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Liao C, Guan Q, Ma X, He X, Su Y, Fan D, Liu J, Ye J, He X, Cui P. Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity. J Clin Nurs 2024. [PMID: 39128973 DOI: 10.1111/jocn.17385] [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: 03/05/2024] [Revised: 05/28/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Developing a severity assessment scale for critically ill patients' thirst and conducting reliability and validity tests, aiming to provide healthcare professionals with a scientific and objective tool for assessing the level of thirst. METHODS Based on literature review and qualitative interviews, a pool of items was generated, and a preliminary scale was formed through two rounds of Delphi expert consultation. Convenience sampling was employed to select 178 ICU patients in a top-three hospital from May 2023 to October 2023 as the study subjects to examine the reliability and validity of the severity assessment scale for critically ill patients' thirst. RESULTS The developed severity assessment scale for critically ill patients' thirst consists of 8 evaluation items and 26 evaluation indicators. The agreement coefficients for two rounds of expert consultation were 100% and 92.6% for the positive coefficient, and the authority coefficients were .900 and .906. Kendall's concordance coefficients were .101 and .120 (all p < .001). The overall Cronbach's α coefficient for the scale was .827. The inter-rater reliability coefficient was .910. The Item-Content Validity Index (I-CVI) ranged from .800 to 1.000, and the Scale-Content Validity Index/Average (S-CVI/Ave) was .950. CONCLUSION The critically ill patients' thirst assessment scale is reliable and valid and can be widely used in clinical practice. PATIENT OR PUBLIC CONTRIBUTION The AiMi Academic Services (www.aimieditor.com) for English language editing and review services. IMPLICATIONS FOR CLINICAL PRACTICE The scale developed in this study is a simple and ICU-specific scale that can be used to assess the severity of thirst in critically ill patients. As such, the severity of thirst in critically ill patients can be evaluated quickly so that targeted interventions can be implemented according to the patient's specific disease and treatment conditions. Therefore, patient comfort can be improved, and thirst-related health problems can be prevented.
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Affiliation(s)
- Chunli Liao
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Qiongyao Guan
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Xiangping Ma
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Xueting He
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Yan Su
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Dandan Fan
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Jing Liu
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Jinyu Ye
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Xifeng He
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Pengyu Cui
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
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Kato NP, Nagatomo Y, Kawai F, Kitai T, Mizuno A. Fluid Restriction for Patients with Heart Failure: Current Evidence and Future Perspectives. J Pers Med 2024; 14:741. [PMID: 39063995 PMCID: PMC11277838 DOI: 10.3390/jpm14070741] [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: 05/20/2024] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Fluid restriction has long been believed to benefit patients with heart failure by counteracting the activated renin-angiotensin aldosterone system and sympathetic nervous activity. However, its effectiveness remains controversial. In this paper, we summarized the current recommendations and reviewed the scientific evidence on fluid restriction in the setting of both acute decompensated heart failure and compensated heart failure. While a recent meta-analysis demonstrated the beneficial effects of fluid restriction on both all-cause mortality and hospitalization compared to usual care, several weaknesses were identified in the assessment of the methodological quality of the meta-analysis using AMSTAR 2. Further randomized controlled trials with larger sample sizes are needed to elucidate the benefits of fluid restriction for both clinical outcomes and patient-reported outcomes in patients with heart failure.
