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Dugunchi F, Mudgal SK, Marznaki ZH, Shirafkan H, Abrotan S, Jafarian F, Pourkia R. Levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease - descriptive and correlational study. BMC Cardiovasc Disord 2024; 24:171. [PMID: 38509506 PMCID: PMC10953129 DOI: 10.1186/s12872-024-03827-w] [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: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Understanding the disease and its acceptance significantly influence adherence to prescribed medications, a critical aspect in managing coronary artery disease (CAD). This study is designed to explore the multifaceted factors influencing medication adherence specifically in CAD patients. Of particular interest is investigating the interconnectedness between medication adherence, the perception of illness, and the level of acceptance of the illness itself among these individuals. METHODS This cross-sectional study involved 280 confirmed CAD patients who were selected through a convenience sampling method adhering to predefined inclusion criteria. The study was conducted between March and September 2023. Three primary parameters-medication adherence, illness perception, and acceptance of illness-were evaluated using standardized tools: The Morisky Medication Adherence Scale-8, Illness Perception Questionnaire-Brief, and Acceptance of Illness Scale. Statistical analyses using SPSS (version 25) were used to analyze the data. RESULTS Patients had moderate illness perception (51.82 ± 7.58) and low acceptance to illness (16.98 ± 4.75), and 61.8 of them adhered to their medication regimen. A positive relationship between acceptance of illness and medication adherence (r = 0.435, p-value < 0.01) was found. Level of education, type of drug and marital status had significantly impact on medication adherence, and gender, level of education, intention to stop drug and marital status were associated with acceptance of illness (p < 0.05). CONCLUSION These results underscore the pivotal role of medication adherence in CAD management. Future interventions should target improving illness perception and acceptance of illness among CAD patients to enhance their overall adherence to prescribed medications and ultimately improve disease management.
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Affiliation(s)
- Farzad Dugunchi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Shiv Kumar Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - Zohreh Hosseini Marznaki
- Imam Ali Hospital, Amol, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Abrotan
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Fateme Jafarian
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Pourkia
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
- Department of Cardiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
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Wondmieneh A, Getie A, Bimerew M. Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e071960. [PMID: 38072478 PMCID: PMC10729130 DOI: 10.1136/bmjopen-2023-071960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023. ELIGIBILITY CRITERIA We include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available. DATA EXTRACTION AND SYNTHESIS The data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed. RESULTS Thirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia. CONCLUSION The majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients. PROSPERO REGISTRATION NUMBER CRD42023394373.
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Affiliation(s)
- Adam Wondmieneh
- Department of Nursing, Injibara University, Injibara, Ethiopia
| | - Addisu Getie
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Bimerew
- Department of Nursing, Injibara University, Injibara, Ethiopia
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Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites 2023; 13:1087. [PMID: 37887412 PMCID: PMC10609002 DOI: 10.3390/metabo13101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.
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Affiliation(s)
- Vittorio Venditti
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Enrico Bleve
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Susanna Morano
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Tiziana Filardi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
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Shaked O, Korn L, Shapiro Y, Zwilling M, Zigdon A. Medical and social factors influencing the utilization of healthcare services among older adults in Israel during the COVID-19 lockdown. Front Public Health 2023; 11:1218507. [PMID: 37829095 PMCID: PMC10565215 DOI: 10.3389/fpubh.2023.1218507] [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: 05/07/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
Background The corona virus disease 2019 (COVID-19) pandemic significantly impacted older adults. However, most older communities focused on the medical issues. The aims of this study were to identify the medical and social factors linked with the usage of medical services during the COVID-19 lockdown in Israel. Methods The study was conducted Over two periods of time from February to April in 2019 (P1), before the COVID-19 and from February to April in 2020 (P2), during the first lockdown. The study was conducted on people aged 65 and older in Israel. The variable statistics were analyzed using frequency tabulation, cross-tabulation frequencies, and t-tests. Two hierarchical logistic regressions were conducted over four steps for each period. Results The participants (n = 102,303) comprised 64.5% female (65,946) and 35.5% male (36,357) (mean age 80.5, SD- 7.46). It was found that participants who had not subscribed to the supportive community services were 7.47 times more likely to access medical services in P1 and 12.417 times more likely to access medical services during the lockdown. This variable was also found to be a strong predictor in the final model. The most significant variable for predicting the participants' needs during P2 was their previous needs in P1. Other social variables were living in assisted living home and living in community settlements. The presence of 12 diseases in this study did not predict service demand. Conclusion Community support reduces medical service demands during disasters and provides services for older adults. During pandemics, however, social services need to be expanded and made more easily accessible to older adults.
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Affiliation(s)
- Ohad Shaked
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
- Natali, Ramat Gan, Israel
| | - Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Yair Shapiro
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Moti Zwilling
- Department of Economics and Business Administration, Ariel University, Ariel, Israel
| | - Avi Zigdon
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
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Hoong JM, Koh HA, Wong K, Lee HH. Effects of a community-based chronic disease self-management programme on chronic disease patients in Singapore. Chronic Illn 2023; 19:434-443. [PMID: 35317664 DOI: 10.1177/17423953221089307] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP) is a small-group intervention attended by people with chronic diseases and aims to promote self-efficacy and improve health. We adopted this programme to improve population health in the Western region of Singapore. This study aimed to evaluate the association of the CDSMP with various health outcomes for people with chronic disease living in the community. METHODS Validated instruments were used to measure various health outcomes. Participants completed baseline questionnaires before the programme. Post-intervention questionnaires were administered 6 months after programme. Primary outcome measures include self-efficacy and self-rated health status while secondary outcomes include several other self-management behaviours and healthcare utilisation. RESULTS 461 participants attended the baseline questionnaire and 265 participants returned for the post-intervention questionnaire from November 2014 to August 2020. Post intervention, participants had statistically significant improvement in self-efficacy, self-rated health score, self-management behaviours and symptoms. The proportion of participants with depression and medication adherence also improved. There were no statistically significant changes in cognitive symptom management and healthcare utilisation. CONCLUSION CDSMP in the community can improve health outcomes and should be standard care for people with chronic disease. It can be an effective way for sustainable chronic disease management in Singapore.
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Affiliation(s)
- Jian Ming Hoong
- Department of Dietetics and Nutrition, 242949Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, Singapore, Singapore
| | - Hui An Koh
- Rehabilitation Department, 242949Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, Singapore, Singapore
| | - Karen Wong
- Department of Medical Social Services, 242949Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, Singapore, Singapore
| | - Hee Hoon Lee
- Allied Health and Community Operations, 242949Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, Singapore, Singapore
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Collins KA, Reeves GR, Miller NH, Whellan DJ, O’Connor CM, Marcus BH, Kitzman DW, Kraus WE. Clinical Predictors of Adherence to Exercise Training Among Individuals With Heart Failure: THE HF-ACTION STUDY. J Cardiopulm Rehabil Prev 2023; 43:205-213. [PMID: 36479935 PMCID: PMC10148892 DOI: 10.1097/hcr.0000000000000757] [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] [Indexed: 12/13/2022]
Abstract
PURPOSE Suboptimal adherence is a major limitation to achieving the benefits of exercise interventions, and our ability to predict and improve adherence is limited. The purpose of this analysis was to identify baseline clinical and demographic characteristics predicting exercise training adherence in the HF-ACTION study cohort. METHODS Adherence to exercise training, defined by the total duration of exercise performed (min/wk), was evaluated in 1159 participants randomized to the HF-ACTION exercise intervention. More than 50 clinical, demographic, and exercise testing variables were considered in developing a model of the min/wk end point for 1-3 mo (supervised training) and 10-12 mo (home-based training). RESULTS In the multivariable model for 1-3 mo, younger age, lower income, more severe mitral regurgitation, shorter 6-min walk test distance, lower exercise capacity, and Black or African American race were associated with poorer exercise intervention adherence. No variable accounted for >2% of the variance and the adjusted R2 for the final model was 0.14. Prediction of adherence was similarly limited for 10-12 mo. CONCLUSIONS Clinical and demographic variables available at the initiation of exercise training provide very limited information for identifying patients with heart failure who are at risk for poor adherence to exercise interventions.
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Affiliation(s)
| | | | - Nancy Houston Miller
- The Lifecare Company, Lost Altos, CA
- Department of Medicine, Stanford University School of Medicine, Los Altos, CA
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | - Bess H. Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, CA
| | - Dalane W. Kitzman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - William E. Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Madujibeya I, Chung ML, Moser DK, Miller JA, Lennie TA. Self-reported engagement in exercise is associated with longer event-free survival in heart failure patients with poor functional capacity. Eur J Cardiovasc Nurs 2023; 22:73-81. [PMID: 35670591 DOI: 10.1093/eurjcn/zvac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
AIMS Despite evidence-based recommendations for clinically stable patients with heart failure (HF) to engage in unsupervised exercise, the minimum cumulative dose of exercise per week associated with improvement in HF outcomes, especially in patients with poor functional capacity, has not been examined. We examined whether patients with HF and poor functional capacity who reported engagement in a guideline-recommended minimum weekly exercise had longer event-free survival than patients who did not exercise. METHODS AND RESULTS This analysis included 310 patients with HF who had completed the Duke Activity Status Index (DASI) and reported their level of engagement in exercise. Patients were grouped into good and poor functional capacity using a DASI cut-point of ≥19 and then further stratified based on their self-reported exercise level: high (≥60 min/week) and low (<60 min/week). Cox regression modelling was used to predict event-free survival for the four groups after adjusting for covariates. Patients (mean age = 61.6 ± 11.4 years, 30.3% female, 44.2% NYHA Classes III-IV) were followed for a median of 362 days. There were eight deaths and 108 all-cause hospitalizations. Patients with poor functional capacity who reported high exercise engagement had a 36% lower risk of all-cause hospitalization or mortality compared with patients with poor functional capacity who reported low exercise engagement (hazard ratio: 0.64, P = 0.028). CONCLUSION Self-reported engagement in a minimum of 60 min of exercise per week was associated with a significant improvement in event-free survival, even in patients with HF with low functional capacity. These results provide evidence that this dose of exercise is beneficial in patients with HF and poor functional capacity.
