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Thomas SC, Neenumol K, Chacko S, Prinu J, Pillai MR, Pisharody S, Chozhakkat S, Vijay MSJ, Iliyas AM, Harikrishnan S, Ganapathi S, Jeemon P. Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study. Wellcome Open Res 2024; 9:219. [PMID: 39211807 PMCID: PMC11358683 DOI: 10.12688/wellcomeopenres.21175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 09/04/2024] Open
Abstract
Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.
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Affiliation(s)
- Sunu C. Thomas
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | | | - Susanna Chacko
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Jose Prinu
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | | | - Sunil Pisharody
- EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India
| | - Somanathan Chozhakkat
- EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India
| | - MS Jyothi Vijay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - A. Mohamed Iliyas
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | | | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Cotie LM, Pakosh M, Ghisi GLDM. Inpatient vs. Outpatient: A Systematic Review of Information Needs throughout the Heart Failure Patient Journey. J Clin Med 2024; 13:1085. [PMID: 38398398 PMCID: PMC10889710 DOI: 10.3390/jcm13041085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
The objective of this systematic review was to identify and describe information needs for individuals with heart failure (HF) throughout their patient journey. Six databases were searched (APA PsycINFO, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL, and Web of Science Core Collection) from inception to February 2023. Search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. Quality appraisal was assessed using the Mixed-Methods Appraisal Tool. A narrative synthesis was used to analyze all the outcomes according to the Synthesis Without Meta-analysis reporting guidelines. Twenty-five studies (15 quantitative and 10 qualitative) were included. Socioeconomic, cultural, and demographic factors influencing information needs were considered. The top three information needs for outpatients included general HF information, signs and symptoms and disease management strategies. For inpatients, medications, risk factors, and general HF were reported as the top needs. These divergent needs emphasize the importance of tailored education at different stages. Additionally, the review identified gaps in global representation, with limited studies from Africa and South America, underscoring the need for inclusive research. The findings caution against overgeneralization due to varied reporting methods. Practical implications call for culturally sensitive interventions to address nuanced HF patients' needs, while future research must prioritize standardized reporting, consider diverse patient journey timepoints, and minimize biases for enhanced reliability and applicability.
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Affiliation(s)
- Lisa M. Cotie
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
| | - Maureen Pakosh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
| | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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Igerc I, Schrems B. Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review. J Clin Nurs 2023; 32:6832-6848. [PMID: 37323097 DOI: 10.1111/jocn.16773] [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: 09/20/2022] [Revised: 12/22/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Abstract
AIMS To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs. DESIGN A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews. REVIEW METHODS A literature search and thematic analysis were conducted. DATA SOURCES Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included. RESULTS Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies. CONCLUSION Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being. IMPACT What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients. REPORTING METHOD PRISMA extension for scoping reviews. NO PATIENT OR PUBLIC CONTRIBUTION Not required as it was a literary work (scoping review).
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Affiliation(s)
- Irina Igerc
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Berta Schrems
- Department of Nursing Science, University of Vienna, Vienna, Austria
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The impact of heart failure on the sexual response cycle: A systematic review. Heart Lung 2022; 56:50-56. [PMID: 35709645 DOI: 10.1016/j.hrtlng.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart failure (HF) is the most prevalent disease among chronic diseases and has been associated with a high prevalence of erectile dysfunction (ED). OBJECTIVE this study aims to analyze research that has as its object of study the sexual activity of patients with HF. METHODS A high-sensitivity search was performed in databases (PUBMED via MEDLINE, Cochrane, EMBASE, Web of Science, SCOPUS AND CINAHL) using descriptors linked to sexuality and heart failure. RESULTS Fifteen studies from 7 countries with a total sample of 6244 participants were included. CONCLUSION It was identified that patients with HF have alterations in their sexual activities, which are more common in males. Among men, it was noticed that the most reported sexual disorder was erectile dysfunction.