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Affiliation(s)
- Naoko P. Kato
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan;
| | - Fujimi Kawai
- Library, Department of Academic Resources, St. Luke’s International University, Tokyo 104-0044, Japan;
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita 564-8565, Japan;
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
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3
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Zheng Y, Chen Q, Xia C, Liu H. Thirst symptoms in patients with heart failure: An integrative review. J Adv Nurs 2024. [PMID: 38771082 DOI: 10.1111/jan.16250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/29/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To identify the risk and protective factors affecting thirst symptoms in patients with heart failure (HF) and intervention strategies to alleviate thirst symptoms. DESIGN An integrative review. METHODS A total of 61 articles were retrieved. Screening yielded a total of 21 articles which were appraised for quality. The quality of studies was assessed using the Mixed Methods Appraisal Tool. DATA SOURCES Ten electronic databases were searched in October 2023, including Embase, Pubmed, CINAHL, Cochrane, Web of Science, Wiley, CNKI, VIP, CBM and WanFang. In addition, we searched grey databases and manually searched reference lists of included and relevant reviews. RESULTS In total, 1644 articles were retrieved, of which 21 were included. Eight studies addressed the factors. Six themes emerged as risk factors, including demographics, severity of disease, psycho-environmental, medication, fluid restriction and homeostasis. Conversely, an increase in fluid intake, a high score of sodium restriction diet attitude and using ARB were identified as protective factors. Thirteen studies focus on intervention strategies. Five unique intervention strategies were identified, including Traditional Chinese Medicine, mint-related interventions, sour-flavour interventions, improved water restriction and cluster nursing strategy. CONCLUSION This finding identified the factors associated with thirst symptoms in patients with HF, especially concerning the elaboration of risk factors, which suggests that healthcare professionals should focus on the risk factors for thirst in patients with HF and consciously avoid the occurrence of these risk factors. Additionally, there are considerable cultural differences in interventions, therefore, to increase adherence during symptom management, careful selection of appropriate intervention strategies based on the requirements and preferences of patients is required. While there are some therapies, there aren't enough high-quality empirical investigations. Thus, multi-centre, large-sample studies are also required in subsequent research to demonstrate the interventions' effectiveness. IMPLICATIONS FOR THE PROFESSION The nurse must notice the symptoms of thirst in HF to slow down the disease's progression and improve the patient's physical and emotional well-being. REPORTING METHOD The review complies with the PRISMA guidelines for reporting systematic reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yingjun Zheng
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Qiongshan Chen
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Chengyu Xia
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Hui Liu
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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Saracíbar-Razquin M, Zaragoza-Salcedo A, Martín-Martín J, Cobo-Sanchez JL, Pérez-García S, Simón-Ricart A, Ara-Lucea P, Jimeno-San Martín L, Ducay-Eguillor M, De La Torre-Lomas N, Pérez-Herreros J, Olano-Lizarraga M. Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale. An Sist Sanit Navar 2024; 47:e1071. [PMID: 38626132 PMCID: PMC11095135 DOI: 10.23938/assn.1071] [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: 10/26/2023] [Revised: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose. METHODS The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale. RESULTS The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items. CONCLUSIONS This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.
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Affiliation(s)
| | - Amparo Zaragoza-Salcedo
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
| | - Jesús Martín-Martín
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
| | | | | | - Aurora Simón-Ricart
- Clínica Universidad de Navarra. Cardiology Department. Pamplona. Spain. https://ror.org/03phm3r45.
| | - Pilar Ara-Lucea
- Clínica Universidad de Navarra. Cardiology Department. Pamplona. Spain. https://ror.org/03phm3r45.
| | | | | | - Noelia De La Torre-Lomas
- University Hospital 12 de Octubre. Cardiology Department. Madrid. Spain. https://ror.org/00qyh5r35.
| | - Jesica Pérez-Herreros
- Hospital Universitario Marqués de Valdecilla. Advanced Heart Failure and Heart Transplant Unit. Santander. Spain. https://ror.org/01w4yqf75.
| | - Maddi Olano-Lizarraga
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
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5
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Kleissl-Muir S, Owen A, Rasmussen B, Zinn C, Driscoll A. Effects of a low carbohydrate diet on heart failure symptoms and quality of life in patients with diabetic cardiomyopathy: A randomised controlled trial pilot study. Nutr Metab Cardiovasc Dis 2023; 33:2455-2463. [PMID: 37798235 DOI: 10.1016/j.numecd.2023.08.015] [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: 05/11/2023] [Revised: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Heart failure, insulin resistance and/or type 2 diabetes mellitus coexist in the syndrome that is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy experience high symptom burden and poor quality of life. We tested the hypothesis that a low carbohydrate diet improves heart failure symptoms and quality of life in patients with diabetic cardiomyopathy. METHODS AND RESULTS We conducted a 16-week randomised controlled pilot trial comparing the effects of a low carbohydrate diet (LC) to usual care (UC) in 17 adult patients with diabetic cardiomyopathy. New York Heart Association classification, weight, thirst distress and quality of life scores as well as blood pressure and biochemical data were assessed at baseline and at 16 weeks. Thirteen (n = 8 LC; n = 5 UC) patients completed the trial. The low carbohydrate diet induced significant weight loss in completers (p = 0.004). There was a large between-group difference in systolic blood pressure at the end of the study (Hedges's g 0.99[-014,2.08]). There were no significant differences in thirst or quality of life between groups. CONCLUSION This is the first clinical trial utilising the low carbohydrate dietary approach in patients with diabetic cardiomyopathy in an outpatient setting. A low carbohydrate diet can lead to significant weight loss in patients with diabetic cardiomyopathy. Future clinical trials with larger samples and that focus on fluid and sodium requirements of patients with diabetic cardiomyopathy who engage in a low carbohydrate diet are warranted. CLINICAL TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12620001278921. DATE OF REGISTRATION 26th November 2020.