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Affiliation(s)
- Ifeanyi Madujibeya
- College of Nursing, University of Kentucky, 751 Rose Street University of Kentucky, Lexington, KY 40536, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 751 Rose Street University of Kentucky, Lexington, KY 40536, USA.,Yonsei University, College of Nursing, Seoul, Korea
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street University of Kentucky, Lexington, KY 40536, USA
| | - Jennifer A Miller
- College of Nursing, University of Kentucky, 751 Rose Street University of Kentucky, Lexington, KY 40536, USA
| | - Terry A Lennie
- College of Nursing and Graduate Center for Nutritional Sciences, University of Kentucky, Lexington, KY, USA
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Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia. Int J Chronic Dis 2022; 2022:9673653. [PMID: 36590698 PMCID: PMC9798104 DOI: 10.1155/2022/9673653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/03/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.
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Patil T, Ali S, Kaur A, Akridge M, Eppes D, Paarlberg J, Parashar A, Jarmukli N. Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF). J Cardiovasc Transl Res 2022; 15:1424-1435. [PMID: 35501544 PMCID: PMC9060399 DOI: 10.1007/s12265-022-10262-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/20/2022] [Indexed: 12/16/2022]
Abstract
This prospective study included patients with heart failure (HF) with reduced ejection fraction (HFrEF) with LVEF < = 40% to evaluate the impact of pharmacist on guideline directed medical therapy (GDMT). The primary outcome was to compare proportion of triple GDMT achieved for Angiotensin-Converting-Enzyme-Inhibitors (ACEI)/Angiotensin-Receptor-Blockers (ARB)/Angiotensin-Receptor-Neprilysin-Inhibitors (ARNI), beta-blockers, aldosterone antagonists (AA), and quadruple GDMT which in additional to triple therapy, included Sodium glucose co-transporter 2 inhibitor (SGLT2i) at 90-day post-enrollment compared to baseline. Secondary endpoints included achieving target and/or maximally tolerated ACEI/ARB/ARNI and beta-blockers combined and individually as well as SGLT2i and AA GDMT at 90-day post-enrollment compared to baseline. We also compared combined and individual HF-related hospitalization/emergency room (ER) visits 90 days pre-/post-enrollment. Of the total 974 patients screened, 80 patients seen at least once in the heart failure medication titration clinic (HMTC) were included in the analysis. Median (IQR) age was 71 (57-69) years with majority white male. There was a significant improvement in the proportion of patients who achieved quadruple GDMT (p = 0.001) and triple GDMT (p-value = 0.020) at 90-day post-enrollment compared to baseline. The secondary GDMT outcomes were also significantly increased at 90 days post-enrollment compared to baseline. Significant difference in mean as well as proportion of combined HF-related hospitalization/ER-visits was found 90 days pre-/post-enrollment (p = 0.047). Our study found that pharmacist's intervention increased the proportion of patients who achieved GDMT at 90 days.
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Affiliation(s)
- Tanvi Patil
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Salihah Ali
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Alamdeep Kaur
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Meghan Akridge
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Davida Eppes
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - James Paarlberg
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Amitabh Parashar
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
| | - Nabil Jarmukli
- Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA 24153 USA
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Peiris RG, Ross H, Chan CT, Poon S, Auguste BL, Rac VE, Farkouh M, McDonald M, Kaczorowski J, Code J, Duero Posada J, Ong S, Kobulnik J, Tomlinson G, Huszti E, Arcand J, Thomas SG, Akbari A, Maunder R, Grover S, Seto E, Simard A, Pope B, Bains M, McIntyre C, Torbay C, Syed F, Nolan RP. Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial. BMJ Open 2022; 12:e059635. [PMID: 36691152 PMCID: PMC9445232 DOI: 10.1136/bmjopen-2021-059635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE-vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self-care materials, and health-related quality of life. METHODS AND ANALYSIS Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. ETHICS AND DISSEMINATION The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care. TRIAL REGISTRATION NUMBER NCT04966104.
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Affiliation(s)
- Rachel Grace Peiris
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Ross
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Stephanie Poon
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bourne Lewis Auguste
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Michael Farkouh
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
| | - Jillianne Code
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, British Columbia, Canada
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Juan Duero Posada
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Ong
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sinai Health System, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Scott G Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Maunder
- Department of Psychiatry, Sinai Health System, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Steven Grover
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Emily Seto
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Anne Simard
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Brad Pope
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Marc Bains
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Carmen McIntyre
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chris Torbay
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Fatima Syed
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Robert P Nolan
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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11
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Prescription, Compliance, and Burden Associated with Salt-Restricted Diets in Heart Failure Patients: Results from the French National OFICSel Observatory. Nutrients 2022; 14:nu14020308. [PMID: 35057490 PMCID: PMC8779371 DOI: 10.3390/nu14020308] [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: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: There is much debate about the use of salt-restricted diet for managing heart failure (HF). Dietary guidelines are inconsistent and lack evidence. (2) Method: The OFICSel observatory collected data about adults hospitalised for HF. The data, collected using study-specific surveys, were used to describe HF management, including diets, from the cardiologists’ and patients’ perspectives. Cardiologists provided the patients’ clinical, biological, echocardiography, and treatment data, while the patients provided dietary, medical history, sociodemographic, morphometric, quality of life, and burden data (burden scale in restricted diets (BIRD) questionnaire). The differences between the diet recommended by the cardiologist, understood by the patient, and the estimated salt intake (by the patient) and diet burden were assessed. (3) Results: Between March and June 2017, 300 cardiologists enrolled 2822 patients. Most patients (90%) were recommended diets with <6 g of salt/day. Mean daily salt consumption was 4.7 g (standard deviation (SD): 2.4). Only 33% of patients complied with their recommended diet, 34% over-complied, and 19% under-complied (14% unknown). Dietary restrictions in HF patients were associated with increased burden (mean BIRD score of 8.1/48 [SD: 8.8]). (4) Conclusion: Healthcare professionals do not always follow dietary recommendations, and their patients do not always understand and comply with diets recommended. Restrictive diets in HF patients are associated with increased burden. An evidence-based approach to developing and recommending HF-specific diets is required.
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12
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Jaarsma T, Klompstra L, Strömberg A, Ben Gal T, Mårtensson J, van der Wal MH. Exploring factors related to non-adherence to exergaming in patients with chronic heart failure. ESC Heart Fail 2021; 8:4644-4651. [PMID: 35167729 PMCID: PMC8712787 DOI: 10.1002/ehf2.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/23/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS This study aimed to explore factors related to non-adherence to exergaming in patients with heart failure. METHODS AND RESULTS Data from patients in the exergame group in the HF-Wii trial were used. Adherence to exergaming was defined as playing 80% or more of the recommended time. Data on adherence and reasons for not exergaming at all were collected during phone calls after 2, 4, 8, and 12 weeks. Logistic regression was performed between patients who were adherent and patients who were non-adherent. Secondly, a logistic regression was performed between patients who not exergamed at all and patients who were adherent to exergaming. Finally, we analysed the reasons for not exergaming at all with manifest content analysis. Almost half of the patients were adherent to exergaming. Patients who were adherent had lower social motivation [odds ratio (OR) 0.072; 95% confidence interval (CI) 0.054-0.095], fewer sleeping problems (OR 0.84; 95% CI 0.76-0.092), and higher exercise capacity (OR 1.003; 95% CI 1.001-1.005) compared with patients who were non-adherent. Patients who not exergamed at all had lower cognition (OR 1.18; 95% CI 1.06-1.31) and more often suffered from peripheral vascular disease (OR 3.74; 95% CI 1.01-13.83) compared with patients who were adherent to exergaming. Patients most often cited disease-specific barriers as a reason for not exergaming at all. CONCLUSIONS A thorough baseline assessment of physical function and cognition is needed before beginning an exergame intervention. It is important to offer the possibility to exergame with others, to be able to adapt the intensity of physical activity.
