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ALHosni F, Al Qadire M, Omari OA, Al Raqaishi H, Khalaf A. Symptom prevalence, severity, distress and management among patients with chronic diseases. BMC Nurs 2023; 22:155. [PMID: 37149599 PMCID: PMC10162903 DOI: 10.1186/s12912-023-01296-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/08/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Advanced knowledge, technology, and treatment approaches resulted in longer survival rates for patients suffering from chronic diseases. However, symptoms of these diseases persist and affect the individual's entire life and normal functioning. AIM To assess symptoms prevalence, severity, distress, and management among patients with chronic obstructive pulmonary diseases (COPD), chronic heart failure (CHF), and end-stage renal disease (ESRD) in Oman. DESIGN A descriptive cross-sectional design was used. SAMPLE AND SETTINGS The study sample comprised 340 participants who were recruited between May and December 2021 from two referral hospitals and one large dialysis unit in the Sultanate of Oman, Muscat Governate using a convenience sampling technique. RESULTS The highly prevalent symptoms among patients with selected chronic diseases were lack of energy (60.9%), pain (57.4%), numbness (53.2%), difficulty sleeping (49.4%), and shortness of breath (45.9%). The most severe symptoms were shortness of breath (53.2%), problems with urination (51.9%), constipation (50.8%), difficulty sleeping (49.7%), and pain (46.2%). The symptom "problems with sexual interests or activity" was found to be the most frequently occurring and highly distressing symptom out of all reported symptoms. CONCLUSIONS The current study's findings showed that symptoms were prevalent and that some symptoms were frequent, severe, and highly distressing. In addition, patients perceived symptom treatment as inadequate. Psychological symptoms received less treatment attention compared with physical symptoms. One of the mainstays for managing symptoms can be the introduction of palliative care. Providing palliative care to these patients can alleviate their suffering and improve their quality of life. In addition, designing chronic disease self-management programmes can make a difference in patients' life.
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Affiliation(s)
- Fatima ALHosni
- College of Nursing, Sultan Qaboos University, P.O. Box 66, Muscat, PC 123, Sultanate of Oman
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, P.O. Box 66, Muscat, PC 123, Sultanate of Oman
- Faculty of Nursing, Al Al-Bayt University, P.O. Box 130040, Mafraq, 25113, Jordan
| | - Omar Al Omari
- College of Nursing, Sultan Qaboos University, P.O. Box 66, Muscat, PC 123, Sultanate of Oman
| | | | - Atika Khalaf
- Faculty of Health Sciences, Kristianstad University, Kristianstad, SE-291 88, Sweden.
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Nguyen TT, Nguyen TX, Nguyen TTH, Nguyen TN, Nguyen HTT, Nguyen HTT, Nguyen AT, Pham T, Vu HTT. Symptom Burden among Hospitalised Older Patients with Heart Failure in Hanoi, Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13593. [PMID: 36294170 PMCID: PMC9602984 DOI: 10.3390/ijerph192013593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to assess the symptom burden among older patients hospitalised for heart failure. This hospital-based, cross-sectional study was conducted at the National Geriatric Hospital, Hanoi, Vietnam, from June 2019 to August 2020. Face-to-face interviews were performed to gather the following information: socio-demographic characteristics, heart failure classification, and clinical characteristics (comorbidities, polypharmacy, pro-B-type natriuretic peptide, left ventricular ejection fraction (LVEF), symptom burden, and depression). Symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS), and depression was measured using the Patient Health Questionnaire. A total of 314 patients participated in the study. The mean participant age was 72.67 (SD = 9.42) years. The most frequently reported symptoms on the ESAS were shortness of breath (95.5%), fatigue (94.8%), and anxiety (81.2%). In univariate analyses, depression was significantly associated with heart failure class (p < 0.05). Multivariate linear regression revealed that major depression was significantly associated with total symptom burden score (Beta: 11.74; 95% CI: 9.24-14.23) and LVEF (Beta: -0.09; 95% CI: -0.17-(-0.007)). Patients hospitalised for heart failure experienced a high burden of symptoms. Further studies addressing adverse outcomes and expanding to community-dwelling older people are essential. Palliative care approaches that target symptom reduction should be considered in patients with heart failure.
