHD registers in 15 general practices, 655 completed six baseline psychometric and functional instruments: PSYCHLOPS, HADS-Depression, HADS-Anxiety, Clinical Interview Schedule-Revised, SF12-Mental and SF12-Physical. Content analysis was used to categorise patients based on their main problem, as elicited by PSYCHLOPS. Mean psychometric scores were adjusted for confounding by age, sex, deprivation and ethnicity and calculated for each response category. RESULTS Response categories were: physical problems, both non-cardiac (23.2%) and cardiac (6.0%); social problems: relationship/family (18.2%), money (7.5%), work (3.1%); functional (9.8%); psychological (6.9%); miscellaneous (7.3%); 'no problem' (18.2%). The highest psychological distress scores were found in 'physical, cardiac' and 'psychological' categories. The 'no problem' category had significantly lower psychological distress and higher functional capacity than other categories. CONCLUSIONS PSYCHLOPS enabled the identification of subtypes of CHD patients, based on a classification of self-reported problems. A high proportion of CHD patients report social problems. Psychological distress was highest in those reporting cardiac or psychological symptoms. Services should be aligned to the reported needs of patients.
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Carr HJ, McDermott A, Tadbiri H, Uebbing AM, Londrigan M. The effectiveness of computer-based learning in hospitalized adults with heart failure on knowledge, re-admission, self-care, quality of life and patient satisfaction: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Häggström J, Boswood A, O'Grady M, Jöns O, Smith S, Swift S, Borgarelli M, Gavaghan B, Kresken JG, Patteson M, Åblad B, Bussadori CM, Glaus T, Kovačević A, Rapp M, Santilli RA, Tidholm A, Eriksson A, Belanger MC, Deinert M, Little CJL, Kvart C, French A, Rønn-Landbo M, Wess G, Eggertsdottir A, Lynne O'Sullivan M, Schneider M, Lombard CW, Dukes-McEwan J, Willis R, Louvet A, DiFruscia R. Longitudinal analysis of quality of life, clinical, radiographic, echocardiographic, and laboratory variables in dogs with myxomatous mitral valve disease receiving pimobendan or benazepril: the QUEST study. J Vet Intern Med 2013; 27:1441-51. [PMID: 24010489 DOI: 10.1111/jvim.12181] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/03/2013] [Accepted: 07/31/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS A total of 260 dogs in CHF because of MMVD. METHODS A prospective single-blinded study with dogs randomized to receive pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS A total of 124 dogs were randomized to pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the pimobendan group (pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.
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Affiliation(s)
- J Häggström
- Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Humphrey L, Kulich K, Deschaseaux C, Blackburn S, Maguire L, Strömberg A. The Caregiver Burden Questionnaire for Heart Failure (CBQ-HF): face and content validity. Health Qual Life Outcomes 2013; 11:84. [PMID: 23706131 PMCID: PMC3673843 DOI: 10.1186/1477-7525-11-84] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/03/2013] [Indexed: 11/10/2022] Open
Abstract
Background A new caregiver burden questionnaire for heart failure (CBQ-HF v1.0) was developed based on previously conducted qualitative interviews with HF caregivers and with input from HF clinical experts. Version 1.0 of the CBQ-HF included 41 items measuring the burden associated with caregiving in the following domains: physical, emotional/psychological, social, and impact on caregiver’s life. Following initial development, the next stage was to evaluate caregivers’ understanding of the questionnaire items and their conceptual relevance. Methods To evaluate the face and content validity of the new questionnaire, cognitive interviews were conducted with caregivers of heart failure patients. The cognitive interviews included a “think aloud” exercise as the patient completed the CBQ-HF, followed by more specific probing questions to better understand caregivers’ understanding, interpretation and the relevance of the instructions, items, response scales and recall period. Results Eighteen caregivers of heart failure patients were recruited. The mean age of the caregivers was 50 years (SD = 10.2). Eighty-three percent of caregivers were female and most commonly the patient was either a spouse (44%) or a parent (28%). Among the patients 55% were NYHA Class 2 and 45% were NYHA Class 3 or 4. The caregiver cognitive interviews demonstrated that the CBQ-HF was well understood, relevant and consistently interpreted. From the initial 41 item questionnaire, fifteen items were deleted due to conceptual overlap and/or item redundancy. The final 26-item CBQ-HF (v3.0) uses a 5-point Likert severity scale, assessing 4 domains of physical, emotional/psychological, social and lifestyle burdens using a 4-week recall period. Conclusions The CBQ-HF (v3.0) is a comprehensive and relevant measure of subjective caregiver burden with strong content validity. This study has established that the CBQ-HF (v3.0) has strong face and content validity and should be valuable as an outcomes measure to help understand and monitor the relationship between patient heart failure severity and caregiver burden. A Translatability AssessmentSM of the measure has since been performed confirming the cultural appropriateness of the measure and psychometric validation is planned for the future to further explore the reliability, and validity of the new questionnaire in a larger caregiver sample.