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Affiliation(s)
- Tiny Jaarsma
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
| | - Leonie Klompstra
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
| | - Anna Strömberg
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
- Department of CardiologyLinkoping UniversityLinkopingSweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Jan Mårtensson
- Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Martje H.L. van der Wal
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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13
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Bidwell JT, Hostinar CE, Higgins MK, Abshire MA, Cothran F, Butts B, Miller AH, Corwin E, Dunbar SB. Caregiver subjective and physiological markers of stress and patient heart failure severity in family care dyads. Psychoneuroendocrinology 2021; 133:105399. [PMID: 34482256 PMCID: PMC8530937 DOI: 10.1016/j.psyneuen.2021.105399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
Greater family caregiver exposure to uncontrolled patient symptoms is predictive of greater caregiver psychological and physiological stress in dementia and other chronic illnesses, but these phenomena have not been well-studied in heart failure (HF) - a disease with high symptom burden. The purpose of this study was to test the hypothesis that worse patient functional status (as reflected by increasing HF symptoms) would be associated with elevated psychological and physiological stress for the caregiver. This was a secondary analysis of data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured on four dimensions: care-related strain/burden (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression Scale), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was measured by markers of HPA axis function (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF patient functional status was quantified by caregiver assessment of New York Heart Association (NYHA) Class. Generalized linear models were used to test associations between patient NYHA Class and stress (one model per indicator). NYHA Class (ordinal) was backwards difference coded in each model to examine caregiver stress in relation to increasing levels of HF severity. Caregivers were mostly female and in their mid-fifties, with a slight majority of the sample being African American and the patient's spouse. Overall, patient functional status was associated with greater caregiver psychological and physiological stress. In terms of psychological stress, higher NYHA Class was significantly associated with greater caregiver anxiety and general stress, but not with caregiver burden or depression. In terms of physiological stress, higher NYHA Class was associated with elevated markers in all models (elevated CAR and higher IL-6, hsCRP, and PAI-1). Across models, most associations between NYHA Class and stress were present at relatively early stages of functional limitation (i.e. Class II), while others emerged when functional limitations became more severe. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.
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Affiliation(s)
- Julie T. Bidwell
- Family Caregiving Institute at the Betty Irene Moore School of Nursing; University of California, Davis; 2570 48th Street, Sacramento, CA 95817, United States of America
| | - Camelia E. Hostinar
- Department of Psychology; University of California, Davis; 1 Shields Avenue, Davis, CA 95616, United States of America
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Martha A. Abshire
- School of Nursing; Johns Hopkins University; 525 N Wolfe Street, Baltimore, MD 21205, United States of America
| | - Fawn Cothran
- Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Sacramento, CA 95817, United States.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States.
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 12 Executive Park Dr, NE. 2nd Floor, Atlanta, GA 30329
| | - Elizabeth Corwin
- School of Nursing, Columbia University, 560 W. 168th St, Room 600, New York, NY 10032, United States.
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
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14
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Ren Z, Zhu H, Zhang T, Hua H, Zhao K, Yang N, Liang H, Xu Q. Effects of a 12-Week Transtheoretical Model-Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial. Obes Surg 2021; 31:4436-4451. [PMID: 34373988 DOI: 10.1007/s11695-021-05607-3] [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: 03/04/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to investigate the effectiveness of the transtheoretical model (TTM)-based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS). MATERIALS AND METHODS We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle. RESULTS Retention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention. CONCLUSION The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients' exercise adherence and physical function immediately after BS. TRIAL REGISTRATION This study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn , registry number: ChiCTR2000039319).
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Affiliation(s)
- Ziqi Ren
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China.,School of Nursing, Fudan University, Shanghai, 200032, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China
| | - Tianzi Zhang
- Department of Nursing, Jiangsu College of Nursing, Huai'an, 223000, Jiangsu, China
| | - Hongxia Hua
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China
| | - Ningli Yang
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hui Liang
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China.
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15
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Dessie G, Burrowes S, Mulugeta H, Haile D, Negess A, Jara D, Alem G, Tesfaye B, Zeleke H, Gualu T, Getaneh T, Kibret GD, Amare D, Worku Mengesha E, Wagnew F, Khanam R. Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia. BMC Cardiovasc Disord 2021; 21:374. [PMID: 34344316 PMCID: PMC8336108 DOI: 10.1186/s12872-021-02170-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education's effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. METHODS To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. RESULTS Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = - 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05). CONCLUSIONS We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. TRIAL REGISTRATION NUMBER PACTR201908812642231.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, USA
| | - Henok Mulugeta
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dessalegn Haile
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Negess
- Departments of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dubie Jara
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Girma Alem
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Haymanot Zeleke
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tenaw Gualu
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temsgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Desalegne Amare
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Worku Mengesha
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fasil Wagnew
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Rasheda Khanam
- School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba City, Australia
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16
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Patterns of Adherence to Secondary Prevention Measures Among Chinese Patients With Coronary Artery Disease: A Longitudinal Study. J Cardiovasc Nurs 2021; 37:E61-E72. [PMID: 34238840 DOI: 10.1097/jcn.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to secondary prevention measures among patients with coronary artery disease (CAD) affects patient prognosis, whereas patients' adherence behaviors change over time. OBJECTIVES The aims of this study were to identify adherence trajectories to secondary prevention measures including medication-taking and a heart-healthy lifestyle and to estimate predictors of adherence trajectories among patients with CAD. METHODS This longitudinal study enrolled 698 patients with CAD who received a percutaneous coronary intervention in China. Demographics, clinical characteristics, adherence to secondary prevention measures, and patient-related factors including disease knowledge, self-efficacy, and health literacy were measured during hospitalization. Adherence behaviors were followed at 1, 3, and 6 months, and 1 year after discharge. Group-based trajectory models estimated adherence trajectories, and multinomial logistic regression identified trajectory group predictors. RESULTS Four trajectory groups were identified for medication-taking adherence: sustained adherence (39.9%), increasing and then decreasing adherence (23.1%), increasing adherence (23.4%), and nonadherence (13.6%). The 3 adherence trajectory groups for a heart-healthy lifestyle were sustained adherence (59.7%), increasing adherence (28.3%), and nonadherence (12.0%). Married patients were more likely (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.56-7.52) to have sustained adherence to medication-taking. However, patients with higher disease knowledge were less likely (OR, 0.93; 95% CI, 0.87-0.99) to be adherent. Patients who were not working (OR, 2.25; 95% CI, 1.03-4.92) had higher self-efficacy (OR, 1.21; 95% CI, 1.08-1.37). Those with higher health literacy (OR, 1.18; 95% CI, 1.01-1.38) were more likely to have sustained adherence to a heart-healthy lifestyle. However, patients having no coronary stents (OR, 0.36; 95% CI, 0.19-0.70) were less likely to have done so. CONCLUSIONS Trajectories of adherence to secondary prevention measures among mainland Chinese patients with CAD are multipatterned. Healthcare providers should formulate targeted adherence support, which considers the influence of disease knowledge, self-efficacy, and health literacy.
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17
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Shirey TE, Hu Y, Ko YA, Nayak A, Udeshi E, Patel S, Morris AA. Relation of Neighborhood Disadvantage to Heart Failure Symptoms and Hospitalizations. Am J Cardiol 2021; 140:83-90. [PMID: 33144159 DOI: 10.1016/j.amjcard.2020.10.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
Residence in socioeconomically deprived neighborhoods may influence patient's health-related behaviors and overall health. We evaluated the association of neighborhood disadvantage on heart failure (HF) symptom burden and hospitalization rates. We characterized neighborhood deprivation in 359 HF subjects (age 56 ± 13 years, 52% black) in metropolitan Atlanta using the Area Deprivation Index (ADI). ANOVA was used to compare HF symptoms measured using the Kansas City Cardiomyopathy Questionnaire, and HF Self-Care Index across ADI tertiles. Zero-inflated Poisson regression was used to compare rates of recurrent HF hospitalization (HFH) across ADI tertiles. Subjects living in more deprived neighborhoods were more likely to be black, have Medicare or Medicaid insurance, and have a lower ejection fraction than those living in less deprived neighborhoods (all p ≤ 0.005). Subjects in more deprived neighborhoods had more severe HF symptoms (p < 0.001), but there was no difference in HF Self-Care Index scores across ADI tertiles. Subjects living in more deprived neighborhoods had a higher odds of being hospitalized for HF than subjects in less deprived neighborhoods. Once subjects had experienced a HFH, however, the association between ADI and the risk of recurrent HFH varied by racial group. In whites, increasing ADI was associated with a marginally decreased risk of recurrent HFH, while there was no association between ADI and recurrent HFH in blacks. In conclusion, patients with HF living in more deprived neighborhoods have greater symptom burden and are more likely to experience a HFH than those living in less deprived neighborhoods.
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18
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Myers SL, Siegel EO, Hyson DA, Bidwell JT. A qualitative study exploring the perceptions and motivations of patients with heart failure who transitioned from non-adherence to adherence. Heart Lung 2020; 49:817-823. [PMID: 33011459 DOI: 10.1016/j.hrtlng.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Management of heart failure (HF) involves complex self-care recommendations. Many patients have difficulty adhering to these recommendations, and mechanisms that support behavior change are poorly understood. OBJECTIVE The objective of this study was to explore the perceptions and motivations of individuals with HF who became adherent to HF treatment recommendations after being non-adherent. METHODS This was a qualitative descriptive study. Participants were recruited from cardiology clinics and completed a semi-structured interview on their experiences and motivations for self-care behavior change. Data was analyzed using thematic analysis. The sample size (n = 8) was sufficient to achieve saturation. RESULTS Five themes were identified: experiencing mortality, optimism and hope, making connections between behavior and health, self-efficacy, and the role of the clinician. The temporal chronological sequence of these themes across participants varied. CONCLUSIONS This study adds to our current understanding of HF self-care by suggesting mechanisms that may enhance existing self-care interventions, and demonstrating the important role of the clinician.