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Affiliation(s)
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, Geelong, VIC, Australia; Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, VIC, Australia; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense M, Denmark
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Cardiology, Austin Health, Heidelberg, VIC, Australia; School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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6
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Picó-Munyoz R, Tárrega A, Laguna L. Origins of thirstiness sensation and current food solutions. Compr Rev Food Sci Food Saf 2023; 22:4433-4450. [PMID: 37583300 DOI: 10.1111/1541-4337.13229] [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: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.
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Affiliation(s)
- Ruth Picó-Munyoz
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Amparo Tárrega
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Laura Laguna
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
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7
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Gocay Bek SG, Yıldız N, Islam M, Ergul M, Sarıoglu I, Guven Taymez D, Eren N, Uslu H, Tosun M, Dervisoglu E, Kalender B, Balcı S, Waldreus N. Thirst intensity survey in ADPKD patients. Clin Exp Nephrol 2023; 27:819-827. [PMID: 37351680 DOI: 10.1007/s10157-023-02373-7] [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: 03/05/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION With increased fluid intake and tolvaptan treatment, the growth rate of cysts can be theoretically decelerated in autosomal polycystic kidney disease. In this prospective study, it was planned to evaluate thirst sensation in these patients and the parameters affecting its intensity. METHODS Forty-one ADPKD patients on tolvaptan and 40 ADPKD patients not on tolvaptan as the control group were evaluated for thirst distress sensation and intensity. The feeling of thirst and the discomfort caused by excessive fluid intake was assessed with Thirst Distress Scale-HF 12 questions (60/12). Thirst intensity was evaluated with a 100 mm visual scale. RESULTS Of the whole group, 35.8% (29) were males, and 64.2% (52) were females. The mean age of the tolvaptan group was 39.17 ± 9.35 years and for the control group, it was 41.95 ± 12.29 years. There was a negative correlation between the thirst distress score of the patients and an increase in creatinine level after a year of tolvaptan treatment (r = - 0.335, p = 0.035). The patients not taking thiazide had higher thirst intensity scores (p = 0.004). There was no impact of tolvaptan dosage, total kidney volume, serum sodium, urinary osmolarity or eGFR on thirst distress and thirst intensity scores. DISCUSSION/CONCLUSION Only thiazide co-treatment had a positive impact on thirst distress and intensity when given tolvaptan. Thirst Distress Scale for ADPKD patients can be used to classify patients before and during tolvaptan treatment.
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Affiliation(s)
- Sibel Gokcay Gocay Bek
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey.