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Clays E, Puddu PE, Luštrek M, Pioggia G, Derboven J, Vrana M, De Sutter J, Le Donne R, Baert A, Bohanec M, Ciancarelli MC, Dawodu AA, De Pauw M, De Smedt D, Marino F, Pardaens S, Schiariti MS, Valič J, Vanderheyden M, Vodopija A, Tartarisco G. Proof-of-concept trial results of the HeartMan mobile personal health system for self-management in congestive heart failure. Sci Rep 2021; 11:5663. [PMID: 33707523 PMCID: PMC7970991 DOI: 10.1038/s41598-021-84920-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
This study tested the effectiveness of HeartMan-a mobile personal health system offering decisional support for management of congestive heart failure (CHF)-on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.
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Affiliation(s)
- Els Clays
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Mitja Luštrek
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
| | - Jan Derboven
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | | | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Rita Le Donne
- Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Anneleen Baert
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marko Bohanec
- Department of Knowledge Technologies, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Maria Costanza Ciancarelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.,Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Amos Adeyemo Dawodu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.,Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Michel De Pauw
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Flavia Marino
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
| | - Sofie Pardaens
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Michele Salvatore Schiariti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Jakob Valič
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Marc Vanderheyden
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Aljoša Vodopija
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
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Heydarpour B, Ezzati P, Soroush A, Saeidi M, Komasi S. Comparison of Sexual Knowledge between Patients Prepared for Cardiac Surgery and Patients Prepared for Cardiac Rehabilitation in Iran. J Tehran Heart Cent 2020; 14:103-108. [PMID: 31998386 PMCID: PMC6981344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Although sexual death during intercourse occurs rarely in patients with cardiovascular diseases (CVDs), most such patients avoid it because they fear a dangerous event. Given the significance of awareness about this issue among patients with CVDs, we sought to compare sexual knowledge between 2 groups of patients prepared for cardiac surgery and patients prepared for cardiac rehabilitation (CR). Methods: This cross-sectional study, conducted between April and July 2016, recruited 157 patients with CVDs (107 candidates for surgery and 50 patients prepared for CR) in Imam Ali Hospital, in the Iranian city of Kermanshah. The cases, selected through entire counting according to our inclusion criteria, responded to a standard sexual knowledge inventory. Sexual knowledge and professionals responsible in providing sexual rehabilitation from the perspective of patients were compared using the independent t-test and the χ2 test. Results: The participants’ mean age was 55.39±9.82 years (male: 58.6%). Overall, the 2 groups had poor sexual knowledge. Although the CR program started 57.85±13.92 days after surgery, the sexual knowledge of this group of patients was not significantly different from that of the patients prepared for surgery (P=0.904). This difference was not significant between the 2 genders (P=0.077). Finally, concerning the professionals responsible in providing sexual rehabilitation, the patients selected psychologists (P=0.006) and nurses (P=0.012) more frequently in the initial phase of CR program. Conclusion: Sexual knowledge was poor in our CR patients at the outset of the program. Given the poor knowledge in these patients 2 months after surgery and the lack of significant difference in knowledge between these patients and those prepared for surgery, it is advisable that they be provided with the necessary information in this regard in this golden time before hospital discharge.
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Affiliation(s)
- Behzad Heydarpour
- Cardiac Rehabilitation Center, School of Medicine, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran
| | - Parvin Ezzati
- Cardiac Rehabilitation Center, School of Medicine, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran
| | - Ali Soroush
- Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Saeidi
- Cardiac Rehabilitation Center, School of Medicine, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran
| | - Saeid Komasi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Sexual Activity in Heart Failure Patients: Information Needs and Association with Health-Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091570. [PMID: 31060294 PMCID: PMC6539722 DOI: 10.3390/ijerph16091570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022]
Abstract
(1) Background: the main objective of this study was to investigate information needs concerning sexual activity and experienced sexual problems in heart failure (HF) patients and, in addition, to examine the association between these sexual problems and health-related quality of life (HRQoL); (2) Methods: in this cross-sectional study, three self-administered questionnaires were distributed to 77 stable ambulatory HF patients to acquire data on HRQoL, sexual problems, and need for counselling; (3) Results: More than half (56.7%) of HF patients experienced a marked decrease or total cessation of sexual activity due to their illness. Additionally, more than one-third perceived a marked decrease or total absence of sexual pleasure (42.5%), interest (32.9%), and constant problems or being unable to perform sexual activity (37.3%). Furthermore, 43.1% of patients experienced an important overall need for counselling concerning sexual activity, with information on relationships (69.2%), symptoms (58.5%), and relaxation (49.2%) being the most desired topics. Multiple linear regression analysis revealed that sexual problems were independently associated with HRQoL, with more sexual problems (t = 3.19, p < 0.01) being related to poor HRQoL; (4) Conclusion: by investigating the experienced problems and counselling needs of HF patients, an alignment between current practice and HF patients’ expectations and needs might be obtained.
