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Chen CW, Lee MC, Wu SFV. Effects of a collaborative health management model on people with congestive heart failure: A systematic review and meta-analysis. J Adv Nurs 2024; 80:2290-2307. [PMID: 38093471 DOI: 10.1111/jan.16011] [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: 06/29/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIM To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. BACKGROUND Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. DESIGN Systematic review and meta-analysis. METHODS We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta-analysis. RESULTS In this study, a systematic review and meta-analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self-care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. CONCLUSION The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all-cause mortality rate, and all-cause hospitalization rate, and improve the quality of life. IMPLICATIONS FOR PRACTICE The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis, and such details do not apply to our work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The Collaborative Health Management Model provides in-depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages. Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. TRIAL AND PROTOCOL REGISTRATION The detailed study protocol can be found on the PROSPERO website.
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Affiliation(s)
- Chih Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital/Department of Nursing/Nurse Practitioner Leader, Tungkang, Taiwan
| | - Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Queensland University of Technology, Brisbane City, Australia
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Ryder M, Mannion T, Furlong E, O'Donoghue E, Travers B, Connolly M, Lucey N. Exploring heart failure nurse practitioner outcome measures: a scoping review. Eur J Cardiovasc Nurs 2024; 23:337-347. [PMID: 38165269 DOI: 10.1093/eurjcn/zvad108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
AIMS Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure. METHODS AND RESULTS A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements. CONCLUSION This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
| | - Tara Mannion
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Claires Integrated Care Centre, Dublin 11, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
| | - Ethel O'Donoghue
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Bronagh Travers
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- Tallaght University Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Niamh Lucey
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Vincent's University Hospital, Dublin, Ireland
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Poghosyan L, Liu J, Spatz E, Flandrick K, Osakwe Z, Martsolf GR. Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease. J Gen Intern Med 2024; 39:61-68. [PMID: 37620724 PMCID: PMC10817858 DOI: 10.1007/s11606-023-08367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. OBJECTIVE To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. DESIGN In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. PARTICIPANTS A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. MAIN MEASURES All-cause and ambulatory care sensitive condition hospitalizations in 2018. KEY RESULTS There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries. CONCLUSIONS Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.
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Affiliation(s)
- Lusine Poghosyan
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA.
- Mailman School of Public Health, Columbia University, New York, USA.
| | - Jianfang Liu
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Erica Spatz
- School of Medicine, Yale University, New Haven, CT, USA
| | - Kathleen Flandrick
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Zainab Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Grant R Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Anderson AJ, Anderson JM, Cengiz A, Yoder LH. Key Factors to Consider When Implementing an Advanced Practice Registered Nurse-Led Heart Failure Clinic. Mil Med 2023; 189:57-63. [PMID: 37956325 DOI: 10.1093/milmed/usad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/11/2023] [Accepted: 09/06/2023] [Indexed: 11/15/2023] Open
Abstract
Advanced practice registered nurses (APRNs) such as clinical nurse specialists and nurse practitioners excel at chronic disease management. Development of an APRN-led heart failure (HF) clinic is an ideal way to manage complex HF patients. However, there are important factors to consider when implementing an APRN-led HF clinic. The purpose of this paper is to provide a consolidation of recommendations to consider when developing and implementing an APRN-led HF clinic. A review of applicable literature within the last 10 years was conducted to determine the key factors to be considered when developing organizational structures and processes for an APRN-led HF clinic. The increasing need for primary care and internal medicine providers supports using APRNs to fill the gap and provide disease management for HF patients. Also, APRNs can impact the overall costs of HF treatment by optimizing postdischarge care and preventing hospitalizations and readmissions. Multiple studies supported implementation of APRN-led HF clinics for disease management to provide complex treatment strategies and comprehensive care to these patients.