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Horrocks J, Closs J, Astin F. Quality of life in older adults with aortic stenosis: a narrative review. Int J Older People Nurs 2013; 9:227-46. [DOI: 10.1111/opn.12026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/19/2012] [Indexed: 01/25/2023]
Affiliation(s)
| | - José Closs
- School of Healthcare; University of Leeds; Leeds UK
| | - Felicity Astin
- School of Nursing; Midwifery and Social Work, University of Salford; Salford UK
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Lakdizaji S, Hassankhni H, Mohajjel Agdam A, Khajegodary M, Salehi R. Effect of educational program on quality of life of patients with heart failure: a randomized clinical trial. J Caring Sci 2013; 2:11-8. [PMID: 25276705 DOI: 10.5681/jcs.2013.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Heart failure is one of the most common cardiovascular diseases which decrease the quality of life. Most of the factors influencing the quality of life can be modified with educational interventions. Therefore, this study examined the impact of a continuous training program on quality of life of patients with heart failure. METHODS This randomized clinical trial study was conducted during May to August 2011. Forty four participants with heart failure referred to Shahid Madani's polyclinics of Tabriz were selected through convenient sampling method and were randomly allocated to two groups. The intervention group (n = 22) received ongoing training including one-to-one teaching, counseling sessions and phone calls over 3 months. The control group (n = 22) received routine care program. Data on quality of life was collected using the Minnesota Living with Heart Failure Questionnaire at baseline as well as three months later. RESULTS The statistical tests showed significant differences in the physical, emotional dimensions and total quality of life in intervention group. But in control group, no significant differences were obtained. There was not any significant association in demographic characteristics and quality of life. CONCLUSION Ongoing training programs can be effective in improving quality of life of patients with heart failure. Hence applying ongoing educational program as a non-pharmacological intervention can help to improve the quality of life of these patients.
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Affiliation(s)
- Sima Lakdizaji
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hassankhni
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Mohajjel Agdam
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Khajegodary
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rezvanieh Salehi
- Department of Cardiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Lainscak M, Farkas J, Inkrot S, Gelbrich G, Neskovic AN, Rau T, Tahirovic E, Töpper A, Apostolovic S, Haverkamp W, Herrmann-Lingen C, Anker SD, Düngen HD. Self-rated health predicts adverse events during beta-blocker treatment: The CIBIS-ELD randomised trial analysis. Int J Cardiol 2013; 163:87-92. [DOI: 10.1016/j.ijcard.2011.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/13/2011] [Indexed: 02/02/2023]
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Beyond survival: Recommendations from INTERMACS for assessing function and quality of life with mechanical circulatory support. J Heart Lung Transplant 2012; 31:1158-64. [DOI: 10.1016/j.healun.2012.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/27/2012] [Accepted: 08/04/2012] [Indexed: 11/17/2022] Open
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Krane M, Deutsch MA, Piazza N, Muhtarova T, Elhmidi Y, Mazzitelli D, Voss B, Ruge H, Badiu CC, Kornek M, Bleiziffer S, Lange R. One-year results of health-related quality of life among patients undergoing transcatheter aortic valve implantation. Am J Cardiol 2012; 109:1774-81. [PMID: 22520622 DOI: 10.1016/j.amjcard.2012.02.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Recently, it has been demonstrated that transcatheter aortic valve implantation (TAVI) can result in significant improvement in patients' quality of life (QOL) in the short term. At present, however, little is known about the long-term improvements in QOL after TAVI. Thus, our aim was to prospectively assess the 1-year QOL outcome of patients undergoing TAVI. We performed a prospective analysis of 186 patients with symptomatic severe aortic valve stenosis ineligible for conventional aortic valve replacement, who underwent TAVI with either the Medtronic CoreValve or Edwards Sapien device. A total of 106 patients completed the 1-year follow-up protocol. The QOL was measured using the Medical Outcomes Study 36-item short-form health survey questionnaire at baseline and at 3 months and 1 year of follow-up. At 1 year of follow-up, significant improvements in the Medical Outcomes Study 36-item short-form health survey questionnaire scores for physical functioning (baseline 34.6 ± 2.3 vs 1 year of follow-up 45.6 ± 2.7; p <0.001), role physical (20 ± 3.0 vs 34.2 ± 4.4; p <0.001), bodily pain (59.9 ± 3 vs 70 ± 2.7; p <0.01), general health (47.3 ± 1.5 vs 55.2 ± 2.1, p <0.001), vitality (35.9 ± 2 vs 48.5 ± 2; p <0.001), and mental health (62.2 ± 2.2 vs 67.3 ± 1.8; p <0.05) were observed compared to baseline. No significant improvement could be detected for social functioning (75.4 ± 2.5 vs 76.5 ± 2.6; p = 0.79) and role emotional (61.1 ± 4.3 vs 66.5 ± 4.7; p = 0.29). At 1 year of follow-up, the various physical and mental scores were comparable to an age-matched standard population. In conclusion, the present study has demonstrated that TAVI can improve the QOL status of high-surgical risk patients with severe aortic valve stenosis that can be maintained for ≤1 year postproceduraly in survivors. Although the mental subscales improved slightly, the mental component summary score failed to reach statistical significance in our study population.