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O'Connor SR, Connaghan J, Maguire R, Kotronoulas G, Flannagan C, Jain S, Brady N, McCaughan E. Healthcare professional perceived barriers and facilitators to discussing sexual wellbeing with patients after diagnosis of chronic illness: A mixed-methods evidence synthesis. PATIENT EDUCATION AND COUNSELING 2019; 102:850-863. [PMID: 30578104 DOI: 10.1016/j.pec.2018.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/19/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore healthcare professional perceived barriers and facilitators to discussing sexual health and wellbeing with patients after diagnosis of chronic illness. METHODS Five databases were searched and included data were synthesised using a meta-ethnographic approach. Confidence in findings was assessed using the GRADE-CERQual framework. Searches, extraction and quality assessment procedures were conducted independently by at least two authors. RESULTS Concepts extracted from 30 included studies were used to develop a conceptual framework based on five overarching themes. These were [1] individual and societal attitudes to sex and sexual wellbeing [2], patient specific factors [3], organizational and professional factors [4], strategies to overcome barriers in practice and [5] perceived training needs. Healthcare professionals acknowledged the importance of discussing and providing support for sexual wellbeing needs, but recognized it is not routinely provided. CONCLUSIONS While patient specific factors and organizational issues such as lack of time were frequently identified as barriers, intra-personal and social perceptions appear to have the strongest influence on healthcare professional perspectives. PRACTICE IMPLICATIONS Brief education and tools to support healthcare professionals to have effective conversations with patients are required. These should address social barriers, normalise sexual issues, and support healthcare professionals to initiate discussions around sexual concerns.
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Affiliation(s)
- Seán R O'Connor
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - John Connaghan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - Suniel Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK; Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Nuala Brady
- Northern Health and Social Care Trust, Northern Ireland, UK
| | - Eilís McCaughan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK.
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Kugler C, Meng M, Rehn E, Morshuis M, Gummert JF, Tigges-Limmer K. Sexual activity in patients with left ventricular assist devices and their partners: impact of the device on quality of life, anxiety and depression. Eur J Cardiothorac Surg 2019; 53:799-806. [PMID: 29211843 DOI: 10.1093/ejcts/ezx426] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Prolonged support with a left ventricular assist device (LVAD) has evolved as an alternative treatment strategy for patients with end-stage heart disease. This requires a shift in focus on sexual activity and psychosocial outcomes in patients with an LVAD and their partners. METHODS This cross-sectional study was designed to capture Sexual Activities in Left Ventricular Assist Device Patients Or PaRtners (SALVADOR) perceptions on illness-related changes in the quality of sexual activity and its impact on quality of life, anxiety and depression using standardized patient-reported outcome scales (Sexual Adjustment Scale, 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale). A total of 72 patients with LVADs (50% response rate) along with 48 partners participated. RESULTS For patients with an LVAD (median age 60 years; 84.7% male), median time on the device was 650 days; 69.5% stayed in long-term partnerships (median 23 years). Prevalence rates for illness-related changes in the quality of sexual activity were 58.3% for patients and 52.1% for partners. Device-related disturbances in sexual activities occurred due to battery pockets (patients/partners: 59.2%/37.6%; P = 0.006) and the driveline (46.3%/37.5%; P = 0.033) and led to significantly increased distress in patients/partners (battery pockets: 53.5%/41.3%; P = 0.006; driveline 54.9%/37.5%; P = 0.004). Disturbances in sexual activity were independently associated with higher rates of depression (odds ratio 1.33, 95% confidence interval 1.14-1.55; P = 0.001) in patients and lower mental quality of life (odds ratio 6.18, 95% confidence interval 1.13-33.98; P = 0.036) in partners. CONCLUSIONS Disturbances in sexual activity are common in patients with an LVAD and their partners while the patients are on durable long-term support. Counselling on long-term adjustment should provide a platform for information seeking on illness-related changes in the quality of sexual activity.