| | - Nuriye Yıldız
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey
| | - Mahmud Islam
- Department of Nephrology, Sakarya University, Sakarya, Turkey
| | - Metin Ergul
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey
| | - Irem Sarıoglu
- Department of Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Necmi Eren
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey
| | - Hande Uslu
- Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Mesude Tosun
- Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Erkan Dervisoglu
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey
| | - Betul Kalender
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli, 41100, Turkey
| | - Sibel Balcı
- Department of Biostatistics and Medical Informatics, Kocaeli University Hospital, Kocaeli, Turkey
| | - Nana Waldreus
- Department of Neurobiology, Care Sciences and Society, Karollinska Institute, Huddinge, Sweden
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Chen Y, Ding J, Xi Y, Huo M, Mou Y, Song Y, Zhou H, Cui X. Thirst in heart failure: A scoping review. Nurs Open 2023; 10:4948-4958. [PMID: 37247329 PMCID: PMC10333895 DOI: 10.1002/nop2.1818] [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: 12/06/2022] [Revised: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
AIM The aim of this study was to summarise the overall picture of thirst-related research in patients with heart failure. DESIGN We conducted a scoping review following the Arskey and O'Malley methodological framework along with the PAGER framework. METHODS PubMed, CINAHL, Web of Science, Embase, The Cochrane Library, Jonna Briggs Institute, ProQuest Database, Google Scholar, PsycINFO, PQDT, CNKI, Wan Fang, VIP and CBM. Additionally, grey literature including grey databases (Opengrey, OpenDoar, Openaire and BASEL Bielefeld Academic Search Engine), conferences or articles (Scopus and Microsoft Academic), graduate theses databases (eTHOS, DART Europe, Worldcat and EBSCO Open Dissertations) and government information media (UK guidance and regulations, USA government websites, EU Bookshop and UN official publications) were searched. The databases were searched from inception to 18 August 2022 for Articles written in English and Chinese. Two researchers independently screened articles based on inclusion and exclusion criteria, and a third researcher adjudicated disagreements. RESULTS We retrieved 825 articles, of which 26 were included. Three themes were summarised from these articles: (a) the incidence of thirst in patients with heart failure; (b) the thirst-related factors in patients with heart failure; and (c) the intervention measures of thirst in patients with heart failure.
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Affiliation(s)
- Yaya Chen
- Department of NursingGansu University of Chinese MedicineLanzhouGansuChina
- Cardiovascular DepartmentThe First People's Hospital of Li CountyLixianGansuChina
| | - Jin Ding
- Cardiovascular CenterAffiliated Hospital of Gansu University of Traditional Chinese MedicineLanzhouGansuChina
| | - Yingbo Xi
- Cardiovascular CenterAffiliated Hospital of Gansu University of Traditional Chinese MedicineLanzhouGansuChina
| | - Minfeng Huo
- Department of Basic MedicineGansu University of Chinese MedicineLanzhouGansuChina
| | - Yingjian Mou
- Cardiovascular DepartmentThe First People's Hospital of Li CountyLixianGansuChina
| | - Yu Song
- Department of NursingGansu University of Chinese MedicineLanzhouGansuChina
| | - Hailing Zhou
- Department of NursingGansu University of Chinese MedicineLanzhouGansuChina
- Cardiovascular CenterAffiliated Hospital of Gansu University of Traditional Chinese MedicineLanzhouGansuChina
| | - Xiaoqin Cui
- Department of NursingGansu University of Chinese MedicineLanzhouGansuChina
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9
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Montgomery RA, Mauch J, Sankar P, Martyn T, Engelman T, Martens P, Faulkenberg K, Menon V, Estep JD, Tang WHW. Oral Sodium to Preserve Renal Efficiency in Acute Heart Failure: A Randomized, Placebo-Controlled, Double-Blind Study. J Card Fail 2023; 29:986-996. [PMID: 37044281 DOI: 10.1016/j.cardfail.2023.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Evidence for modulating the sodium chloride (NaCl) intake of patients hospitalized with acute heart failure (AHF) is inconclusive. Salt restriction may not benefit; hypertonic saline may aid diuresis. OBJECTIVE To compare the safety and efficacy of oral NaCl during intravenous (IV) diuretic therapy in renal function and weight. METHODS Seventy hospitalized patients with AHF who were being treated with IV furosemide infusion consented to receive, randomly, 2 grams of oral NaCl or placebo 3 times a day in a double-blind manner during diuresis. Treatment efficacy (bivariate primary endpoints of change in serum creatinine levels and change in weight) was measured at 96 hours, and adverse safety events were tracked for 90 days. RESULTS Sixty-five patients (34 NaCl, 31 placebo) were included for analysis after 5 withdrew. A median of 13 grams of NaCl was given compared to placebo. At 96 hours, there was no significant difference between treatment groups with respect to the primary endpoint (P = 0.33); however, the trial was underpowered, and there was greater than expected standard deviation in weight change. The mean change in creatinine levels and weight was 0.15 ± 0.44 mg/dL and 4.6 ± 4.2 kg in the placebo group compared with 0.04 ± 0.40 mg/dL and 4.0 ± 4.3 kg in the NaCl group (P = 0.30 and 0.57, respectively). Across efficacy and safety endpoints, we observed no significant difference between the 2 groups other than changes in serum sodium levels (-2.6 ± 2.7 in the placebo group and -0.3 ± 3.3 mEq/L in the NaCl group; P < 0.001) and in serum blood urea nitrogen levels (11 ± 15 in the placebo group; 3.1 ± 13 mEq/L in the NaCl group; P = 0.025). CONCLUSIONS In this single-center study, liberal vs restrictive oral sodium chloride intake strategies did not impact the safety and efficacy of intravenous diuretic therapy in patients with AHF. (ClinicalTrials.gov registration NCT04334668.).