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Affiliation(s)
| | | | - Adem Cengiz
- University of Texas at Austin School of Nursing, Austin, TX 78712, USA
| | - Linda H Yoder
- University of Texas at Austin School of Nursing, Austin, TX 78712, USA
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Jeemon P, Bahuleyan CG, Chandgalu Javaregowda D, Punnoose E, Rajendiran G, Unni G, Abdullakutty J, Balakrishnan J, Joseph J, Gnanaraj JP, Sreedharan M, Pillai MR, KR N, Thomas P, Sebastian P, Daniel R, Edakutty R, Ahmad S, Mattummal S, Thomas SC, Joseph S, Pisharody S, Chacko S, Syam N, Nair T, Nanjappa V, Ganesan V, George V, Ganapathi S, Harikrishnan S. Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomised controlled trial. Wellcome Open Res 2023; 8:197. [PMID: 37795133 PMCID: PMC10545985 DOI: 10.12688/wellcomeopenres.19196.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 10/06/2023] Open
Abstract
Background: Heart failure (HF) is a debilitating condition associated with enormous public health burden. Management of HF is complex as it requires care-coordination with different cadres of health care providers. We propose to develop a team based collaborative care model (CCM), facilitated by trained nurses, for management of HF with the support of mHealth and evaluate its acceptability and effectiveness in Indian setting. Methods: The proposed study will use mixed-methods research. Formative qualitative research will identify barriers and facilitators for implementing CCM for the management of HF. Subsequently, a cluster randomised controlled trial (RCT) involving 22 centres (tertiary-care hospitals) and more than 1500 HF patients will be conducted to assess the efficacy of the CCM in improving the overall survival as well as days alive and out of hospital (DAOH) at two-years (CTRI/2021/11/037797). The DAOH will be calculated by subtracting days in hospital and days from death until end of study follow-up from the total follow-up time. Poisson regression with a robust variance estimate and an offset term to account for clustering will be employed in the analyses of DAOH. A rate ratio and its 95% confidence interval (CI) will be estimated. The scalability of the proposed intervention model will be assessed through economic analyses (cost-effectiveness) and the acceptability of the intervention at both the provider and patient level will be understood through both qualitative and quantitative process evaluation methods. Potential Impact: The TIME-HF trial will provide evidence on whether a CCM with mHealth support is effective in improving the clinical outcomes of HF with reduced ejection fraction in India. The findings may change the practice of management of HF in low and middle-income countries.
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Affiliation(s)
- Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | | | | | - Eapen Punnoose
- Malankara Orthodox Syrian Church Medical College, Kolenchery, Kerala, India
| | | | - Govindan Unni
- Jubilee Mission medical College and Research Institute, Thrissur, Kerala, India
| | | | | | | | - Justin Paul Gnanaraj
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamilnadu, India
| | - Madhu Sreedharan
- NIMS Heart Foundation, NIMS Medicity, Thiruvananthapuram, Kerala, India
| | | | - Neenumol KR
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | | | | | - Rachel Daniel
- NS Memorial Institute of Medical Sciences, Kollam, Kerala, India
| | | | - Sajan Ahmad
- St Gregorios Memorial Mission Hospital, Parumala, Kerala, India
| | | | - Sunu C Thomas
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Stigi Joseph
- Little Flower Hospital and Research Centre, Angamaly, Ernakulam, Kerala, India
| | - Sunil Pisharody
- EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India
| | - Susanna Chacko
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - N Syam
- Government District Hospital, Kollam, Kerala, India
| | - Tiny Nair
- PRS Hospital, Thiruvananthapuram, Kerala, India
| | - Veena Nanjappa
- Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, Karnataka, India
| | | | | | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
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Vinck TAM, Deneer R, Verstappen C, Kok WE, Salah K, Scharnhorst V, Otterspoor LC. Validation of the ELAN-HF Score and self-care behaviour on the nurse-led heart failure clinic after admission for heart failure. BMC Nurs 2022; 21:158. [PMID: 35729554 PMCID: PMC9210612 DOI: 10.1186/s12912-022-00914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF). DESIGN Quantitative, prospective, single centre, cohort study. METHODS N-Terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days. RESULTS 88 patients were included. The median age of the study population was 75 years (IQR 69-83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08-1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 - 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99-1.03, p = 0.174). CONCLUSION This study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population. TRIAL REGISTRATION This study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.