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Affiliation(s)
- Thanh Thi Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
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Asano R, Anderson KM, Koirala B, Abshire M, Himmelfarb CD, Davidson PM. The Edmonton Symptom Assessment Scale in Heart Failure: A Systematic Review. J Cardiovasc Nurs 2022; 37:341-349. [PMID: 37707967 DOI: 10.1097/jcn.0000000000000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety. PURPOSE The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes. METHODS The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms "heart failure," "CHF," "cardiac failure," "heart decompensation," "myocardial failure," "Edmonton Symptom Assessment Scale". Hand searching of articles was also undertaken. RESULTS The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status. CONCLUSION This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration. CLINICAL IMPLICATIONS The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.
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Singh GK, Ivynian SE, Davidson PM, Ferguson C, Hickman LD. Elements of Integrated Palliative Care in Chronic Heart Failure Across the Care Continuum: A Scoping Review. Heart Lung Circ 2021; 31:32-41. [PMID: 34593316 DOI: 10.1016/j.hlc.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/09/2021] [Accepted: 08/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals with chronic heart failure experience high symptom burden, reduced quality of life and high health care utilisation. Although there is growing evidence that a palliative approach, provided concurrently with usual treatment improves outcomes, the method of integrating palliative care for individuals living with chronic heart failure across the care continuum remains elusive. AIM To examine the key elements of integrated palliative care recommended for individuals living with chronic heart failure across the care continuum. DESIGN Scoping review. DATA SOURCES Databases searched were CINAHL, Ovid MEDLINE, Scopus and OpenGrey. Studies written in English and containing key strategic elements specific to chronic heart failure were included. Search terms relating to palliative care and chronic heart failure and the Joanna Briggs Institute methodology for scoping reviews was used. RESULTS Seventy-nine (79) articles were selected that described key elements to integrate palliative care for individuals with chronic heart failure. This review identifies four levels of key strategic elements: 1) clinical; 2) professional; 3) organisational and 4) system-level integration. Implementing strategies across these elements facilitates integrated palliative care for individuals with chronic heart failure. CONCLUSIONS Inter-sectorial collaborations across systems and the intersection of health and social services are essential to delivering integrated, person-centred palliative care. Further research focussing on patient and family needs at a system-level is needed. Research with strong theoretical underpinnings utilising implementation science methods are required to achieve and sustain complex behaviour change to translate key elements.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Qld, Australia.
| | - Serra E Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA & Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Caleb Ferguson
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW, Australia; Western Sydney Local Health District, Blacktown Hospital, Sydney, NSW, Australia
| | - Louise D Hickman
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Fadol AP, Patel A, Shelton V, Krause KJ, Bruera E, Palaskas NL. Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2021; 7:32. [PMID: 34556191 PMCID: PMC8459494 DOI: 10.1186/s40959-021-00117-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. AIMS To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. DESIGN Systematic literature review on PC in patients with HF and in patients with cancer. DATA SOURCES Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. RESULTS Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. CONCLUSION The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.
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Affiliation(s)
- Anecita P Fadol
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ashley Patel
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Valerie Shelton
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas L Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Singh GK, Ferguson C, Davidson PM, Newton PJ. Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians. Contemp Nurse 2021; 57:113-127. [PMID: 33970800 DOI: 10.1080/10376178.2021.1928522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear. AIMS This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians' end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names. METHODS An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018. FINDINGS There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'. CONCLUSION Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access. IMPACT STATEMENT Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.
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Affiliation(s)
- Gursharan K Singh
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Caleb Ferguson
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.,Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Afonso BQ, Ferreira NDC, Butcher RDCGES. Content validation of the symptom control outcome for heart failure patients in palliative care. ACTA ACUST UNITED AC 2020; 41:e20190427. [PMID: 33111762 DOI: 10.1590/1983-1447.2020.20190427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To estimate the content validity of the Symptom Control nursing outcome for heart failure patients in palliative care and to analyze the influence of experts' experience in the judgment of the relevance of indicators. METHODS A methodological study conducted in São Paulo in 2018, with an adaptation of Fehring's validation model. The relevance of the 11 outcome indicators was assessed by 19 experts by means of an electronically submitted survey. The influence of the experts' experience on judgment was analyzed by the Wilcoxon-Mann-Whitney test and by Kendall's Tau correlation. RESULTS The indicators were considered pertinent; with 54.5% classified as critical. There was no association between the weighted means of the indicators and the experts' experience. CONCLUSIONS The indicators analyzed are relevant for the evaluation of the Symptom Control outcome in this group of patients. The experts' judgment was not influenced by their area of clinical experience or by their experience with the Nursing Outcomes Classification (NOC).