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Affiliation(s)
- Sharon L Myers
- Heart and Vascular Center, University of California, Davis, 2335 Stockton Blvd, Sacramento, CA, 95817, United States.
| | - Elena O Siegel
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
| | - Dianne A Hyson
- College of Social Sciences and Interdisciplinary Studies, California State University, Sacramento, 6000 J St, Sacramento, CA, 95819, United States.
| | - Julie T Bidwell
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
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19
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Chen AMH, Yehle KS, Plake KS, Rathman LD, Heinle JW, Frase RT, Anderson JG, Bentley J. The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model. Heart Lung 2020; 49:702-708. [PMID: 32861889 DOI: 10.1016/j.hrtlng.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.
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Affiliation(s)
- Aleda M H Chen
- Assistant Dean and Associate Professor, Cedarville University School of Pharmacy, 251N. Main St., Cedarville, OH 45314, USA.
| | - Karen S Yehle
- Professor Emerita, Purdue University, School of Nursing, 502N. University Street, West Lafayette, IN, 47907, USA.
| | - Kimberly S Plake
- Associate Head of Professional Education, Associate Professor, Director, Purdue University Academic and Ambulatory Care Fellowship Program, Faculty Associate, Center for Aging and the Life Course, 575 Stadium Mall Dr., West Lafayette, IN, 47907, USA.
| | - Lisa D Rathman
- Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health/PENN Medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA.
| | - J Wes Heinle
- At time of project: Research Assistant, The Heart Group of Lancaster General Health/PENN medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA
| | - Robert T Frase
- Graduate Student, Purdue University, Department of Sociology, 700W. State Street, West Lafayette, IN 47907, USA.
| | - James G Anderson
- Purdue University, Department of Medical Sociology and Health Communication, 700W. State Street, West Lafayette, IN 47907, USA.
| | - John Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Faser Hall 225, University, MS, 38677, USA.
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20
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Giles L, Freeman C, Field P, Sörstadius E, Kartman B. Humanistic burden and economic impact of heart failure – a systematic review of the literature. F1000Res 2020. [DOI: 10.12688/f1000research.19365.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.
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Nayak A, Liu C, Mehta A, Ko YA, Tahhan AS, Dhindsa DS, Uppal K, Jones DP, Butler J, Morris AA, Quyyumi AA. N8-Acetylspermidine: A Polyamine Biomarker in Ischemic Cardiomyopathy With Reduced Ejection Fraction. J Am Heart Assoc 2020; 9:e016055. [PMID: 32458724 PMCID: PMC7429012 DOI: 10.1161/jaha.120.016055] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Patients with ischemic cardiomyopathy (ICM) have worse outcomes than those with coronary artery disease alone and those with non-ICM. N8-acetylspermidine (N8AS) is a polyamine that regulates ischemic cardiac apoptosis and resultant cardiac dysfunction. We hypothesized that N8AS is a mechanistic biomarker of adverse outcomes in patients with ICM. Methods and Results High-resolution plasma metabolomics profiling and mass spectrometry were used to quantitate N8AS levels in a discovery cohort of 474 patients with coronary artery disease (age: 68±11 years, 12% black, 26% women): 154 with ICM, and 320 without ICM; and in an external validation cohort of 85 patients with ICM (age: 60±12 years, 37% black, 19% women). Patients without heart failure (HF) at baseline were followed for incident HF. The association between N8AS (log2-transformed, standardized) and outcomes of all-cause mortality and incident HF were examined using Cox regression. N8AS was higher (10.39 [interquartile range, 7.21-17.75] versus 8.29 nmol/L [interquartile range, 5.91-11.42]; P<0.001) in patients with ICM compared with patients who had coronary artery disease without ICM. Higher N8AS levels were associated with higher mortality in patients with ICM (hazard ratio [HR], 1.48; 95% CI, 1.19-1.85 per SD increase [P=0.001]), independent of B-type natriuretic peptide, high-sensitivity troponin I, and high-sensitivity C-reactive protein. Findings were validated in the independent cohort. Moreover, higher N8AS level was associated with incident HF in patients without HF at baseline (HR, 4.16; 95% CI, 1.41-12.25 per SD increase [P=0.01]). Conclusions Independent of traditional HF measures, higher N8AS levels are associated with higher mortality in patients with ICM and incident HF in those who have coronary artery disease without HF. N8AS is a novel mechanistic biomarker in ICM.
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Affiliation(s)
- Aditi Nayak
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Chang Liu
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Ayman S Tahhan
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Karan Uppal
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Dean P Jones
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Javed Butler
- Division of Cardiology University of Mississippi Jackson MS
| | - Alanna A Morris
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
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Jankowska-Polańska B, Świątoniowska-Lonc N, Sławuta A, Krówczyńska D, Dudek K, Mazur G. Patient-Reported Compliance in older age patients with chronic heart failure. PLoS One 2020; 15:e0231076. [PMID: 32298283 PMCID: PMC7161980 DOI: 10.1371/journal.pone.0231076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/15/2020] [Indexed: 01/14/2023] Open
Abstract
METHODS AND RESULTS 475 patients (including 222 women), mean age 69.7±7.7, with HF, hospitalized at University Hospital between January and December 2018 were included in the study. The patients were selected by a physician specializing in cardiology. A cardiac nurse assessed the non-pharmacological level of compliance using the Revised Heart Failure Compliance Questionnaire (RHFCQ). The socio-clinical data were obtained from medical records. The majority of the study group were patients in NYHA II (62.4%) and NYHA III (28.3%), the mean duration of the disease was 6.2±4.9 years, and the mean ejection fraction of the left ventricle (EF) was 48.6±12.6. The average level of compliance in the study group measured on a scale from 0 to 4 points was: median = 2.7, IQR [2.32; 3.25]. Only 6.9% of the respondents adhere to recommendations totally (all dimensions of RHFCQ). In univariate analysis, predictors negatively affecting compliance were: female gender (rho = -0.325), age below 65 years (rho = -0.014)), loneliness (rho = -0.559), number of hospitalizations (rho = -0.242), higher stage of NYHA (rho = -1.612), co-morbidities (rho = -0.729), re-hospitalizations (rho = -0.729), beta-blockers treatment (rho = -1.612) and diuretics treatment (rho = -0.276). Factors positively affecting compliance were: EF≥45% (rho = 0.020) and treatment with ACEI/ARB (rho = 0.34), whereas compliance was negatively affected by-EF<45% (β = 0.009). Independent predictors influencing the level of compliance were: loneliness (β = -1.816), number of hospitalizations (β = -0.117), NYHA III and IV and number of co-morbidities (β = -0.676). CONCLUSIONS Patients with HF do not adhere to therapeutic recommendations. The lowest compliance levels were found for exercise and daily weighing, and the highest for follow-up appointment-keeping and medication. Loneliness and age are the strongest predictors which influence the level of compliance.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | | | - Agnieszka Sławuta
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Krówczyńska
- Medical University of Warsaw, Department of Clinical Nursing, Warsaw, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Technical University of Wroclaw, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Lee H, Park G, Lee KS, Jin H, Chun KJ, Kim JH. Knowledge, Adherence to Lifestyle Recommendations, and Quality of Life Among Koreans With Heart Failure. J Cardiovasc Pharmacol Ther 2020; 25:324-331. [PMID: 32233801 DOI: 10.1177/1074248420916324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess heart failure (HF) knowledge, adherence to lifestyle recommendations, and quality of life (QOL) among Koreans with HF and identify factors influencing QOL. METHODS A cross-sectional and correlational design was used and a total of 142 Koreans with HF were recruited between April 2012 and September 2013. Data were analyzed using multiple logistic regression with SPSS version 21.0. RESULTS The mean age of participants was 64.1 ± 7.4 years. A higher proportion of participants were male, married, unemployed, had a high education level, and class I New York Heart Association (NYHA) functional status. A higher proportion of participants had ≥2 comorbidities and the most prevalent comorbidity was diabetes. The mean score of HF knowledge was 6.9 (possible range 0-15) and the most frequent incorrect items were "proper actions to reduce thirst" and "causes of leg swelling" in both better and worse QOL groups. Among the recommended lifestyle, pneumococcal vaccination had the least adherence in both groups. Multiple logistic regression showed that patients in NYHA class I, with a higher left ventricular ejection fraction, who had knowledge of "amount of fluid intake a day" and consumed more than moderate alcohol tended to have better QOL. Conclusion: More active interventions targeting HF knowledge in proper actions to reduce thirst, causes of leg swelling, and the amount of fluid intake per day are required. Patients with HF in more serious condition need special attention regarding the risk of worse QOL. The role of alcohol consumption in QOL among HF patients in Korea needs further exploration.