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Affiliation(s)
- T A M Vinck
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.
| | - R Deneer
- Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Ccag Verstappen
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands
| | - W E Kok
- Amsterdam UMC, University of Amsterdam, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | - K Salah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - V Scharnhorst
- Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - L C Otterspoor
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands
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Pant BP, Satheesh S, Pillai AA, Anantharaj A, Ramamoorthy L, Selvaraj R. Outcomes with heart failure management in a multidisciplinary clinic - A randomized controlled trial. Indian Heart J 2022; 74:327-331. [PMID: 35709974 PMCID: PMC9453057 DOI: 10.1016/j.ihj.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/30/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Bhagwati Prasad Pant
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Lakshmi Ramamoorthy
- Department of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Raja Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Karami Salaheddin Kola M, Jafari H, Charati JY, Shafipour V. Comparing the effects of teach-back method, multimedia and blended training on self-care and social support in patients with heart failure: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:248. [PMID: 34485545 PMCID: PMC8395889 DOI: 10.4103/jehp.jehp_1481_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/10/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers. MATERIALS AND METHODS In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20-30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). RESULTS All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001). CONCLUSION According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.
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Affiliation(s)
| | - Hedayat Jafari
- Traditional and Complementary Medicine Research Center, Addiction Institute Mazandaran University of Medical Science, Sari, Iran
| | - Jamshid Yazdani Charati
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Vida Shafipour
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Ordóñez-Piedra J, Ponce-Blandón JA, Robles-Romero JM, Gómez-Salgado J, Jiménez-Picón N, Romero-Martín M. Effectiveness of the Advanced Practice Nursing interventions in the patient with heart failure: A systematic review. Nurs Open 2021; 8:1879-1891. [PMID: 33689229 PMCID: PMC8186677 DOI: 10.1002/nop2.847] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 01/14/2023] Open
Abstract
RATIONALE AND AIM Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills to make complex decisions for a better professional practice. In the United States, this figure has been developed in different ways, but in some European countries, it is not yet fully developed, although it may imply a significant advance in terms of continuity and quality of care in patients with chronic or multiple pathologies, including cardiac ones and, more specifically, heart failure (HF). The follow-up of HF patients in many countries has focused on the medical management of the process, neglecting all the other comprehensive health aspects that contribute to decompensation of HF, worsening quality indicators or patient satisfaction, and there are not updated reviews to clarify the relevance of APN in HF, comparing the results of APN interventions with doctors clinical practice, since the complexity of care that HF patients need makes it difficult to control the disease through regular treatment. For this reason, this systematic review was proposed in order to update the available knowledge on the effectiveness of APN interventions in HF patients, analysing four PICO questions (Patients, Interventions, Comparison and Outcomes): whether APN implies a reduction in the number of hospital readmissions, if it reduces mortality, if it has a positive cost-benefit relationship and if it implies any improvement in the quality of life of HF patients. DESIGN AND METHODS A systematic review was performed based on the PRISMA statement, searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were selected based on the following criteria: English/Spanish language, up to 6 years since publication, and original quantitative studies of experimental, quasi-experimental or observational character. Papers were excluded if they do not comply with CONSORT or STROBE checklists, and if they had not been published in journals indexed in JCR and/or SJR. For the analysis, two separate researchers used the Cochrane Handbook form for systematic reviews of intervention, collecting authorship variables, study methods, risks of bias, intervention and comparison groups, results obtained, PICO question or questions answered, and the main conclusions. RESULTS A total of 43,754 patients participated in the 11 included studies for the development of this review, mostly from United States and non-European countries, with a clearly visible lack of European publications. Regarding the results related to first PICO question, researches reviewed proved that APN implied a reduction in the number of hospital readmissions in patients with heart failure (up to 33%). Regarding the second question, mortality was always lower in groups assisted by APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third question, APN was cost-effective in this type of patient as the cost reduction was eventually calculated in 1.9 million euros. Regarding the last question, quality of life of patients who have been cared for by an APN had notoriously improved, although one of the papers concluded that no significant differences were found. All the questions addressed obtained a positive answer; therefore, APN is a practice that reduced hospital readmissions and mortality in HF patients. The cost-effectiveness is much better with APN than with usual care, and although the quality of life of HF patients seems to improve with APN, more studies are needed to support this focused on this.