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Affiliation(s)
- Beatriz Quirino Afonso
- Universidade de São Paulo (USP), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto. São Paulo, São Paulo, Brasil.,Instituto do Coração da Faculdade de Medicina da USP. São Paulo, São Paulo, Brasil
| | - Natany da Costa Ferreira
- Universidade de São Paulo (USP), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto. São Paulo, São Paulo, Brasil.,College of Nursing, University of Iowa, Iowa City, Iwoa, United States of America
| | - Rita de Cassia Gengo E Silva Butcher
- Universidade de São Paulo (USP), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto. São Paulo, São Paulo, Brasil.,NANDA International-Boston College, The Marjory Gordon Program for Clinical Reasoning and Knowledge Development, Boston, Massachusetts, United States of America
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Chang YK, Kaplan H, Geng Y, Mo L, Philip J, Collins A, Allen LA, McClung JA, Denvir MA, Hui D. Referral Criteria to Palliative Care for Patients With Heart Failure: A Systematic Review. Circ Heart Fail 2020; 13:e006881. [PMID: 32900233 DOI: 10.1161/circheartfailure.120.006881] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with heart failure have significant symptom burden, care needs, and often a progressive course to end-stage disease. Palliative care referrals may be helpful but it is currently unclear when patients should be referred and by whom. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with heart failure. METHODS We searched Ovid, MEDLINE, Ovid Embase, and PubMed databases for articles in the English language from the inception of databases to January 17, 2019 related to palliative care referral in patients with heart failure. Two investigators independently reviewed each citation for inclusion and then extracted the referral criteria. Referral criteria were then categorized thematically. RESULTS Of the 1199 citations in our initial search, 102 articles were included in the final sample. We identified 18 categories of referral criteria, including 7 needs-based criteria and 10 disease-based criteria. The most commonly discussed criterion was physical or emotional symptoms (n=51 [50%]), followed by cardiac stage (n=46 [45%]), hospital utilization (n=38 [37%]), prognosis (n=37 [36%]), and advanced cardiac therapies (n=36 [35%]). Under cardiac stage, 31 (30%) articles suggested New York Heart Association functional class ≥III and 12 (12%) recommended New York Heart Association class ≥IV as cutoffs for referral. Prognosis of ≤1 year was mentioned in 21 (21%) articles as a potential trigger; few other criteria had specific cutoffs. CONCLUSIONS This systematic review highlighted the lack of consensus regarding referral criteria for the involvement of palliative care in patients with heart failure. Further research is needed to identify appropriate and timely triggers for palliative care referral.
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Affiliation(s)
- Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Holland Kaplan
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yimin Geng
- Research Medical Library (Y.G.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China (L.M.)
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia (J.P., A.C.).,Royal Melbourne Hospital, Parkville, Australia (J.P.)
| | - Anna Collins
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia (J.P., A.C.)
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora (L.A.A.)
| | - John A McClung
- Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York (J.A.M.)
| | - Martin A Denvir
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (M.A.D.)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
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Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Fail 2020; 7:2193-2207. [PMID: 32757363 PMCID: PMC7524132 DOI: 10.1002/ehf2.12875] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic heart failure (CHF) is a chronic, progressive disease that has detrimental consequences on a patient's quality of life (QoL). In part due to requirements for market access and licensing, the assessment of current and future treatments focuses on reducing mortality and hospitalizations. Few drugs are available principally for their symptomatic effect despite the fact that most patients' symptoms persist or worsen over time and an acceptance that the survival gains of modern therapies are mitigated by poorly controlled symptoms. Additional contributors to the failure to focus on symptoms could be the result of under‐reporting of symptoms by patients and carers and a reliance on insensitive symptomatic categories in which patients frequently remain despite additional therapies. Hence, formal symptom assessment tools, such as questionnaires, can be useful prompts to encourage more fidelity and reproducibility in the assessment of symptoms. This scoping review explores for the first time the assessment options and management of common symptoms in CHF with a focus on patient‐reported outcome tools. The integration of patient‐reported outcomes for symptom assessment into the routine of a CHF clinic could improve the monitoring of disease progression and QoL, especially following changes in treatment or intervention with a targeted symptom approach expected to improve QoL and patient outcomes.