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Affiliation(s)
- Christiane Kugler
- Faculty of Medicine, Nursing Science, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Michael Meng
- Faculty of Medicine, Nursing Science, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Erik Rehn
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Katharina Tigges-Limmer
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
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11
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Baert A, Clays E, Bolliger L, De Smedt D, Lustrek M, Vodopija A, Bohanec M, Puddu PE, Ciancarelli MC, Schiariti M, Derboven J, Tartarisco G, Pardaens S. A Personal Decision Support System for Heart Failure Management (HeartMan): study protocol of the HeartMan randomized controlled trial. BMC Cardiovasc Disord 2018; 18:186. [PMID: 30261836 PMCID: PMC6161437 DOI: 10.1186/s12872-018-0921-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022] Open
Abstract
Background Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure available. Therefore, improving disease management is crucial, with mobile health (mHealth) being a promising technology. The aim of the HeartMan study is to evaluate the effect of a personal mHealth system on top of standard care on disease management and health-related quality of life (HRQoL) in HF. Methods HeartMan is a randomized controlled 1:2 (control:intervention) proof-of-concept trial, which will enrol 120 stable ambulatory HF patients with reduced ejection fraction across two European countries. Participants in the intervention group are equipped with a multi-monitoring health platform with the HeartMan wristband sensor as the main component. HeartMan provides guidance through a decision support system on four domains of disease management (exercise, nutrition, medication adherence and mental support), adapted to the patient’s medical and psychological profile. The primary endpoint of the study is improvement in self-care and HRQoL after a six-months intervention. Secondary endpoints are the effects of HeartMan on: behavioural outcomes, illness perception, clinical outcomes and mental state. Discussion HeartMan is technologically the most innovative HF self-management support system to date. This trial will provide evidence whether modern mHealth technology, when used to its full extent, can improve HRQoL in HF. Trial registration This trial has been registered on https://clinicaltrials.gov/ct2/show/NCT03497871, on April 13 2018 with registration number NCT03497871.
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Affiliation(s)
- Anneleen Baert
- Department of Public Health, Ghent University, University Hospital Ghent, entrance 42 (4K3) Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Els Clays
- Department of Public Health, Ghent University, University Hospital Ghent, entrance 42 (4K3) Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Larissa Bolliger
- Department of Public Health, Ghent University, University Hospital Ghent, entrance 42 (4K3) Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health, Ghent University, University Hospital Ghent, entrance 42 (4K3) Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Mitja Lustrek
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Aljoša Vodopija
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Marko Bohanec
- Department of Knowledge Technologies, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Paolo Emilio Puddu
- Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Michele Schiariti
- Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Gennaro Tartarisco
- Italian National Research Council (CNR) - Institute of Applied Science and Intelligent System (IASI), Messina Unit, Messina, Italy
| | - Sofie Pardaens
- Department of Public Health, Ghent University, University Hospital Ghent, entrance 42 (4K3) Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Onze-Lieve-Vrouw Hospital Aalst, Cardiovascular Center, Aalst, Belgium.