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Affiliation(s)
- Javier Ordóñez-Piedra
- Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | | | | | - Juan Gómez-Salgado
- Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, Spain.,Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería de Cruz Roja, Universidad de Sevilla, Sevilla, Spain
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10
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Zuraida E, Irwan AM, Sjattar EL. Self-management education programs for patients with heart failure: a literature review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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11
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Schmidt MM, Griffin JM, McCabe P, Stuart-Mullen L, Branda M, OByrne TJ, Bowers M, Trotter K, McLeod C. Shared medical appointments: Translating research into practice for patients treated with ablation therapy for atrial fibrillation. PLoS One 2021; 16:e0246861. [PMID: 33577612 PMCID: PMC7880477 DOI: 10.1371/journal.pone.0246861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background People with atrial fibrillation (AF) have lower reported quality of life and increased risk of heart attack, death, and stroke. Lifestyle modifications can improve arrhythmia-free survival/symptom severity. Shared medical appointments (SMAs) have been effective at targeting lifestyle change in other chronic diseases and may be beneficial for patients with AF. Objective To determine if perceived self-management and satisfaction with provider communication differed between patients who participated in SMAs compared to patients in standard care. Secondary objectives were to examine differences between groups for knowledge about AF, symptom severity, and healthcare utilization. Methods We conducted a retrospective analysis of data collected where patients were assigned to either standard care (n = 62) or a SMA (n = 59). Surveys were administered at pre-procedure, 3, and 6 months. Results Perceived self-management was not significantly different at baseline (p = 0.95) or 6 months (p = 0.21). Patients in SMAs reported more knowledge gain at baseline (p = 0.01), and higher goal setting at 6 months (p = 0.0045). Symptom severity for both groups followed similar trends. Conclusion Patients with AF who participated in SMAs had similar perceived self-management, patient satisfaction with provider communication, symptom severity, and healthcare utilization with their counterparts, but had a statistically significant improvement in knowledge about their disease.
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Affiliation(s)
- Monika M. Schmidt
- U.S. Department of Veteran’s Affairs, Nashville, TN, United States of America
- * E-mail:
| | | | - Pamela McCabe
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Megan Branda
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States of America
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12
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Bakhshayesh S, Hoseini B, Bergquist R, Nabovati E, Gholoobi A, Mohammad-Ebrahimi S, Eslami S. Cost-utility analysis of home-based cardiac rehabilitation as compared to usual post-discharge care: systematic review and meta-analysis of randomized controlled trials. Expert Rev Cardiovasc Ther 2020; 18:761-776. [PMID: 32893713 DOI: 10.1080/14779072.2020.1819239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Determining cost-utility differences between home-based cardiac rehabilitation (HBCR) on the one hand, and usual post-discharge care (UC) on the other, can improve resource-allocation in healthcare settings. AREAS COVERED In June 2019, PubMed, Web of Science, Scopus, and Cochrane library were searched for randomized controlled HBCR trials. Standardized mean differences (SMDs) of cost and quality-adjusted life years (QALYs) between HBCRs and UCs were calculated using random effect models. Heterogeneity was assessed by inconsistency index (I2) and publication bias by funnel plot and Egger's regression test. Thirteen articles, representing 2,992 participants, were deemed representative for final analysis. In the meta-analysis, a significant difference with respect to QALYs favored HBCR, while no significant cost difference was observed between HBCR and UC. However, subgroup-analysis of trials with different follow-up durations revealed somewhat different results, and HBCR was found to be significantly better with regard to both cost and QALYs for patients with heart failure. Cost-utility analysis categorizing interventions as 'dominant', 'effective', 'doubtful', and 'dominated', found HBCRs dominant. EXPERT OPINION Although HBCR tended to be superior compared to UC in this review, larger and more robust trials addressing specific patients groups are needed for definitive results.
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Affiliation(s)
- Samaneh Bakhshayesh
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Health Information Technology, Neyshabur University of Medical Sciences , Neyshabur, Iran
| | - Robert Bergquist
- Ingerod, SE-454 94 Brastad, Sweden, Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization , Geneva, Switzerland
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences , Kashan, Iran.,Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences , Kashan, Iran
| | - Arash Gholoobi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Shahab Mohammad-Ebrahimi
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Amsterdam UMC (location AMC), University of Amsterdam , Amsterdam, The Netherlands
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13
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Abstract
BACKGROUND Heart failure (HF) affects over 6.5 million Americans and is the leading reason for hospital admissions in patients over the age of 65. Readmission rates within 30 days are 21.4% nationally, and 12% of those are likely preventable. Veterans are especially vulnerable to developing cardiac diseases requiring hospitalization and subsequent readmission. LOCAL PROBLEM The Southern Arizona Veterans Administration Health Care System has over 5,600 patients diagnosed with HF and a 30-day readmission rate of 21.65%. The aim of this quality improvement project was to reduce 30-day all-cause readmissions by 1% over 8 weeks. METHODS To reduce HF readmissions, the plan-do-study-act rapid-cycle method of quality improvement was used. INTERVENTIONS A dedicated multidisciplinary HF clinic was formed with a cardiology nurse practitioner, clinical pharmacists, and a dietician. A veteran-centered shared decision-making tool for setting self-care goals was implemented. RESULTS The readmission rate of patients seen in the multidisciplinary clinic (n = 33) was reduced by 0.2%. The percentage of veterans seen within 14 days increased from 30% to 54.5%. The average number of days between discharge and cardiology follow-up improved from 45 to 19 days. Veterans were able to set at least one self-care goal 87% of the time. Patient satisfaction with the multidisciplinary clinic was high at 93%. CONCLUSIONS Implementing a dedicated, multidisciplinary HF clinic reduced readmissions, improved timeliness of visits, and was well received. Use of a veteran-centered patient engagement tool resulted in more veterans setting self-care goals.