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Affiliation(s)
- Haejung Lee
- College of Nursing, Pusan National University, Yangsan-si, South Korea
| | - Gaeun Park
- Department of Nursing, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Kyoung Suk Lee
- College of Nursing, Seoul National University, Gwanak-gu, Seoul, Korea
| | - HyeKyung Jin
- College of Nursing, Kaya University, Gimhae-si, South Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Jong Hyun Kim
- Department of Internal Medicine, BHC Hanseo Hospital, Busan, South Korea
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Eimer S, Mahmoodi-Shan GR. Self-care Behaviour of the Elderly with Heart Failure and its Associated Factors in Hospitals of Gonbad Kavus in 2018. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2020. [DOI: 10.29252/jgbfnm.17.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Lu M, Hravnak M, Ma J, Lin Y, Zhang X, Shen Y, Xia H. Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease. Nurs Res 2020; 69:E199-E207. [DOI: 10.1097/nnr.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sager DM, Burch AE, Alhosaini H, Vaughan T, Sears SF. Changes in cardiac anxiety and self-care practices in heart failure patients following implantation of wireless hemodynamic monitoring sensors. Eur J Cardiovasc Nurs 2020; 19:440-443. [DOI: 10.1177/1474515120905405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Wireless implantable hemodynamic monitors assist cardiac care providers in tailoring medication regimens to reduce chronic heart failure hospital admissions and to improve patient quality of life. Previous research exists to support wireless implantable hemodynamic monitors favorable impact on medical endpoints but, however, their psychological and behavioral effects have not yet been established. The purpose of this pilot study was to investigate patient psychological and behavioral changes after receiving the wireless implantable hemodynamic monitor. Methods: Patients with heart failure ( n=26) who were implanted with wireless implantable hemodynamic monitor sensors completed the Cardiac Anxiety Questionnaire and Self-Care of Heart Failure Index version 6.2 at pre-implant and at one-month post-implant, as well as an initial demographic questionnaire. Results: Heart failure patients who received a wireless implantable hemodynamic monitor experienced a significant reduction in cardiac anxiety, t(25)=2.93, p=0.007, z=−0.46, d=0.58, driven by a reduction in fear of their condition, t(25)=2.26, p=0.03, z=−0.42, d=0.44. Increases in self-care behaviors fell short of significance t(25)=1.67, p=0.11, but showed a medium effect size, d=0.33. Conclusion: Heart failure patients who received a wireless implantable hemodynamic monitor reported significantly reduced cardiac fear, indicating that wireless implantable hemodynamic monitor technology may produce a collateral benefit in psychological effects. Patient self-care may also benefit but the current study was under-powered to reach statistical significance. Patient education about psychological and behavioral aspects of the wireless implantable hemodynamic monitor implant may yield increased patient engagement and broader health benefits if these results are confirmed in a larger study.
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Affiliation(s)
- David M Sager
- Department of Psychology, East Carolina University, USA
| | - Ashley E Burch
- Department of Cardiovascular Sciences, East Carolina University, USA
| | - Hassan Alhosaini
- Department of Cardiovascular Sciences, East Carolina University, USA
- Heart Failure and Pulmonary Hypertension Program, Vidant Health, USA
| | - Tracy Vaughan
- Heart Failure and Pulmonary Hypertension Program, Vidant Health, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, USA
- Department of Cardiovascular Sciences, East Carolina University, USA
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McGee BT, Higgins MK, Phillips V, Butler J. Prescription drug spending and hospital use among Medicare beneficiaries with heart failure. Res Social Adm Pharm 2020; 16:1452-1458. [PMID: 31953113 DOI: 10.1016/j.sapharm.2019.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Heart failure (HF) is a common cause of hospitalization in Medicare. Optimal medication adherence lowers hospitalization risk in HF patients. Although out-of-pocket spending can adversely affect adherence to HF medications, it is unknown whether medication spending ultimately increases hospital use for Medicare beneficiaries with HF. OBJECTIVE To examine the association between out-of-pocket medication payments and HF-related hospital use among Medicare Part D subscribers. METHODS Retrospective analysis of the 2010-12 Medicare Current Beneficiary Survey. The sample comprised community-dwelling respondents with fee-for-service Medicare, continuous Part D coverage, and self-reported HF (n = 819 participant-year records). The effects of average out-of-pocket payment for a 30-day HF-related prescription on odds and frequency of hospitalization and total inpatient days attributable to HF were estimated. Design-adjusted models adjusted for sociodemographic and health status variables, survey year and censoring, and included a pre-specified interaction of out-of-pocket payment with Medicaid co-eligibility. RESULTS The interaction term was statistically significant in all the models. For beneficiaries without Medicaid, average out-of-pocket payment per prescription was not significantly associated with odds of HF-related hospitalization (odds ratio = 1.01, 95% CI = 0.98-1.05, P = .399). The association between out-of-pocket payment and hospitalization frequency was statistically significant (incidence rate ratio [IRR] = 1.02, 95% CI = 1.00-1.05, P = .048), as was the association between out-of-pocket payment and total inpatient days (IRR = 1.04, 95% CI = 1.00-1.08, P = .041). For Medicaid co-eligible beneficiaries, the validity of model estimates is limited, because the range of actual out-of-pocket payments was negligible. CONCLUSIONS Fee-for-service Medicare beneficiaries with Part D, self-reported HF, and no supplemental Medicaid tolerated out-of-pocket medication payments without elevated risk of HF-related hospital use, but medication spending modestly increased hospital use intensity. Therefore, Part D plans with higher out-of-pocket requirements for essential HF medications may warrant additional scrutiny.
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Affiliation(s)
- Blake Tyler McGee
- Laney Graduate School, Emory University, 201 Dowman Dr. NW, Atlanta, GA, 30322, USA.
| | - Melinda K Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd. NW, Atlanta, GA, 30322, USA.
| | - Victoria Phillips
- Rollins School of Public Health, Emory University, 1518 Clifton Rd. NW, Atlanta, GA, 30322, USA.
| | - Javed Butler
- Department of Medicine, University of Mississippi, 2500 N State St. Jackson, MS, 39216, USA.
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Barutaut M, Fournier P, Peacock WF, Evaristi MF, Caubère C, Turkieh A, Desmoulin F, Eurlings LWM, van Wijk S, Rocca HPBL, Butler J, Koukoui F, Dambrin C, Mazeres S, Le Page S, Delmas C, Galinier M, Jung C, Smih F, Rouet P. Insulin-like Growth Factor Binding Protein 2 predicts mortality risk in heart failure. Int J Cardiol 2019; 300:245-251. [PMID: 31806281 DOI: 10.1016/j.ijcard.2019.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Insulin-like Growth Factor Binding Protein 2 (IGFBP2) showed greater heart failure (HF) diagnostic accuracy than the "grey zone" B-type natriuretic peptides, and may have prognostic utility as well. OBJECTIVES To determine if IGFBP2 provides independent information on cardiovascular mortality in HF. METHODS A retrospective study of 870 HF patients from 3 independent international cohorts. Presentation IGFBP2 plasma levels were measured by ELISA, and patients were followed from 1 year (Maastricht, Netherlands) to 6 years (Atlanta, GA, USA and Toulouse, France). Multivariate analysis, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were performed in the 3 cohorts. The primary outcome was cardiovascular mortality. RESULTS In multivariate Cox proportional hazards analysis, the highest quartile of IGFBP2 was associated with mortality in the Maastricht cohort (adjusted hazard ratio 1.69 (95% CI, 1.18-2.41), p = 0.004) and in the combined Atlanta and Toulouse cohorts (adjusted hazard ratio 2.04 (95%CI, 1.3-3.3), p = 0.003). Adding IGFBP2 to a clinical model allowed a reclassification of adverse outcome risk in the Maastricht cohort (NRI = 18.7% p = 0.03; IDI = 3.9% p = 0.02) and with the Atlanta/Toulouse patients (NRI of 40.4% p = 0.01, 31,2% p = 0.04, 31.5% p = 0,02 and IDI of 2,9% p = 0,0005, 3.1% p = 0,0005 and 4,2%, p = 0.0005, for a follow-up of 1, 2 and 3 years, respectively). CONCLUSION In 3 international cohorts, IGFBP2 level is a strong prognostic factor for cardiovascular mortality in HF, adding information to natriuretic monitoring and usual clinical markers, that should be further prospectively evaluated for patients' optimized care.
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Affiliation(s)
- Manon Barutaut
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Pauline Fournier
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France; University Hospital of Toulouse, Cardiology Department, F-31432 Toulouse, France
| | - William F Peacock
- Emergency Medicine at the Baylor College of Medicine in Houston, TX, USA
| | - Maria Francesca Evaristi
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Céline Caubère
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Annie Turkieh
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Franck Desmoulin
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Luc W M Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Sandra van Wijk
- Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands
| | | | - Javed Butler
- Department of Medicine, Stony Brook University, NY, USA
| | - François Koukoui
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Camille Dambrin
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France; University Hospital of Toulouse, Cardiology Department, F-31432 Toulouse, France
| | - Serge Mazeres
- Institute of Pharmacology and Structural Biology (IPBS), Toulouse, France
| | - Servane Le Page
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France
| | - Clement Delmas
- University Hospital of Toulouse, Cardiology Department, F-31432 Toulouse, France
| | - Michel Galinier
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France; University Hospital of Toulouse, Cardiology Department, F-31432 Toulouse, France
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
| | - Fatima Smih
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France; Spartacus-Biomed, Clermont Le Fort, France
| | - Philippe Rouet
- LA Maison de la MItochondrie (LAMMI), Obesity and heart failure: molecular and clinical investigations, UMR CNRS 5288, 1 Avenue Jean Poulhes, BP 84225, 31432 Toulouse cedex 4, France; INI-CRCT F-CRIN, GREAT Networks, France.