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12
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Grant JS, Graven LJ. Problems experienced by informal caregivers of individuals with heart failure: An integrative review. Int J Nurs Stud 2018; 80:41-66. [PMID: 29353711 DOI: 10.1016/j.ijnurstu.2017.12.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/13/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this review was to examine and synthesize recent literature regarding problems experienced by informal caregivers when providing care for individuals with heart failure in the home. DESIGN Integrative literature review. DATA SOURCES A review of current empirical literature was conducted utilizing PubMed, CINAHL, Embase, Sociological Abstracts, Social Sciences Full Text, PsycARTICLES, PsycINFO, Health Source: Nursing/Academic Edition, and Cochrane computerized databases. 19 qualitative, 16 quantitative, and 2 mixed methods studies met the inclusion criteria for review. REVIEW METHODS Computerized databases were searched for a combination of subject terms (i.e., MeSH) and keywords related to informal caregivers, problems, and heart failure. The title and abstract of identified articles and reference lists were reviewed. Studies were included if they were published in English between January 2000 and December 2016 and examined problems experienced by informal caregivers in providing care for individuals with heart failure in the home. Studies were excluded if not written in English or if elements of caregiving in heart failure were not present in the title, abstract, or text. Unpublished and duplicate empirical literature as well as articles related to specific end-stage heart failure populations also were excluded. Methodology described by Cooper and others for integrative reviews of quantitative and qualitative research was used. Quality appraisal of the included studies was evaluated using the Joanna Briggs Institute critical appraisal tools for cross-sectional quantitative and qualitative studies. RESULTS Informal caregivers experienced four key problems when providing care for individuals with heart failure in the home, including performing multifaceted activities and roles that evolve around daily heart failure demands; maintaining caregiver physical, emotional, social, spiritual, and financial well-being; having insufficient caregiver support; and performing caregiving with uncertainty and inadequate knowledge. CONCLUSIONS Informal caregivers of individuals with heart failure experience complex problems in the home when providing care which impact all aspects of their lives. Incorporating advice from informal caregivers of individuals with heart failure will assist in the development of interventions to reduce negative caregiver outcomes. Given the complex roles in caring for individuals with heart failure, multicomponent interventions are potentially promising in assisting informal caregivers in performing these roles.
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Affiliation(s)
- Joan S Grant
- University of Alabama at Birmingham, School of Nursing, 1701 University Blvd, Birmingham, AL 35294-1210, United States.
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Arenhall E, Eriksson M, Nilsson U, Steinke EE, Fridlund B. Decreased sexual function in partners after patients’ first-time myocardial infarction. Eur J Cardiovasc Nurs 2018; 17:521-526. [DOI: 10.1177/1474515117751904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied. Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner. Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics. Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency. Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction.
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Affiliation(s)
- Eva Arenhall
- Department of Cardiology, Örebro University, Sweden
- School of Medical Sciences, Örebro University, Sweden
| | - Mats Eriksson
- School of Health Sciences, Örebro University, Sweden
| | | | | | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Sweden
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14
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Nieminen MS, Fonseca C, Brito D, Wikström G. The potential of the inodilator levosimendan in maintaining quality of life in advanced heart failure. Eur Heart J Suppl 2017; 19:C15-C21. [PMID: 29249906 PMCID: PMC5932556 DOI: 10.1093/eurheartj/sux003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Maintaining adequate quality of life (QoL) is an important therapeutic objective for patients with advanced heart failure and, for some patients, may take precedence over prolonging life. Achieving good QoL in this context may involve aspects of patient care that lie outside the familiar limits of heart failure treatment. The inodilator levosimendan may be advantageous in this setting, not least because of its sustained duration of action, ascribed to a long-acting metabolite designated OR-1896. The possibility of using this drug in an outpatient setting is a notable practical advantage that avoids the need for patients to attend a clinic appointment. Intermittent therapy can be integrated into a wider system of outreach and patient monitoring. Practical considerations in the use of levosimendan as part of a palliative or end-of-life regimen focused on preserving QoL include the importance of starting therapy at low doses and avoiding bolus administration unless immediate effects are required and patients have adequate baseline arterial blood pressure.
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Affiliation(s)
- Markku S Nieminen
- Heart and Lung Center, Helsinki University Hospital, Meilahti Tower Hospital, PL 340, 00029 HUS Helsinki, Finland
| | - Cândida Fonseca
- Heart Failure Unit, Department of Internal Medicine, Hospital Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal
| | - Dulce Brito
- Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Gerhard Wikström
- Department of Cardiology, Institute of Medical Sciences, Uppsala University, Akademiska sjukhuset, Ing.40, 5 tr, 751 85 Uppsala, Sweden
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Fruhwald S, Pollesello P, Fruhwald F. Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations. Expert Rev Cardiovasc Ther 2016; 14:1335-1347. [PMID: 27778514 DOI: 10.1080/14779072.2016.1247694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.