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Joynt Maddox K, Bleser WK, Crook HL, Nelson AJ, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006483. [PMID: 32393125 DOI: 10.1161/circoutcomes.120.006483] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients' longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.
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Affiliation(s)
- Karen Joynt Maddox
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, and Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.J.M.)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Hannah L Crook
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Adam J Nelson
- Duke Clinical Research Institute, Duke University, Durham, NC (A.J.N.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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15
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Olano-Lizarraga M, Martín-Martín J, Oroviogoicoechea C, Saracíbar-Razquin M. Unexplored Aspects of the Meaning of Living with Chronic Heart Failure: A Phenomenological Study within the Framework of the Model of Interpersonal Relationship between the Nurse and the Person/Family Cared for. Clin Nurs Res 2020; 30:171-182. [PMID: 31896283 DOI: 10.1177/1054773819898825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient's perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.
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Affiliation(s)
- Maddi Olano-Lizarraga
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jesús Martín-Martín
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina Oroviogoicoechea
- Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Area of Nursing Research, Training and Development, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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16
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Shafipour V, Karami Salahodinkolah M, Ganji J, Hasani Moghadam S, Jafari H, Salari S. Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2020. [DOI: 10.4103/jnms.jnms_19_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Marani H, Baranek H, Abrams H, McDonald M, Nguyen M, Posada JD, Ross H, Schofield T, Shaw J, Bhatia RS. Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system. JOURNAL OF COMORBIDITY 2020; 10:2235042X20924172. [PMID: 32596163 PMCID: PMC7303776 DOI: 10.1177/2235042x20924172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning. METHODS Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM. RESULTS Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge. CONCLUSIONS The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications.
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Affiliation(s)
- Husayn Marani
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada
| | - Hayley Baranek
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
| | - Howard Abrams
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Megan Nguyen
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
| | - Juan Duero Posada
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Toni Schofield
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - James Shaw
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Women’s College Hospital, Toronto, Ontario,
Canada
- Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
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18
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Olano-Lizarraga M, Zaragoza-Salcedo A, Martín-Martín J, Saracíbar-Razquin M. Redefining a 'new normality': A hermeneutic phenomenological study of the experiences of patients with chronic heart failure. J Adv Nurs 2019; 76:275-286. [PMID: 31642086 DOI: 10.1111/jan.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
AIM To explore the perception of normality in life experienced by patients with chronic heart failure. DESIGN A hermeneutic phenomenological study was conducted. METHODS Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis. RESULTS From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others. CONCLUSIONS The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process. IMPACT Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.
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Affiliation(s)
- Maddi Olano-Lizarraga
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Amparo Zaragoza-Salcedo
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jesús Martín-Martín
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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19
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Abstract
PURPOSE OF REVIEW Heart failure (HF) is the first cause of hospitalization in the elderly in Western countries, generating tremendous healthcare costs. Despite the spread of multidisciplinary post-discharge programs, readmission rates have remained unchanged over time. We review the recent developments in this setting. RECENT FINDINGS Recent data plead for global reorganization of HF care, specifically targeting patients at high risk for further readmission, as well as a stronger involvement of primary care providers (PCP) in patients' care plan. Besides, tools, devices, and new interdisciplinary expertise have emerged to support and be integrated into those programs; they have been greeted with great enthusiasm, but their routine applicability remains to be determined. HF programs in 2018 should focus on pragmatic assessments of patients that will benefit the most from the multidisciplinary care; delegating the management of low-risk patients to trained PCP and empowering the patient himself, using the newly available tools as needed.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Belanger East, Montreal, Quebec, H1T1C8, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Belanger East, Montreal, Quebec, H1T1C8, Canada.