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Duque L, Brown L, Celano CM, Healy B, Huffman JC. Is it better to cultivate positive affect or optimism? Predicting improvements in medical adherence following a positive psychology intervention in patients with acute coronary syndrome. Gen Hosp Psychiatry 2019; 61:125-129. [PMID: 31280918 PMCID: PMC6861647 DOI: 10.1016/j.genhosppsych.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/14/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Adherence to health behaviors following an acute coronary syndrome (ACS) is strongly associated with superior prognosis. Both optimism and positive affect may play important roles in such adherence. However, the relationship between changes in these constructs in the context of positive psychology interventions (PPIs) and adherence to health behaviors is not fully understood. Accordingly, we aimed to examine these relationships among a cohort of post-ACS patients receiving a PPI. METHOD Post-ACS participants who received a PPI during a factorial trial (N = 128) completed self-report measures of positive affect and optimism, along with the Medical Outcomes Study Specific Adherence Scale items for diet, physical activity, and medication adherence, over 16 weeks. The baseline and longitudinal effects of positive affect and optimism-representing changes in those constructs-on adherence were analyzed using mixed effects regression models. RESULTS Positive affect, but not optimism, was longitudinally associated with greater overall adherence to health behaviors (positive affect: β = 0.057, p = .006; optimism: β = 0.032, p = .36), with the effect driven by physical activity adherence (positive affect: β = 0.040, p = .004; optimism: β = 0.005, p = .83). CONCLUSION Changes in positive affect may be more strongly associated with post-ACS adherence than optimism; this could have important implications for the development of PPIs to promote adherence.
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Affiliation(s)
- Laura Duque
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brian Healy
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Lu M, Xia H, Ma J, Lin Y, Zhang X, Shen Y, Hravnak M. Relationship between adherence to secondary prevention and health literacy, self-efficacy and disease knowledge among patients with coronary artery disease in China. Eur J Cardiovasc Nurs 2019; 19:230-237. [PMID: 31595771 DOI: 10.1177/1474515119880059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Adherence to secondary prevention is an indispensable part of the management of patients with coronary artery disease. Finding patient factors affecting their adherence behaviours is important for improving the treatment effect and limiting further disease progression. Aims: To examine the association between health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention in patients in China. Methods: In this cross-sectional study, 598 patients with coronary artery disease were enrolled in two tertiary hospitals in China during a hospitalisation for receiving percutaneous coronary intervention. Patient-reported data were collected on demographics, health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention (medication-taking and heart-healthy lifestyle (exercise, reducing/eliminating alcohol intake and smoking, low salt and fat diet, stress reduction)). Chi-squared tests and regression analyses were performed. Results: The proportions of recalled self-report of adherence to medication-taking and a heart-healthy lifestyle immediately prior to the coronary artery disease hospitalisation were 84.7% and 53.2%, respectively. In logistic regression, health literacy, self-efficacy and disease knowledge was significantly associated with non-adherence to secondary coronary artery disease prevention. Limited health literacy demonstrated a 1.61-fold odds for non-adherence to a heart-healthy lifestyle. Each score increase of self-efficacy and disease knowledge had 0.98-fold odds and 1.05-fold odds of non-adherence to a heart-healthy lifestyle. Conclusions: Adherence to medication-taking was relatively good in Chinese patients prior to coronary artery disease hospitalisation, but adherence to heart-healthy lifestyle behaviours should be improved. Health literacy, self-efficacy and disease knowledge should be taken into account when intervening to improve secondary coronary artery disease prevention.
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Affiliation(s)
- Minmin Lu
- School of Nursing, Fudan University, China
| | - Haiou Xia
- School of Nursing, Fudan University, China
| | - Jianying Ma
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Ying Lin
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Xian Zhang
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Yunzhi Shen
- Huashan Hospital, Affiliated to Fudan University, China
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Raines E, Dickey SL. An exploration of learning needs: identifying knowledge deficits among hospitalized adults with heart failure. AIMS Public Health 2019; 6:248-267. [PMID: 31637275 PMCID: PMC6779596 DOI: 10.3934/publichealth.2019.3.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023] Open
Abstract
The current study examined the learning needs of hospitalized patients with chronic heart failure (CHF) by identifying their current CHF self-care behaviors and knowledge levels, while identifying relationships between clinical variables, and their learning needs. A descriptive, cross-sectional design was utilized to examine a convenience sample of 42 hospitalized patients with CHF. Self-care behaviors and knowledge levels were measured using the Self Care of Heart Failure Index V. 6.2, and the Japanese Heart Failure Knowledge Scale. Descriptive statistics were used to describe the learning needs and sociodemographic data and Pearson product moment correlation examined relationships between the learning needs and clinical variables. The mean scores of self-care were 38.6% (maintenance), 41.6% (management) and 17.8% (confidence). The participant's mean knowledge level score was 74.9%. Multiple CHF hospital readmissions had a significant negative correlation with CHF knowledge scores (r = -0.358, p < 0.05), suggesting the lower the knowledge score, the higher the prevalence of CHF readmissions. There were significant positive correlations between self-care maintenance (r = 0.525, p < 0.05), management (r = 0.435, p < 0.05), confidence (r = 0.366, p < 0.05), knowledge level (r = 0.752, p < 0.05) and not living alone. Thus, indicating that living with family support is correlated with better self-care and greater knowledge. The presence of multiple comorbidities revealed significant positive correlations (p < 0.05) with self-care scores (maintenance [r = 0.391], management [r = 0.438], and confidence r = 0.504), indicating a higher number of comorbidities, yielded lower self-care behaviors. Findings revealed poor self-care behaviors in all three areas (maintenance, management, confidence). These findings suggested that patients had difficulty implementing knowledge into self-care. By identifying knowledge deficits and contributing factors to suboptimal self-care, the chronic care model can be used as a guideline for ideal CHF education and management. Improving self-care behaviors can be obtained by initiating an active engagement between health care teams and the patient.
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Affiliation(s)
| | - Sabrina L. Dickey
- College of Nursing, Florida State University, Tallahassee, Florida, United States
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McGee BT, Phillips V, Higgins MK, Butler J. Prescription Drug Spending and Medication Adherence Among Medicare Beneficiaries with Heart Failure. J Manag Care Spec Pharm 2019; 25:705-713. [PMID: 31134861 PMCID: PMC10397985 DOI: 10.18553/jmcp.2019.25.6.705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Evidence suggests that cost sharing adversely affects appropriate prescription drug use for chronic disorders. However, few studies have evaluated this effect in heart failure (HF), the most common cause of hospitalization in Medicare. OBJECTIVE To determine whether spending on HF pharmacotherapy by Medicare Part D enrollees was associated with prescription refill adherence. METHODS This correlational study used pooled data from the 2010-2012 Medicare Current Beneficiary Survey (MCBS). The analysis sample consisted of community-dwelling MCBS participants with self-reported HF and continuous Part D coverage during the year of participation. 3 drug classes were analyzed independently: beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs). 1,448 weighted participant-year records (derived from 964 individuals) met the inclusion criteria, of which 846 (58%) were included for beta-blockers, 633 (44%) for ACE inhibitors, and 229 (16%) for ARBs. Spending was measured by average out-of-pocket payment for the relevant prescription, standardized to a 30-day supply, as a percentage of average monthly income. Adherence was measured by the medication possession ratio (MPR): total days supplied for all but the last refill divided by number of days between the first and last fills of the year. RESULTS Accounting for sampling weights, the median (interquartile range) monthly income was $1,472 ($949-$2,466), and average percentage of monthly income spent on a 30-day medication supply was 0.22% for beta-blockers, 0.19% for ACE inhibitors, and 0.90% for ARBs. Mean MPR was 88.9% for beta-blockers, 88.5% for ACE inhibitors, and 90.4% for ARBs. Risk-adjusted models showed that percentage of income spent on a beta-blocker prescription was directly associated with odds of nonadherence (MPR < 80%), odds ratio = 1.38, 95% CI = 1.01-1.89, P = 0.045, and inversely associated with beta-blocker MPR, B = -4.17, SE = 1.23, P = 0.001. No such association was observed for ACE inhibitors or ARBs. CONCLUSIONS Price sensitivity was evident for beta-blockers but not for antiangiotensin drugs, despite very low out-of-pocket costs and high adherence. This study is relevant to value-based pricing of HF management drugs in Part D plans. DISCLOSURES No outside funding supported this study. Butler has served as a paid consultant or advisor on unrelated projects for Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3, Innolife, Janssen, Medtronic, Merck, Novartis, Relypsa, Stealth Peptide, SC Pharma, Vifor, and ZS Pharma. The other authors have no potential conflicts of interest to declare. An early version of this paper was presented as a poster at Sigma Theta Tau International's 28th Nursing Research Congress; July 27-31, 2017; Dublin, Ireland.
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Affiliation(s)
- Blake Tyler McGee
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta
| | | | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson
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Awh K, Venuti MA, Gleason LP, Rogers R, Denduluri S, Kim YY. Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:726-734. [DOI: 10.1111/chd.12784] [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] [Received: 01/29/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Katherine Awh
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Morgan A. Venuti
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lacey P. Gleason
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Rachel Rogers
- Biostatistics and Data Management Core The Children's Hospital of Philadelphia Research Institute Philadelphia Pennsylvania
| | - Srinivas Denduluri
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
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Lu M, Ma J, Lin Y, Zhang X, Shen Y, Xia H. Relationship between patient's health literacy and adherence to coronary heart disease secondary prevention measures. J Clin Nurs 2019; 28:2833-2843. [PMID: 30938879 DOI: 10.1111/jocn.14865] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/18/2019] [Accepted: 03/23/2019] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China. BACKGROUND Adherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching. DESIGN A descriptive cross-sectional design. METHODS A total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self-report on demographics, HL and adherence to secondary CHD prevention behaviours (medication-taking and heart-healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS-EU-Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS-SAS). Descriptive, chi-square test and regression analyses were conducted. The study was reported based on STROBE checklist. RESULTS Overall, 74.5% of the patients had limited HL. Adherence rates to medication-taking and heart-healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart-healthy lifestyle (OR 1.69). CONCLUSION HL was not significantly associated with medication adherence but was related to heart-healthy lifestyle adherence. RELEVANCE TO CLINICAL PRACTICE Nurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart-healthy lifestyle behaviours, and not just taking medications.