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Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Elisha R Gallivan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Melanie McGinlay
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Anet G Toms
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
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Puckett C, Goodlin SJ. A Modern Integration of Palliative Care Into the Management of Heart Failure. Can J Cardiol 2020; 36:1050-1060. [DOI: 10.1016/j.cjca.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
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Kurogi EM, Butcher RDCGES, Salvetti MDG. Relationship between functional capacity, performance and symptoms in hospitalized patients with heart failure. Rev Bras Enferm 2020; 73:e20190123. [PMID: 32490991 DOI: 10.1590/0034-7167-2019-0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the prevalence of symptoms in heart failure patients and to investigate the relationship between symptoms, functional capacity and performance. METHODS cross-sectional study, developed at a hospital specializing in cardiology. The sample (n=170) consisted of patients with heart failure, assessed by means of a sociodemographic form, New York Heart Association Functional Class, Edmonton Symptom Rating Scale and Karnofsky Physical Performance Scale. Analyzes were performed using Spearman's Correlation and Pearson's Chi-Square test. RESULTS dyspnea, fatigue and edema were the main symptoms that led to the search for health services. During hospitalization, the main symptoms were anxiety, sleep disturbance and sadness. Weak negative correlations were observed between functionality, functional class, and symptom overload. CONCLUSIONS the prevalence of symptoms was high and changed throughout the hospitalization period. Patients with poorer functional capacity and poorer performance had greater symptom overload.
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Vámosi M, Lauberg A, Borregaard B, Christensen AV, Thrysoee L, Rasmussen TB, Ekholm O, Juel K, Berg SK. Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses. Findings from the DenHeart study. Int J Cardiol 2020; 300:268-275. [DOI: 10.1016/j.ijcard.2019.09.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
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Chuzi S, Pak ES, Desai AS, Schaefer KG, Warraich HJ. Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient. Curr Heart Fail Rep 2019; 16:220-228. [DOI: 10.1007/s11897-019-00440-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nguyen Q, Wang K, Nikhanj A, Chen-Song D, DeKock I, Ezekowitz J, Mirhosseini M, Cujec B, Oudit GY. Screening and Initiating Supportive Care in Patients With Heart Failure. Front Cardiovasc Med 2019; 6:151. [PMID: 31696120 PMCID: PMC6817607 DOI: 10.3389/fcvm.2019.00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF. Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population. Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.
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Affiliation(s)
- Quynh Nguyen
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Kaiming Wang
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Anish Nikhanj
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Dale Chen-Song
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Ingrid DeKock
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Bibiana Cujec
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJA, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res 2019; 116:12-27. [DOI: 10.1093/cvr/cvz200] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
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Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen Georg August University, Robertkochstrasse 40, 37075 Göttingen, Germany
| | - David C Currow
- University of Technology Sydney, Broadway, Ultimo, Sydney, 2007 New South Wales, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Sarah J Goodlin
- Department of Medicine-Geriatrics, Portland Veterans Affairs Medical Center and Patient-cantered Education and Research, 3710 SW US Veterans Rd, Portland, 97239 OR, USA
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Kraków, Śniadeckich 10, Poland
| | | | - Daisy J A Janssen
- Department of Research and Education, CIRO, Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Carlo Leget
- University of Humanistic Studies, Chair Care Ethics, Kromme Nieuwegracht 29, Utrecht, The Netherlands
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Matteo Moroni
- S.S.D. Cure Palliative, sede di Ravenna, AUSL Romagna, Via De Gasperi 8, 48121 Ravenna, Italy
| | - Paul S Mueller
- Mayo Clinic Health System, Mayo Clinic Collage of Medicine and Science, 700 West Avennue South, La Crosse, 54601 Wisconsin, USA
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland St. Vincent’s University Hospital Dublin,Belfield, Dublin 4, Ireland
| | - Steffen T Simon
- Department of Palliative Medicine, Medical Faculty of the Universityof Cologne, Köln, Germany
- Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty ofthe University of Cologne, Kerpener Strasse 62, 50924 Köln, Germany
| | | | - Philip J Larkin
- Service des soins palliatifs Lausanne University Hospital, CHUV, Centre hospitalier univeritaire vaudois, Lausanne Switzerland
- Institut universitaire de formation et de recherche en soins – IUFRS, Faculté de viologie et de medicine – FBM, Lausanne, Switzerland
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Flint KM, Fairclough DL, Spertus JA, Bekelman DB. Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:233-241. [PMID: 30649237 PMCID: PMC6613596 DOI: 10.1093/ehjqcco/qcy061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/03/2018] [Accepted: 12/29/2018] [Indexed: 01/06/2023]
Abstract
AIMS Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being ('QoL domains'). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits. METHODS AND RESULTS Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0-100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean ± standard deviation (SD) KCCQ score was 46.9 ± 19.3, mean age was 65.5 ± 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ ≤ 25, 61-84%/48-62% for KCCQ ≤ 50, 84-97%/26-40% for KCCQ ≤ 60, and 96-100%/8-13% for KCCQ ≤ 75. Patients with KCCQ ≤ 60 had mean ± SD 4.5 ± 2.5 QoL domain deficits (maximum 12), vs. 1.6 ± 1.6 for KCCQ > 60 (P < 0.001). Similar results were seen for KCCQ ≤25 (6.6 ± 2.4 vs. 3.3 ± 2.4), KCCQ ≤ 50 (4.8 ± 2.6 vs. 2.5 ± 2) and KCCQ ≤ 75 (4.0 ± 2.6 vs. 1.0 ± 1.2) (all P < 00001). CONCLUSION KCCQ ≤ 60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits.