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Du H, Everett B, Newton PJ, Salamonson Y, Davidson PM. Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure. J Clin Nurs 2011; 21:301-10. [PMID: 22175249 DOI: 10.1111/j.1365-2702.2011.03983.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. BACKGROUND The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual's level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. DESIGN Discursive. METHODS Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. CONCLUSIONS Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. RELEVANCE TO CLINICAL PRACTICE The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity.
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Affiliation(s)
- HuiYun Du
- Curtin Health Innovation Research Institute, School of Nursing and Midwifery, Curtin University, Perth, WA, Australia.
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Cano de la Cuerda R, Alguacil Diego IM, Alonso Martín JJ, Molero Sánchez A, Miangolarra Page JC. Cardiac rehabilitation programs and health-related quality of life. State of the art. Rev Esp Cardiol 2011; 65:72-9. [PMID: 22015019 DOI: 10.1016/j.recesp.2011.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 07/03/2011] [Indexed: 10/16/2022]
Abstract
Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.
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Affiliation(s)
- Roberto Cano de la Cuerda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Foster ER, Cunnane KB, Edwards DF, Morrison MT, Ewald GA, Geltman EM, Zazulia AR. Executive dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart failure. Am J Occup Ther 2011; 65:306-13. [PMID: 21675336 DOI: 10.5014/ajot.2011.000588] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF). METHOD People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation. RESULTS Possible depression (64%) and cognitive impairment (15%-59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%-46% of the variance in participation (ps < .01). CONCLUSION Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.
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Affiliation(s)
- Erin R Foster
- Program in Occupational Therapy, Department of Neurology and Department of Psychiatry, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA.
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Health-related quality of life in Brazilian outpatients with Chagas and non-Chagas cardiomyopathy. Heart Lung 2011; 40:e25-31. [DOI: 10.1016/j.hrtlng.2010.05.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 04/23/2010] [Accepted: 05/21/2010] [Indexed: 01/09/2023]
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Majani G, Pierobon A, Pinna GD, Giardini A, Maestri R, La Rovere MT. Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure. ACTA ACUST UNITED AC 2011; 18:836-42. [PMID: 21450593 DOI: 10.1177/1741826711398804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data. METHODS One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value. RESULTS Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02). CONCLUSIONS Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.
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Affiliation(s)
- Giuseppina Majani
- Psychology Unit, Scientific Institute of Montescano, Salvatore Maugeri Foundation IRCCS, Pavia, Italy.
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Cowie A, Thow MK, Granat MH, Mitchell SL. A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level. ACTA ACUST UNITED AC 2011; 18:158-66. [PMID: 21450662 DOI: 10.1177/1741826710389389] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In heart failure, reduced physical activity level can adversely affect physical and psychosocial functioning. No previous heart failure research has compared effects of home and hospital-based exercise training upon physical activity level, or has objectively assessed their long-term effects upon physical activity. This study used an activPAL™ monitor to examine immediate and long-term effects of home and hospital-based aerobic exercise training upon physical activity level. DESIGN Randomized controlled trial. METHODS Sixty patients with heart failure (mean age 66 years; NYHA class II/III; 51 male/9 female) were randomized to home training, hospital training or control. Both programmes consisted of aerobic circuit training, undertaken twice a week for one hour, for eight weeks. All participants wore the activPAL™ at baseline, and after eight weeks, for one week. Six months after cessation of training, a subgroup of participants from the home and hospital training groups (n = 10 from each group) wore the activPAL™ for a further week. RESULTS Hospital-based training significantly increased steps taken per day during 'extra long' (P = 0.04) and 'long' (P = 0.01) walks. Neither programme had any immediate effect upon physical activity level otherwise. Though daily upright duration for the home group significantly improved six months after cessation of training (P = 0.02), generally physical activity level was maintained in the long term for both training groups. CONCLUSIONS Hospital-based training enabled participants to walk for longer periods. It is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period.
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Affiliation(s)
- Aynsley Cowie
- Cardiac Rehabilitation, The Ayr Hospital, Dalmellington Road, Ayr, Scotland, UK.