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Affiliation(s)
- Minmin Lu
- School of Nursing, Fudan University, Shanghai, China
| | - Jianying Ma
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Ying Lin
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xian Zhang
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunzhi Shen
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Haiou Xia
- School of Nursing, Fudan University, Shanghai, China
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Seid MA, Abdela OA, Zeleke EG. Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients' point of view. PLoS One 2019; 14:e0211768. [PMID: 30730931 PMCID: PMC6366768 DOI: 10.1371/journal.pone.0211768] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nowadays, heart failure (HF) related morbidity and mortality rate is increasing globally. Younger populations happen to be more affected by HF in sub- Saharan African than the western countries. Even though medications, low sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and its exacerbation, poor adherence to these self-care recommendations is contributing to an increased in hospitalization, morbidity, and mortality. Therefore, this study aimed to assess heart failure patients' adherence to self-care recommendations and its associated factors. METHODS A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017. The participants were selected by systematic random sampling technique. Data were collected through face to face interview and from the patients' medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients' adherence level. RESULTS Of 310 study participants only 22.3% (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR = 2.34, 95% CI: 1.18-4.62), good level of heart failure knowledge (AOR = 2.49, 95% CI: 1.276-4.856) and free from chronic comorbid diseases (AOR = 2.57, 95% CI: 1.28-5.14). CONCLUSION Overall, heart failure patients' adherence to self-care recommendations is poor and selective. Being male in gender, had no chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients' knowledge about heart failure signs, symptoms and its management approaches, to improve the patients' adherence level.
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Affiliation(s)
| | | | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Pednekar PP, Ágh T, Malmenäs M, Raval AD, Bennett BM, Borah BJ, Hutchins DS, Manias E, Williams AF, Hiligsmann M, Turcu-Stiolica A, Zeber JE, Abrahamyan L, Bunz TJ, Peterson AM. Methods for Measuring Multiple Medication Adherence: A Systematic Review-Report of the ISPOR Medication Adherence and Persistence Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:139-156. [PMID: 30711058 DOI: 10.1016/j.jval.2018.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/29/2018] [Accepted: 08/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications. OBJECTIVES To identify and characterize the multiple medication adherence (MMA) methods used in the literature. METHODS A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized. RESULTS The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA. CONCLUSIONS There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.
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Affiliation(s)
- Priti P Pednekar
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA.
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Maria Malmenäs
- Real World Strategy & Analytics, Mapi Group, Stockholm, Sweden
| | | | | | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia
| | - Allison F Williams
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Mickaël Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Adina Turcu-Stiolica
- Department of Pharmaceutical Marketing and Management, University of Medicine and Pharmacy, Craiova, Romania
| | - John E Zeber
- Central Texas Veterans Health Care System, Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA
| | | | | | - Andrew M Peterson
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA
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Morris AA, McAllister P, Grant A, Geng S, Kelli HM, Kalogeropoulos A, Quyyumi A, Butler J. Relation of Living in a "Food Desert" to Recurrent Hospitalizations in Patients With Heart Failure. Am J Cardiol 2019; 123:291-296. [PMID: 30442360 DOI: 10.1016/j.amjcard.2018.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 01/19/2023]
Abstract
Food deserts (FD), low-income areas with low access to healthful foods, are associated with higher burden of cardiovascular risk factors. Few studies have examined the impact of FD on clinical outcomes in heart failure (HF). FD status was assessed in 457 HF patients (mean age 55.9 ± 12.5 years; 50.3% Black) using the Food Desert Research Atlas. The Andersen-Gill extension of Cox model was used to examine the association of living in a FD with risk of repeat hospitalization (all-cause and HF-specific). Patients living in a FD were younger (p = 0.01), more likely to be Black (p <0.0001), less educated (p = 0.003), and less likely to have commercial insurance (p = 0.003). During a median follow-up of 827 (506, 1,379) days, death occurred in 60 (13.1%) subjects, and hospitalizations occurred in 262 (57.3%) subjects. There was no difference in the risk of death based on FD status. The overall frequency of all-cause (94.1 vs 63.6 per 100 patient-years) and HF-specific (59.6 vs 30.5 per 100 patient-years) hospitalizations was higher in subjects who lived in a FD. After adjustment for covariates, living in a FD was associated with an increased risk of repeat all-cause (hazard ratio 1.39, 95% confidence interval 1.19 to 1.63; p = 0.03) and HF-specific (hazard ratio 1.30, 95% confidence interval 1.02 to 1.65; p = 0.03) hospitalizations. In conclusion, patients living in a FD have a higher risk of repeat all-cause and HF-specific hospitalization.
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Schrauben SJ, Hsu JY, Wright Nunes J, Fischer MJ, Srivastava A, Chen J, Charleston J, Steigerwalt S, Tan TC, Fink JC, Ricardo AC, Lash JP, Wolf M, Feldman HI, Anderson AH. Health Behaviors in Younger and Older Adults With CKD: Results From the CRIC Study. Kidney Int Rep 2019; 4:80-93. [PMID: 30596171 PMCID: PMC6308910 DOI: 10.1016/j.ekir.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION A cornerstone of kidney disease management is participation in guideline-recommended health behaviors. However, the relationship of these health behaviors with outcomes, and the identification of barriers to health behavior engagement, have not been described among younger and older adults with chronic kidney disease. METHODS Data from a cohort study of 5499 individuals with chronic kidney disease was used to identify health behavior patterns with latent class analysis stratified by age <65 and ≥65 years. Cox models, stratified by diabetes, assessed the association of health behavior patterns with chronic kidney disease (CKD) progression, atherosclerotic events, and death. Logistic regression was used to assess for barriers to health behavior engagement. RESULTS Three health behavior patterns were identified: 1 "healthy" pattern, and 2 "less healthy" patterns comprising 1 pattern with more obesity and sedentary activity and 1 with more smoking and less obesity. Less healthy patterns were associated with an increased hazard of poor outcomes. Among participants <65 years of age, the less healthy patterns (vs. healthy pattern) was associated with an increased hazard of death in diabetic individuals (hazard ratio [HR] = 2.17, 95% confidence interval [CI] = 1.09-4.29; and HR = 2.50, 95% CI = 1.39-4.50) and cardiovascular events among nondiabetic individuals (HR = 1.49, 95% CI = 1.04-2.43; and HR = 2.97, 95% CI = 1.49-5.90). Individuals with the more obese/sedentary pattern had an increased risk of CKD progression in those who were diabetic (HR = 1.34, 95% CI = 1.13-1.59). Among older adults, the less healthy patterns were associated with increased risk of death (HR = 2.97, 95% CI = 1.43-6.19; and HR = 3.47, 95% CI = 1.48-8.11) in those who were nondiabetic. Potential barriers to recommended health behaviors include lower health literacy and self-efficacy. CONCLUSION Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.
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Affiliation(s)
- Sarah J. Schrauben
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Wright Nunes
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J. Fischer
- Department of Medicine, University of Illinois at Chicago, and Center of Management for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Anand Srivastava
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Susan Steigerwalt
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jeffrey C. Fink
- Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, and Center of Management for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, and Center of Management for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Myles Wolf
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Harold I. Feldman
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amanda H. Anderson
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Deka P, Pozehl B, Williams MA, Norman JF, Khazanchi D, Pathak D. MOVE-HF: an internet-based pilot study to improve adherence to exercise in patients with heart failure. Eur J Cardiovasc Nurs 2018; 18:122-131. [DOI: 10.1177/1474515118796613] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pallav Deka
- Department of Nursing, University of South Dakota, USA
| | - Bunny Pozehl
- College of Nursing, University of Nebraska Medical Center, USA
| | - Mark A Williams
- Divison of Cardiology, Creighton University School of Medicine, USA
| | - Joseph F Norman
- College of Allied Health Professions, University of Nebraska Medical Center, USA
| | - Deepak Khazanchi
- College of Information Science and Technology, University of Nebraska at Omaha, USA
| | - Dola Pathak
- Department of Statistics, University of Nebraska at Lincoln, USA
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Pozehl BJ, McGuire R, Duncan K, Kupzyk K, Norman J, Artinian NT, Deka P, Krueger SK, Saval MA, Keteyian SJ. Effects of the HEART Camp Trial on Adherence to Exercise in Patients With Heart Failure. J Card Fail 2018; 24:654-660. [PMID: 30010027 DOI: 10.1016/j.cardfail.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence. METHODS AND RESULTS This randomized controlled trial evaluated the effect of a multicomponent intervention, Heart Failure Exercise and Resistance Training (HEART) Camp, on adherence to exercise (after 6, 12, and 18 months) compared with an enhanced usual care (EUC) group. Patients (n = 204) were 55.4% male, overall average age was 60.4 years, and 47.5% were nonwhite. The HEART Camp group had significantly greater adherence at 12 (42%) and 18 (35%) months compared with the EUC group (28% and 19%, respectively). No significant difference (P > .05) was found at 6 months. The treatment effect did not differ based on patient's age, race, gender, marital status, type of HF (preserved or reduced ejection fraction) or New York Heart Association functional class. Left ventricular ejection fraction (LVEF) significantly moderated the treatment effect, with greater adherence at higher LVEF. CONCLUSIONS The multicomponent HEART Camp intervention showed efficacy with significant effects at 12 months and 18 months. Adherence levels remained modest, indicating a need for additional research to address methods and strategies to promote adherence to exercise in patients with HF.