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Affiliation(s)
- Robert A Montgomery
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Mauch
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | | | - Trejeeve Martyn
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Tim Engelman
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Pieter Martens
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Kathleen Faulkenberg
- Department of Pharmacy Practice & Science, University of Kentucky, Lexington, KY
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Jerry D Estep
- Department of Cardiology, Cleveland Clinic Weston, Weston. FL
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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10
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Çiftçi B, Yıldız GN, Avşar G, Köse S, Aydın E, Doğan S, Çelik Ş. Development of the Thirst Discomfort Scale: A Validity and Reliability Study. Am J Crit Care 2023; 32:176-183. [PMID: 37121897 DOI: 10.4037/ajcc2023954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Thirst is a sensation associated with a dry mouth and the desire or craving to drink water. Surgical patients are among those hospitalized individuals who are at high risk of developing both osmotic and hypovolemic thirst. OBJECTIVES To develop a new measurement tool for evaluating the thirst-related discomfort of surgical patients and to assess its validity and reliability. METHODS The study population consisted of patients admitted to the surgical clinics of a research hospital in Turkey between January and March 2022. The new measurement tool was developed in several stages: a pilot implementation phase with 51 patients and the main implementation phase with 198 patients. Data were collected by means of face-to-face interviews with patients. Exploratory factor and confirmatory factor analyses were performed using IBM SPSS Statistics, version 22, and IBM SPSS Amos. RESULTS The final Thirst Discomfort Scale consisted of 12 items in 3 subdimensions. The Cronbach α values of the scale subdimensions ranged from 0.787 to 0.848, and the Cronbach α value for the scale as a whole was 0.886. The scale explained 66.237% of the total variance of the data. CONCLUSION The Thirst Discomfort Scale consisting of 12 items and 3 subdimensions is a valid and reliable measurement tool for evaluating thirst-related discomfort of surgical patients.
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Affiliation(s)
- Bahar Çiftçi
- Bahar Çiftçi is an assistant professor, Department of Fundamentals of Nursing, Atatürk University, Atateknokent, Erzurum, Turkey
| | - Güzel Nur Yıldız
- Güzel Nur Yıldız is an instructor, Department of Dialysis, Muş Alparslan University, Muş, Turkey
| | - Gülçin Avşar
- Gülçin Avşar is an associate professor, Department of Fundamentals of Nursing, Atatürk University, Atateknokent, Erzurum, Turkey
| | - Sema Köse
- Sema Köse is an instructor, Department of Nursing, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Esra Aydın
- Esra Aydın is an instructor, Department of Dialysis, Gümüşhane University, Gümüşhane, Turkey
| | - Sevgi Doğan
- Sevgi Doğan is a research assistant, Department of Fundamentals of Nursing, Atatürk University, Erzurum, Turkey
| | - Şeymanur Çelik
- Şeymanur Çelik is a research assistant, Department of Fundamentals of Nursing, Atatürk University, Erzurum, Turkey
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11
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Wefer F, Inkrot S, Waldréus N, Jaarsma T, von Cube M, Kugler C. Translation and Psychometric Evaluation of the German Version of the Thirst Distress Scale for Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:378-385. [PMID: 37707971 DOI: 10.1097/jcn.