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20
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Kelly F, Liska C, Morash R, Hu J, Carroll SL, Shorr R, Dent S, Stacey D. Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review. Chronic Illn 2019; 15:3-26. [PMID: 28927284 DOI: 10.1177/1742395317731608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Shared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes management, but little is known about their use for other illnesses. The objective was to determine the effect that shared medical appointments have on patients with a physical chronic illness, healthcare providers, and the healthcare system. METHODS A systematic review was conducted searching databases from January 1970 to September 2016. Eligible trials evaluated shared medical appointments for patients with a homogeneous chronic illness, excluding diabetes and mental illness. Screening, data extraction, and risk of bias were conducted independently by two authors. Analysis was descriptive. RESULTS Of 2364 citations, nine randomized trials were included. Shared medical appointments were evaluated for cardiovascular illnesses (four studies), breast cancer, chronic kidney disease, Parkinson's disease, stress urinary incontinence, and carpal tunnel syndrome. Compared to usual care, no negative effects on patient quality of life, knowledge and satisfaction were reported. One study reported no difference in healthcare provider satisfaction. Another study showed fewer hospital admissions for patients who attended shared medical appointments. DISCUSSION Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses. Overall, there appears to be no patient harms. Further studies should include more objective outcomes and larger sample sizes.
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Affiliation(s)
- F Kelly
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C Liska
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - R Morash
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Hu
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - S L Carroll
- 4 School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - R Shorr
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - S Dent
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - D Stacey
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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21
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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22
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Meaning-making and quality of life in heart failure interventions: a systematic review. Qual Life Res 2018; 28:557-565. [DOI: 10.1007/s11136-018-1993-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Bader F, Atallah B, Sadik ZG, Tbishat L, Gabra G, Soliman M, Bakr K, Ferrer R, Stapleton J, Khalil M. Nurse-led education for heart failure patients in developing countries. ACTA ACUST UNITED AC 2018; 27:690-696. [PMID: 29953275 DOI: 10.12968/bjon.2018.27.12.690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure readmissions are associated with significant morbidity and mortality. Adequate education on adherence and self-care behaviours can affect readmission rates positively and nurses are at the frontline of patient education. Such education is valuable when establishing heart failure programmes in developing countries, in light of the challenging socioeconomic circumstances in these. This study aimed to evaluate nurses' heart failure knowledge, to assess patients' baseline knowledge, and to evaluate the effectiveness of structured nurse-driven education. METHODS a total of 131 cardiac centre-based nurses and 30 chronic heart failure patients participated in the study in Kuwait. Patients were surveyed a second time 3 to 6 months later, while being followed at an advanced heart failure clinic by dedicated heart failure nurses. RESULTS the majority of the nurses (80%) had not received heart failure education previously, although they were able to recognise most heart failure symptoms. Significant improvement in patients' knowledge was noted between the initial and follow-up surveys. CONCLUSION establishing a dedicated advanced heart failure programme to care for patients in a developing country can result in significant improvement in disease awareness and self-care behaviours when led by well-trained heart failure nurses. More research is needed to determine if these findings are shared by other countries in the Middle-East and other developing countries.