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Madden M, Furze G, Lewin RJ. Complexities of patient choice in cardiac rehabilitation: qualitative findings. J Adv Nurs 2011; 67:540-9. [DOI: 10.1111/j.1365-2648.2010.05509.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pilot testing of a multicomponent home care intervention for older adults with heart failure: an academic clinical partnership. J Cardiovasc Nurs 2010; 25:E27-40. [PMID: 20671564 DOI: 10.1097/jcn.0b013e3181da2f79] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Heart failure (HF) has clinically significant psychological and physical consequences for older persons, and hospitalization for HF is frequent and costly to the Medicare program. As HF is the most common primary Medicare home care diagnosis, there is a critical need to develop home care services that improve heath-related outcomes for this population. The primary aim of this pilot study was to develop, implement, and test the initial feasibility and potential efficacy of the Home-Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. Observed outcomes were quality of life (QOL), depressive symptoms, and 90-day hospitalization. METHODS Twenty-four patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multibranch Medicare-certified home health agency. Intervention group patients received 8 structured nurse education visits using evidence-based protocols designed in previous trials to teach HF self-management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of life was assessed using the Minnesota Living With Heart Failure questionnaire. Depressive symptoms were assed using the Patient Health Questionnaire 9 at baseline and 90-day study end point. RESULTS Study protocols and instrumentation were found to be feasible and effective. Examination of enrollment data led to a reevaluation of eligibility criteria. Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 8.99, P = .007) and significantly reduced depressive symptoms (F = 35.10, P = .001) in comparison to control group patients at the study end point. There was a trend toward lower hospital readmission rates in the intervention group (16% vs 25%), but this was not statistically significant. CONCLUSION This pilot study suggests that a full-scale trial of the HEART intervention is feasible.
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Morales-Asencio JM, Martin-Santos FJ, Morilla-Herrera JC, Fernández-Gallego MC, Celdrán-Mañas M, Navarro-Moya FJ, Rodríguez-Salvador MM, Muñoz-Ronda FJ, Gonzalo-Jiménez E, Carrasco AM. Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-icE-PRO Study). BMC Health Serv Res 2010; 10:324. [PMID: 21126369 PMCID: PMC3018450 DOI: 10.1186/1472-6963-10-324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/02/2010] [Indexed: 11/11/2022] Open
Abstract
Background Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). Methods/Design Objectives: General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. Specific aims: 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. Design: Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. Discussion First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.
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Krane M, Deutsch MA, Bleiziffer S, Schneider L, Ruge H, Mazzitelli D, Schreiber C, Brockmann G, Voss B, Bauernschmitt R, Lange R. Quality of life among patients undergoing transcatheter aortic valve implantation. Am Heart J 2010; 160:451-7. [PMID: 20826252 DOI: 10.1016/j.ahj.2010.05.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 05/08/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been introduced to offer a new treatment option for patients who are not eligible for conventional aortic valve replacement. Especially in this subset of patients, the expected improvement of quality of life (QoL) after valve implantation will be critical for decision-making for TAVI. METHODS We performed a prospective analysis of 99 patients (41 male) aged 82 years (range 57-94 years) who underwent TAVI. For assessment of QoL, the Short Form 36 Health Survey Questionnaire was used preoperatively and 3 months after TAVI. RESULTS Thirty-day mortality rate was 10.1%. The Short Form 36 Health Survey Questionnaire scores for physical functioning (34.7 +/- 2.8 vs 48.5 +/- 3.4, P < .001), bodily pain (61.7 +/- 3.1 vs 73.2 +/- 2.9, P < .01), general health (47.1 +/- 1.9 vs 54.1 +/- 2.3, P < .01), and vitality (37 +/- 2.8 vs 46.1 +/- 2.7, P < .01) increased significantly 3 months after TAVI compared with preoperative scores. No significant changes were found for role-physical (21.7 +/- 4.1 vs 31.1 +/- 5.1, P < .08), social functioning (74.6 +/- 3.4 vs 74.6 +/- 3.1, P = 1), and mental health (63 +/- 2.9 vs 67.4 +/- 2.2, P = .17) 3 months after TAVI. Only the score for role-emotional (69.3 +/- 5.6 vs 51.7 +/- 6, P = .02) decreased significantly 3 months after TAVI compared with the preoperative score. Corresponding to these results, the physical health summarized score (31.2 +/- 1.2 vs 38.6 +/- 1.6, P < .001) was significantly increased 3 months after TAVI compared with the preoperative score, whereas the mental health summarized score (48.5 +/- 1.8 vs 47.3 +/- 1.7, P = .5) showed no changes. CONCLUSION In patients who are not eligible for conventional aortic valve replacement, TAVI leads to a considerable QoL improvement within 3 months after valve implantation.
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Affiliation(s)
- Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
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