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Affiliation(s)
- Kelsey M Flint
- Rocky Mountain Regional VA Medical Center, Cardiology, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA
- Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA
| | - Diane L Fairclough
- Department of Biostatics and Informatics, Colorado School of Public Health, 13199 E Montview Blvd, Suite 339, Aurora, CO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, USA
| | - David B Bekelman
- Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA
- Rocky Mountain Regional VA Medical Center, Palliative Care, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, 12631 E 17th Ave, Anschutz Medical Campus, Aurora, CO, USA
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Timmons MJ, MacIver J, Alba AC, Tibbles A, Greenwood S, Ross HJ. Using Heart Failure Instruments to Determine when to Refer Heart Failure Patients to Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971302900403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The purpose of this study was to determine whether the Edmonton Symptom Assessment Scale (ESAS) or the Palliative Performance Scale (PPS) are associated with traditionally used scores for heart failure patients — specifically, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), an overall health visual analog scale (VAS), and the Seattle Heart Failure Model (SHFM). Furthermore, we sought to determine whether the PPS or the ESAS provided additional information on quality of life, symptom severity, or prognosis above that provided by the traditional scores for patients with heart failure. Methods: We administered the ESAS, MLHFQ, VAS, PPS, and SHFM in a shuffled manner to 78 New York Heart Association Functional Classification (NYHA-FC) III-IV ambulatory heart failure patients. Pearson's r correlation was used to determine whether the scores from the ESAS and PPS correlated with the scores from the MLHFQ, VAS, and SHFM. Results: The sample was predominately male (62.8 percent), mean age 60.1 ± 13 years, with a diagnosis of idiopathic cardiomyopathy (45 percent). Moderate correlations were found between the ESAS and MLHFQ (r=0.483, p<0.01), the ESAS and VAS (r=-0.345, p<0.01), the PPS and MLHFQ (r=-0.54, p<0.01), and the PPS and VAS (r=0.53, p<0.01). There was no significant correlation between the PPS and SHFM. Conclusion: The results of this study suggest that administration of the ESAS and PPS provides additional information on symptom severity and functional decline for patients with heart failure. Standardized administration of these scales may aid in the assessment and evaluation of heart failure patients.
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Affiliation(s)
- Matthew J. Timmons
- HJ Ross (corresponding author): Peter Munk Cardiac Centre, University Health Network, 11C-1203-585 University Avenue, Toronto, Ontario, Canada M5G 2N2
| | - Jane MacIver
- Department of Family Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ana C. Alba
- Department of Family Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alana Tibbles
- Department of Family Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Greenwood
- Department of Family Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Heather J. Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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18
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Alpert CM, Smith MA, Hummel SL, Hummel EK. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Fail Rev 2018; 22:25-39. [PMID: 27592330 DOI: 10.1007/s10741-016-9581-4] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.
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Affiliation(s)
- Craig M Alpert
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael A Smith
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.,Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott L Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ellen K Hummel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA.
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19
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Abstract
PURPOSE OF REVIEW The current review discusses the integration of guideline and evidence-based palliative care into heart failure end-of-life (EOL) care. RECENT FINDINGS North American and European heart failure societies recommend the integration of palliative care into heart failure programs. Advance care planning, shared decision-making, routine measurement of symptoms and quality of life and specialist palliative care at heart failure EOL are identified as key components to an effective heart failure palliative care program. There is limited evidence to support the effectiveness of the individual elements. However, results from the palliative care in heart failure trial suggest an integrated heart failure palliative care program can significantly improve quality of life for heart failure patients at EOL. SUMMARY Integration of a palliative approach to heart failure EOL care helps to ensure patients receive the care that is congruent with their values, wishes and preferences. Specialist palliative care referrals are limited to those who are truly at heart failure EOL.