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Affiliation(s)
- Feras Bader
- Staff Physician, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates (UAE)
| | - Bassam Atallah
- Cardiology Pharmacotherapy Specialist, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, UAE
| | - Ziad G Sadik
- Senior Pharmacotherapy Specialist, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, UAE
| | - Laith Tbishat
- Resident, General Surgery Department, Royal Medical Services, Amman, Jordan
| | - Guirgis Gabra
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Medhat Soliman
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Khalid Bakr
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Richard Ferrer
- Heart Failure and Transplant Nurse Coordinator, Clinical and Nursing Department, Cleveland Clinic Abu Dhabi, UAE
| | - Judy Stapleton
- Heart Failure and Transplant Nurse Coordinator, Clinical and Nursing Department, Cleveland Clinic Abu Dhabi, UAE
| | - Mohammed Khalil
- Staff Physician, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
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Piamjariyakul U, Thompson NC, Russell C, Smith CE. The effect of nurse-led group discussions by race on depressive symptoms in patients with heart failure. Heart Lung 2018; 47:211-215. [PMID: 29606370 DOI: 10.1016/j.hrtlng.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND African Americans with heart failure (HF) have the highest rates of depression among all ethnicities in the USA. OBJECTIVES To compare the effects by race on depressive symptoms and topics discussed in the first clinic appointment after HF hospitalization. METHODS This study is a secondary analysis of data from a randomized clinical trial testing a patient group discussion of HF self-management with 93 Caucasians and 77 African Americans. RESULTS Reduction in depressive symptoms was significantly greater among African American patients within the intervention group (F = 3.99, p = .047) than controls. There were significant differences by race in four topics (dietitian referral, appointment date, help preparing discussion questions, and advice on worsening HF symptoms) concerning patient-physician discussions. CONCLUSION The intervention showed greater effect in reducing depressive symptoms among African Americans than Caucasians. Preparing patients for discussions at physician appointments on diet, depressive symptoms, and HF symptoms is recommended.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, 1 Medical Center Dr., PO Box 9600, Morgantown, WV 26506-9600.
| | - Noreen C Thompson
- University of Kansas Hospital Department of Nursing, 4000 Cambridge St., Mail Stop 2018, Kansas City, KS 66160
| | - Christy Russell
- Center for Advanced Heart Failure and Transplantation, University of Kansas Hospital, 3901 Rainbow Blvd., Mail Stop 4023, Kansas City, KS 66160
| | - Carol E Smith
- University of Kansas School of Nursing, University of Kansas School of Preventive Medicine, 3901 Rainbow Blvd., Mail Stop 4043, Kansas City, KS 66160
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Harikrishnan S, Sanjay G, Agarwal A, Kumar NP, Kumar KK, Bahuleyan CG, Vijayaraghavan G, Viswanathan S, Sreedharan M, Biju R, Rajalekshmi N, Nair T, Suresh K, Jeemon P. One-year mortality outcomes and hospital readmissions of patients admitted with acute heart failure: Data from the Trivandrum Heart Failure Registry in Kerala, India. Am Heart J 2017; 189:193-199. [PMID: 28625377 PMCID: PMC10424635 DOI: 10.1016/j.ahj.2017.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/31/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are sparse data on outcomes of patients with heart failure (HF) from India. The objective was to evaluate hospital readmissions and 1-year mortality outcomes of patients with HF in Kerala, India. METHODS We followed 1,205 patients enrolled in the Trivandrum Heart Failure Registry for 1 year. A trained research nurse contacted each participant every 3 months using a structured questionnaire which included hospital readmission and mortality information. RESULTS The mean (SD) age was 61.2 (13.7) years, and 31% were women. One out of 4 (26%) participants had HF with preserved ejection fraction. Only 25% of patients with HF with reduced ejection fraction received guideline-directed medical therapy at discharge. Cumulative all-cause mortality at 1 year was 30.8% (n = 371), but the greatest risk of mortality was in the first 3 months (18.1%). Most deaths (61%) occurred in patients younger than 70 years. One out of every 3 (30.2%) patients was readmitted at least once over 1 year. The hospital readmission rates were similar between HF with preserved ejection fraction and HF with reduced ejection fraction patients. New York Heart Association functional class IV status and lack of guideline-directed medical treatment after index hospitalization were associated with increased likelihood of readmission. Similarly, older age, lower education status, nonischemic etiology, history of stroke, higher serum creatinine, lack of adherence to guideline-directed medical therapy, and hospital readmissions were associated with increased 1-year mortality. CONCLUSIONS In the Trivandrum Heart Failure Registry, 1 of 3 HF patients died within 1 year of follow-up during their productive life years. Suboptimal adherence to guideline-directed treatment is associated with increased propensity of readmission and death. Quality improvement programs aiming to improve adherence to guideline-based therapy and reducing readmission may result in significant survival benefits in the relatively younger cohort of HF patients in India.