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Affiliation(s)
| | - Rita McGuire
- University of Nebraska Medical Center, Lincoln, Nebraska
| | | | - Kevin Kupzyk
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph Norman
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Pallav Deka
- University of South Dakota, Sioux Falls, South Dakota
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Exercise Therapy Benefits for Heart Failure. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Deka P, Pozehl B, Norman JF, Khazanchi D. Feasibility of using the Fitbit ® Charge HR in validating self-reported exercise diaries in a community setting in patients with heart failure. Eur J Cardiovasc Nurs 2018; 17:605-611. [PMID: 29546995 DOI: 10.1177/1474515118766037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Use of wrist-worn activity monitors has increased over the past few years; however, the use of the Fitbit® Charge HR (FCHR) in a community setting in patients with heart failure has not been tested. PURPOSE The purpose of the study was to assess the feasibility, practicality and acceptability of utilizing the FCHR to validate self-reported exercise diaries and monitor exercise in community dwelling patients with heart failure. METHODS Thirty heart failure patients (12 females and 18 males) aged 64.7 ± 11.5 years were provided with a FCHR. Participants were provided with an exercise routine and for eight weeks, recorded their exercise sessions in self-reported exercise diaries and used the FCHR to record those exercise sessions. RESULTS Exercise data from the self-reported exercise diaries were validated with data from the FCHR. Participants' perception and acceptance of using the FCHR was positive. Validation of exercise and physical activity interventions using the FCHR appears feasible and acceptable in patients with heart failure. CONCLUSION Wrist-worn activity monitors can be useful for objective measurement of exercise adherence and monitoring of physical activity in patients with heart failure in a community setting.
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Affiliation(s)
- Pallav Deka
- 1 Department of Nursing, University of South Dakota, Sioux Falls, USA
| | - Bunny Pozehl
- 2 College of Nursing, University of Nebraska Medical Center, Omaha, USA
| | - Joseph F Norman
- 3 College of Allied Health Professions, University of Nebraska Medical Center, Omaha, USA
| | - Deepak Khazanchi
- 4 College of Information Science & Technology, Peter Kiewit Institute, University of Nebraska at Omaha, USA
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Deka P, Pozehl B, Williams MA, Yates B. Adherence to recommended exercise guidelines in patients with heart failure. Heart Fail Rev 2018; 22:41-53. [PMID: 27671166 DOI: 10.1007/s10741-016-9584-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Exercise training has been shown to be beneficial in patients with heart failure, and its effectiveness is connected to adherence to the exercise program. Nonetheless, adherence to exercise in these patients remains a concern. Heart failure patients can be considered adherent to an exercise program if they meet 80 % of the recommended dose. We summarize exercise recommendations for patients with heart failure, identify exercise prescription methodologies used in studies that have reported exercise adherence, identify strategies and tools used to improve adherence and examine whether these strategies were developed using a theoretical platform with the primary aim to change behavior and improve adherence to exercise. Factors which may also impact adherence such as exercise setting, intensity and length of participation, gender, race, New York Heart Association functional class and heart failure with preserved and reduced ejection fraction were also investigated. Finally, recommendations for future studies for improving adherence to exercise in patients with heart failure are provided.
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Affiliation(s)
- Pallav Deka
- College of Nursing, University of Nebraska Medical Center, Commerce Court 1230 O Street, Suite 131, Lincoln, NE, 68588-0220, USA.
| | - Bunny Pozehl
- College of Nursing, University of Nebraska Medical Center, Commerce Court 1230 O Street, Suite 131, Lincoln, NE, 68588-0220, USA
| | - Mark A Williams
- Divison of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Bernice Yates
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
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A Ventricular Assist Device Recipient and Suicidality: Multidisciplinary Collaboration With a Psychiatrically Distressed Patient. J Cardiovasc Nurs 2018; 32:135-139. [PMID: 26422637 DOI: 10.1097/jcn.0000000000000293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes. PURPOSE We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily discontinuing warfarin (Coumadin) several months after VAD implantation. The patient's psychosocial and medical histories and outcomes are presented. CONCLUSIONS This case underscores the importance of pre-VAD as well and ongoing psychosocial evaluation and management for this unique patient population. CLINICAL IMPLICATIONS Medical teams who are treating patients with cardiovascular disease who are under consideration for VAD or heart transplantation need to be aware of the multitude of ways in which patients can express depressed and suicidal mood and work with a multidisciplinary team to treat such symptoms to optimize patients' success with VAD/heart transplantation.
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Implementing a Protocol to Improve Self-Care Behaviors in Adult Patients With Heart Failure. J Dr Nurs Pract 2018; 11:59-71. [DOI: 10.1891/2380-9418.11.1.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background:Heart failure (HF) is a condition that affects millions of Americans and costs $30 billion to treat annually. HF is the cause for frequent hospitalizations. Self-care practices have been found to improve quality of life, decrease hospitalizations, and reduce treatment costs.Participants:Fifteen adult patients with a HF diagnosis ages 18 to 70 voluntarily participated in the implementation of a protocol aimed at improving self-care behaviors in patients with HF in a private cardiology practice located in a southeastern city.Methods:The project was a quality improvement design. A protocol was implemented using resources from the American Heart Association. Monitoring logs were provided to patients to record daily weights, sodium intake, blood pressure, and symptoms. Educational resources included information about medications and a list of valid HF websites. Participants were provided medication organizers and a two-liter container with which to monitor daily fluid intake. The written information and logs were compiled in red folders.Results:Of the 15 participants, there were no hospital admissions or readmissions for HF during the implementation period. Leg and ankle swelling worsened; dyspnea improved; fewer participants felt like a burden to their family; HF knowledge improved.Discussion:The findings indicate the feasibility of implementing the protocol throughout a private practice organization.
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Optimizing a Positive Psychology Intervention to Promote Health Behaviors After an Acute Coronary Syndrome: The Positive Emotions After Acute Coronary Events III (PEACE-III) Randomized Factorial Trial. Psychosom Med 2018; 80:526-534. [PMID: 29624523 PMCID: PMC6023730 DOI: 10.1097/psy.0000000000000584] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite the clear benefits of physical activity and related behaviors on prognosis, most patients experiencing an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. METHODS As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing), allowing three concurrent comparisons within the trial. The study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. RESULTS The intervention was well accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (β = 8.58, 95% confidence interval = -0.49-17.65, effect size difference = .43, p = .064), motivational interviewing was associated with overall adherence (β = 0.95, 95% confidence interval = 0.02-1.87, effect size difference = .39, p = .044), and weekly exercise completion was generally superior to daily. CONCLUSIONS These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT02754895.
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da Silva AF, Cavalcanti ACD, Malta M, Arruda CS, Gandin T, da Fé A, Rabelo-Silva ER. Treatment adherence in heart failure patients followed up by nurses in two specialized clinics. Rev Lat Am Enfermagem 2017; 23:888-94. [PMID: 26487139 PMCID: PMC4660411 DOI: 10.1590/0104-1169.0268.2628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/22/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives: to analyze treatment adherence in heart failure (HF) patients followed up by the
nursing staff at specialized clinics and its association with patients'
characteristics such as number of previous appointments, family structure, and
comorbidities. Methods: a cross-sectional study was conducted at two reference clinics for the treatment
of HF patients (center 1 and center 2). Data were obtained using a 10-item
questionnaire with scores ranging from 0 to 26 points; adherence was considered
adequate if the score was ≥ 18 points, or 70% of adherence. Results: a total of 340 patients were included. Mean adherence score was 16 (±4) points.
Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was
demonstrated that patients who lived with their family had higher adherence
scores, that three or more previous nursing appointments was significantly
associated with higher adherence (p<0.001), and that hypertension was
associated with low adherence (p=0.023). Conclusions: treatment adherence was considered satisfactory in less than a half of the
patients followed up at the two clinics specialized in HF. Living with the family
and attending to a great number of nursing appointments improved adherence, while
the presence of hypertension led to worse adherence.
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Affiliation(s)
| | | | - Mauricio Malta
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Thamires Gandin
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Adriana da Fé
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Cavalcante AMRZ, Lopes CT, Brunori EFR, Swanson E, Moorhead SA, Bachion MM, de Barros ALBL. Self-Care Behaviors in Heart Failure. Int J Nurs Knowl 2017; 29:146-155. [PMID: 28523764 DOI: 10.1111/2047-3095.12170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.
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Affiliation(s)
| | - Camila Takao Lopes
- Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, São Paulo, Brazil
| | | | | | | | - Maria Márcia Bachion
- College of Nursing, Federal University of Goias (FEN-UFG), Goiânia, Goiânia, Brazil
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Hammash MH, Crawford T, Shawler C, Schrader M, Lin CY, Shewekah D, Moser DK. Beyond social support: Self-care confidence is key for adherence in patients with heart failure. Eur J Cardiovasc Nurs 2017; 16:632-637. [DOI: 10.1177/1474515117705939] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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