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Affiliation(s)
- Jane Maciver
- Ted Rogers Center for Heart Research and the Peter Munk Cardiac Center, University Health Network
- Lawrence S. Bloomberg Faculty of Nursing
| | - Heather J. Ross
- Ted Rogers Center for Heart Research and the Peter Munk Cardiac Center, University Health Network
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Abstract
PURPOSE OF REVIEW Patients with Stage D heart failure can benefit from palliative care consultation to help them manage unpleasant symptoms and improve quality of life. Although guidelines describe how to manage symptoms, very little direction is provided on how to evaluate the effectiveness of those interventions. RECENT FINDINGS Numerous studies have used the measurement of symptoms, emotional distress, functional capacity and quality of life to evaluate the effectiveness of interventions in heart failure. There is limited evidence on the use of these instruments in heart failure palliative care. Four studies were identified that evaluate the effectiveness of palliative care consultation for patients with advanced heart failure. All four studies measured symptom severity, emotional distress, and quality of life. The application of appropriate instruments is discussed. Suggestions for scores that should trigger palliative care consultation are identified. SUMMARY The routine administration of standardized instruments to measure symptom severity and quality of life may improve the assessment and management of patients with Stage D heart failure. Ongoing discussion and research is needed to determine if these instruments are the best tools to use with heart failure palliative care patients.
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22
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Kane PM, Daveson BA, Ryan K, Ellis-Smith CI, Mahon NG, McAdam B, McQuilllan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Koffman J, Murtagh FEM. Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure. BMJ Support Palliat Care 2017; 7:470-479. [PMID: 28864449 DOI: 10.1136/bmjspcare-2017-001355] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 11/04/2022]
Abstract
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF. OBJECTIVES To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF. METHODS A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability. RESULTS Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable. CONCLUSIONS A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
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Affiliation(s)
- Pauline M Kane
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karen Ryan
- Palliative Care, St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clare I Ellis-Smith
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Niall G Mahon
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Cecelia Tracey
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Christine Howley
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
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Berg SK, Svanholm J, Lauberg A, Borregaard B, Herning M, Mygind A, Christensen AV, Christensen AI, Ekholm O, Juel K, Thrysøe L. Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a register-based follow-up: the DenHeart study protocol. BMJ Open 2014; 4:e004709. [PMID: 24793253 PMCID: PMC4025470 DOI: 10.1136/bmjopen-2013-004709] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patient reported health status, which includes symptom burden, functional status and quality of life, is an important measure of health. Differences in health status between diagnostic groups within cardiology have only been sparsely investigated. These outcomes may predict morbidity, mortality, labour market affiliation and healthcare utilisation in various diagnostic groups. A national survey aiming to include all cardiac diagnostic groups from a total Heart Centre population has been designed as the DenHeart survey. METHODS AND ANALYSIS DenHeart is designed as a cross-sectional survey with a register-based follow-up. All diagnostic groups at the five national Heart Centres are included during 1 year (15 April 2013 to 15 April 2014) and asked to fill out a questionnaire at hospital discharge. The total eligible population, both responders and non-responders, will be followed in national registers. The following instruments are used: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire (B-IPQ), HeartQoL and Edmonton Symptom Assessment Scale. The following variables are collected from national registers: action diagnosis, procedures, comorbidity, length of hospital stay, type of hospitalisation, visits to general practitioners and other agents in primary healthcare, dispensed prescription medication, vital status and cause of death. Labour market affiliation, sick leave, early retirement pension, educational degree and income will be collected from registers. Frequency distributions and multiple logistic regression analyses will be used to describe and assess differences in patient reported outcomes at hospital discharge between diagnostic groups and in-hospital predicting factors. Cox proportional hazards regression models with age as the time scale will be used to investigate associations between patient reported outcomes at baseline and morbidity/mortality, labour market affiliation and healthcare utilisation after 1 year. ETHICS AND DISSEMINATION The study complies with the Declaration of Helsinki. The study has been approved by the Danish Data Protection Agency: 2007-58-0015/30-0937 and registered at ClinicalTrials.gov (NCT01926145). Study findings will be disseminated widely through peer reviewed publications and conference presentations.