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Affiliation(s)
| | - Ganapathi Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | | | - R Biju
- Cosmopolitan Hospital, Trivandrum, India
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Wan TTH, Terry A, Cobb E, McKee B, Tregerman R, Barbaro SDS. Strategies to Modify the Risk of Heart Failure Readmission: A Systematic Review and Meta-Analysis. Health Serv Res Manag Epidemiol 2017; 4:2333392817701050. [PMID: 28462286 PMCID: PMC5406120 DOI: 10.1177/2333392817701050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Human factors play an important role in health-care outcomes of heart failure (HF) patients. A systematic review and meta-analysis of clinical trial studies on HF hospitalization may yield positive proofs of the beneficial effect of specific care management strategies. Purpose: To investigate how the 8 guiding principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition reduce HF readmissions. Basic Procedures: Appropriate keywords were identified related to the (1) independent variable of hospitalization and treatment, (2) the moderating variable of care management principles, (3) the dependent variable of readmission, and (4) the disease of HF to conduct searches in 9 databases. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PubMed, PsycInfo, Science Direct, and Web of Science. Only prospective studies associated with HF hospitalization and readmissions, published in English, Chinese, Spanish, and German journals between January 1, 1990, and August 31, 2015, were included in the systematic review. In the meta-analysis, data were collected from studies that measured HF readmission for individual patients. Main Findings: The results indicate that an intervention involving any human factor principles may nearly double an individual’s probability of not being readmitted. Participants in interventions that incorporated single or combined principles were 1.4 to 6.8 times less likely to be readmitted. Principal Conclusions: Interventions with human factor principles reduce readmissions among HF patients. Overall, this review may help reconfigure the design, implementation, and evaluation of clinical practice for reducing HF readmissions in the future.
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Affiliation(s)
- Thomas T H Wan
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Amanda Terry
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Enesha Cobb
- Florida Hospital Translational Research Institute, Orlando, FL, USA
| | - Bobbie McKee
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Rebecca Tregerman
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Sara D S Barbaro
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
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Sezgin D, Mert H, Özpelit E, Akdeniz B. The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial. Int J Nurs Stud 2017; 70:17-26. [PMID: 28214615 DOI: 10.1016/j.ijnurstu.2017.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure is associated with exacerbated symptoms such as dyspnea and edema and results in frequent hospitalization and a poor quality of life. With the adoption of a comprehensive nursing care and follow-up program, patients with heart failure may exhibit improvements in their self-care capabilities and their hospitalizations may be reduced. OBJECTIVE The purpose of this study was to examine the effect of a nursing care and follow-up program for patients with heart failure on self-care, quality of life, and rehospitalization. DESIGN AND SETTING This research was conducted as a single-center, single-blind, randomized controlled study at the heart failure outpatient clinic of a university hospital in Turkey. PARTICIPANTS A total of 90 patients with heart failure were randomly assigned into either the specialized nursing care group (n=45) or the control group (n=45). METHODS The nursing care and follow-up program applied in the intervention group was based on the Theory of Heart Failure Self-care. Data were collected at the beginning of the trial, and at three and six months after the study commenced. Self-care of the patients was assessed by the Self-Care of Heart Failure Index. Quality of life was assessed with the "Left Ventricular Dysfunction Scale". Rehospitalization was evaluated based on information provided by the patients or by hospital records. RESULTS A statistically significant difference was found between the intervention and control group with respect to the self-care and quality of life scores at both three and six months. While the intervention group experienced fewer rehospitalizations at three months, no significant differences were found at six months. CONCLUSION The results obtained in this study show that the nursing care and follow-up program implemented for patients with heart failure improved self-care and quality of life. Although there were no significant differences between the groups at six months, fewer rehospitalizations in the intervention group was considered to be an important result.
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Affiliation(s)
- Dilek Sezgin
- Department of Internal Medicine Nursing, Dokuz Eylül University Faculty of Nursing, Inciralti, Izmir, Turkey.
| | - Hatice Mert
- Department of Internal Medicine Nursing, Dokuz Eylül University Faculty of Nursing, Inciralti, Izmir, Turkey.
| | - Ebru Özpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İnciraltı, İzmir, Turkey.
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İnciraltı, İzmir, Turkey.
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Molano DY, Hernández C. Capítulo 7. Papel de la enfermera en las unidades de falla cardiaca y educación en falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Piamjariyakul U, Werkowitch M, Wick J, Russell C, Vacek JL, Smith CE. Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans. Heart Lung 2015; 44:466-73. [DOI: 10.1016/j.hrtlng.2015.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
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