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Affiliation(s)
- Sonja Fruhwald
- a Department of Anesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine , Medical University of Graz , Graz , Austria
| | - Piero Pollesello
- b Critical Care Proprietary Products , Orion Pharma , Espoo , Finland
| | - Friedrich Fruhwald
- c Department of Internal Medicine, Division of Cardiology , Medical University of Graz , Graz , Austria
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16
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Jaarsma T. Sexual function of patients with heart failure: facts and numbers. ESC Heart Fail 2016; 4:3-7. [PMID: 28217306 PMCID: PMC5292636 DOI: 10.1002/ehf2.12108] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022] Open
Abstract
Approximately 60% to 87% of patients with heart failure (HF) report sexual problems, and numbers as low as 31% of HF patients younger than 70 have normal sexual function. When compared with healthy elders, the amount of perceived sexual dysfunction might be similar (around 56%), but patients with HF are reporting more erectile dysfunction (ED) and also perceive that their HF symptoms (20%) or HF medication (10%) is the cause for their problems. The prevalence of ED is highly prevalent in men with cardiac disease and reported in up to 81% of cardiac patients, compared with 50% in the general older population. In total 25-76% of women with HF report sexual problems or concerns. The physical effort related to sexual activity in cardiac patients can be compared to mild to moderate physical activity. The related energy expenditure of sexual activity falls in the range of three to five metabolic units (METs), which can be compared to the energy needed to climb three flights of stairs, general housework, or gardening. Information about sexual activity is often overlooked by health care professionals treating HF patients. Advice and counselling about this subject are needed to decrease worries of patients and partners, avoid skipping medication because of fear for side effects, or prevent inappropriate use of potency enhancing drugs or herbs.
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Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Division of NursingLinköping UniversityLinköpingSweden; Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneVic.Australia
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17
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Aaberg V. The state of sexuality education in baccalaureate nursing programs. NURSE EDUCATION TODAY 2016; 44:14-19. [PMID: 27429324 DOI: 10.1016/j.nedt.2016.05.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is a great deal of consensus about the need for sexuality education in nursing education programs, however the current state of sexuality education in the United States in terms of the content and amount of time dedicated to sexuality content has not been examined since 1976. OBJECTIVES The purpose of this study is to describe the amount and focus of sexuality content currently taught and to identify the barriers to the inclusion of sexuality education in baccalaureate nursing programs in the United States. DESIGN This is an exploratory, descriptive study. SETTINGS Data was gathered from nurse educators across the United States. PARTICIPANTS Nurse educators who teach in baccalaureate nursing programs in the United States. METHODS Online email survey with closed and open questions. Open responses were categorized and counted. RESULTS The current state of sexuality education in nursing programs in the United States was examined and found to be lacking consistent and adequate information. Only 16% of nurse educator participants believe their students are prepared to deal with sexuality issues in the clients they work with and 27% report that sexuality content is not part of their curriculum. Some programs do not cover content such as LGBT sexual health, normal sexual function, and taking a sexual history. Barriers to sexuality education include lack of time, higher priority given to other content, and lack of comfort with the topic. CONCLUSIONS Sexuality education in nursing programs is lacking and this oversight prevents the adequate education of nursing students. This lack of adequate sexuality content highlights the need for standardization of sexuality education in nursing curricula so that nursing students can learn to provide truly holistic care of clients.
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Affiliation(s)
- Vicki Aaberg
- RN 3307 Third Ave West, Suite 106, Seattle Pacific University, Seattle, WA 98119, United States
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Steinke EE, Jaarsma T. Sexual counseling and cardiovascular disease: practical approaches. Asian J Androl 2016; 17:32-9. [PMID: 25219908 PMCID: PMC4291873 DOI: 10.4103/1008-682x.135982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, Kansas, USA
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