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Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Unit 2151, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Jette Svanholm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Astrid Lauberg
- Departments of Cardiology and Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Department of Thoracic, Cardiac and Vascular Surgery, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Margrethe Herning
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Anna Mygind
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome. Palliat Support Care 2014; 12:495-513. [DOI: 10.1017/s1478951513001338] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:According to the World Health Organization (WHO), palliative care (PC) should be available to everyone suffering from life-threatening diseases and should be started early on in the illness trajectory. However, PC is often initiated much later and is restricted to cancer patients. There is a need for more knowledge about how early PC can be implemented in clinical practice. The purpose of our study was to document the best evidence on methods for early identification (EI) of palliative trajectories in cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) populations, and to identify preconditions for early integration of general PC in hospitals and outcomes for patients and relatives.Method:A comprehensive systematic review of methods, preconditions, and outcomes was conducted via an electronic literature search of publications between 2002 and September 2012. A final sample of 44 papers was reviewed in detail.Results:Our study identified disease-specific and general methods for EI of patients who might benefit from PC. Prognostication of end-stage disease based on (holistic) clinical judgment, prognostic factors, and/or care needs are the most frequently recommended methods. A number of interacting disease-, staff-, user-, and organization-specific barriers need to be overcome in order to implement early integration of PC in clinical practice. Early integration of PC may lead to better symptom management, prolonged survival, and better quality of life.Significance of Results:No methods can be recommended for routine clinical practice without further validation. There is an urgent need to develop and evaluate methods based on the holistic assessment of symptoms or needs. The barriers to early integration of PC are most extensive with regard to CHF and COPD. Professional training and education are recommended to facilitate early implementation of PC. The evidence about outcome is sparse and mostly relates to cancer populations receiving specialized PC.
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Kavalieratos D, Kamal AH, Abernethy AP, Biddle AK, Carey TS, Dev S, Reeve BB, Weinberger M. Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer. J Palliat Med 2014; 17:475-81. [PMID: 24588568 DOI: 10.1089/jpm.2013.0526] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer. OBJECTIVE To characterize the unresolved symptom and treatment needs with which patients with HF and those with cancer present to PC. METHODS We used data from the Palliative Care Research Registry (PCRR), a repository of quality improvement data from three community-based PC organizations. We abstracted first PC visit data from the PCRR for patients with primary diagnoses of HF or cancer seen between 2008 and 2012. We assessed the association of primary diagnosis (i.e., HF or cancer) on three outcomes: unresolved symptoms, treatment gaps, and a composite indicator of symptom control and quality of life. Analyses included descriptive statistics and multivariate Poisson regression. RESULTS Our analytic sample comprised 334 patients with HF and 697 patients with cancer, the majority of whom were white and male. Compared to patients with cancer, patients with HF presented with fewer unresolved symptoms, both overall and at moderate/severe distress levels. Patients with HF more commonly reported moderately/severely distressful dyspnea (25% versus 18%, p=0.02), and more commonly experienced dyspnea-related treatment gaps (17% versus 8%, p<0.001). CONCLUSIONS Patients with HF possess care needs that are squarely within the purview of PC. Future work is needed to delineate how PC referral policies should be refined to optimize PC access for patients with HF.
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Affiliation(s)
- Dio Kavalieratos
- 1 Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Johnson MJ, Bland JM, Davidson PM, Newton PJ, Oxberry SG, Abernethy AP, Currow DC. The relationship between two performance scales: New York Heart Association Classification and Karnofsky Performance Status Scale. J Pain Symptom Manage 2014; 47:652-8. [PMID: 23910628 DOI: 10.1016/j.jpainsymman.2013.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/03/2013] [Accepted: 05/08/2013] [Indexed: 11/21/2022]
Abstract
CONTEXT Performance status is used to quantify the well-being and functional status of people with illness. Clinicians and researchers from differing fields may not instinctively understand the scales, typically disease specific, used in other disciplines. OBJECTIVES To provide a preliminary description of the relationship between the Karnofsky Performance Status Scale (KPS) and the New York Heart Association Classification (NYHA) and to stimulate discussion in research and clinical practice. METHODS Simultaneous KPS and NYHA data (172 observations) from three studies of people with chronic heart failure were pooled. Linear regression was used to predict the mean KPS from NYHA. The strength of association between the scales was investigated using a Kendall's Tau-b correlation coefficient. The agreement between the predicted and observed KPS scores was investigated using weighted kappa with quadratic weights. RESULTS Linear regression demonstrated a relationship between KPS and NYHA (P < 0.0001; R(2) = 0.3). Predicted KPS from NYHA class rounded to the nearest 10 gave the following values: Class I, predicted KPS 90%; Class II, predicted KPS 80%; Class III, predicted KPS 70%; and Class IV, predicted KPS 60%. A moderate strength of association between KPS and NYHA (Kendall's Tau-b correlation coefficient of -0.49; P < 0.0001) and agreement between observed and predicted KPS (kappa coefficient = 0.52) was shown. CONCLUSION We suggest that the NYHA discriminates poorly between clinically important performance states in people with advanced disease (NYHA III and IV; KPS <50%). The KPS, used in conjunction, would provide useful additional information in research and clinical practice.
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Affiliation(s)
- Miriam J Johnson
- Palliative Medicine, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - J Martin Bland
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Patricia M Davidson
- Cardiovascular and Chronic Care Centre, University of Technology Sydney, St. Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Phillip J Newton
- Cardiovascular and Chronic Care Centre, University of Technology Sydney, St. Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | | | - Amy P Abernethy
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia
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Waller A, Girgis A, Davidson PM, Newton PJ, Lecathelinais C, Macdonald PS, Hayward CS, Currow DC. Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability, and validity of a needs assessment tool. J Pain Symptom Manage 2013; 45:912-25. [PMID: 23017612 DOI: 10.1016/j.jpainsymman.2012.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/02/2012] [Accepted: 05/08/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). OBJECTIVES To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF. METHODS A convenience sample of multidisciplinary health professionals working in heart failure care was invited to comment, via an online survey and consultation, on suitability and required modifications to a validated cancer care needs assessment measure to inform the support and palliative care needs of patients with CHF and their caregivers. Psychometric testing was then undertaken with 52 patients with CHF recruited from a multidisciplinary heart failure service to explore inter-rater reliability and concurrent validity of the newly adapted Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF). RESULTS Health professionals (n=21) rated the tool as easy to administer, comprehensive, and relevant for the CHF population. Prevalence- and bias-adjusted kappa values indicated good agreement between pairs of raters for each item in the NAT: PD-HF (range 0.54-0.90). Participants indicating a higher severity of concern in the NAT: PD-HF physical, daily living, and spiritual items reported significantly higher Heart Failure Needs Assessment Questionnaire physical and existential scores. CONCLUSION This study provides preliminary evidence for the NAT: PD-HF as a potential strategy for identifying and informing the management of physical and psychosocial issues experienced by people with CHF. Further work is needed to examine additional psychometrics, benefits relating to unnecessary symptom burden, futile treatments, and admissions to hospital.
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Affiliation(s)
- Amy Waller
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada.
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Current World Literature. Curr Opin Support Palliat Care 2013; 7:116-28. [DOI: 10.1097/spc.0b013e32835e749d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wajnberg A, Ornstein K, Zhang M, Smith KL, Soriano T. Symptom burden in chronically ill homebound individuals. J Am Geriatr Soc 2012. [PMID: 23205716 DOI: 10.1111/jgs.12038] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To document the degree of symptom burden in an urban homebound population. DESIGN Cross-sectional survey. SETTING The Mount Sinai Visiting Doctors (MSVD) program. PARTICIPANTS All individuals newly enrolled in the MSVD. MEASUREMENTS Edmonton Symptom Assessment Scale (ESAS), which consists of 10 visual analogue scales scored from 0 to 10; symptoms include pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, shortness of breath, and other. RESULTS ESAS scores were completed for 318 participants. Most participants were aged 80 and older (68%) and female (75%); 36% were white, 22% black, and 32% Hispanic. Forty-three percent had Medicaid, and 32% lived alone. Ninety-one percent required assistance with one or more activities of daily living, 45% had a Karnofsky Performance Scale score between 0 and 40 (unable to care for self), and 43% reported severe burden on one or more symptoms. The most commonly reported symptoms were loss of appetite, lack of well-being, tiredness, and pain; the symptoms with the highest scores were depression, pain, appetite, and shortness of breath. Participants were more likely to have severe symptom burden if they self-reported their ESAS, had chronic obstructive pulmonary disease or diabetes mellitus with end organ damage, or had a Charlson Comorbidity Index greater than 3 and less likely to have severe burden if they had dementia. CONCLUSION In chronically ill homebound adults, symptom burden is a serious problem that needs to be addressed alongside primary and specialty care needs.
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Affiliation(s)
- Ania Wajnberg
- Mount Sinai Visiting Doctors Program, Division of General Internal Medicine, Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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