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with chronic heart failure, thirst can be perceived as an intensive and burdensome symptom, which may have a negative impact on patients' quality of life. To initiate thirst-relieving interventions, assessment of thirst and its related distress is essential. At the time of this study, no instrument was available to evaluate thirst distress in patients with heart failure in Germany. OBJECTIVE The aims of this study were to translate the "Thirst Distress Scale for patients with Heart Failure" (TDS-HF) from English into German and to test validity and reliability of the scale. METHODS The English version of the TDS-HF was translated into German. A linguistically and culturally sensitive forward-and-backward translation was performed. Psychometric evaluation included confirmatory factor analysis, reliability in terms of internal consistency, and concurrent validity. RESULTS Eighty-four hospitalized patients (mean age, 72 ± 10 years; 29% female; mean left ventricular ejection fraction, 36% ± 12%; 62% New York Heart Association functional classes III-IV, 45% on fluid restriction) from an acute care hospital were involved in the study. The item-total correlation ranged from 0.58 to 0.78. Interitem correlations varied between 0.37 and 0.79. Internal consistency was high, with a Cronbach α of 0.89. There was a high correlation between the total score of the TDS-HF and the visual analog scale to assess thirst intensity ( r = 0.72, P ≤ .001), and a low correlation with fluid restriction ( r = 0.35, P = .002). CONCLUSIONS The evaluation of the German TDS-HF showed satisfactory psychometric properties in this sample. The instrument is usable for further research and additional psychometric testing.
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12
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Herrmann JJ, Beckers-Wesche F, Baltussen LEHJM, Verdijk MHI, Bellersen L, Brunner-la Rocca HP, Jaarsma T, Pisters R, Sanders-van Wijk S, Rodwell L, Van Royen N, Gommans DHF, Van Kimmenade RRJ. Fluid REStriction in Heart failure versus liberal fluid UPtake: Rationale and design of the randomised FRESH-UP study. J Card Fail 2022; 28:1522-1530. [PMID: 35705150 DOI: 10.1016/j.cardfail.2022.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 12/11/2022]
Abstract
AIMS It is common practice for clinicians to advise fluid restriction to heart failure (HF) patients, but data from clinical trials are lacking. Moreover, fluid restriction is associated with thirst distress and may adversely impact quality of life (QoL). To address this gap in evidence, the Fluid REStriction in Heart failure versus liberal fluid UPtake (FRESH-UP) study was initiated. METHODS The FRESH-UP study is a randomised, controlled, open-label, multicentre trial to investigate the effect of a 3-month period of liberal fluid intake versus fluid restriction (1500ml/day) on QoL in outpatient chronic HF patients (NYHA II-III). The primary aim is to assess the effect on QoL after 3 months using the Overall Summary Score of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Thirst distress as assessed by the Thirst Distress Scale for patients with HF, KCCQ Clinical Summary Score, each of the KCCQ domains and clinically meaningful changes in these scores, the EQ-5D-5L, patient reported fluid intake and safety (i.e. death, HF hospitalisations) are secondary outcomes. The FRESH-UP study is registered at ClinicalTrials.gov (NCT04551729). CONCLUSION The results of the FRESH-UP study will substantially add to the level of evidence concerning fluid management in chronic HF and may impact QoL of these patients.
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Affiliation(s)
- Job J Herrmann
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | | | - Marjolein H I Verdijk
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Tiny Jaarsma
- Faculty of Medical and Health Sciences, Department of Social and Welfare Studies, Linköping University, Sweden
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Sandra Sanders-van Wijk
- Department of Cardiology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, The Netherlands
| | - Laura Rodwell
- Section Biostatistics, Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Niels Van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D H Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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13
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van der Wal MHL, Jaarsma T, Jenneboer LC, Linssen GCM. Thirst in stable heart failure patients; time to reconsider fluid restriction and prescribed diuretics. ESC Heart Fail 2022; 9:2181-2188. [PMID: 35546481 PMCID: PMC9288740 DOI: 10.1002/ehf2.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 01/28/2023] Open
Abstract
Aims One of the bothersome symptoms that heart failure (HF) patients can experience is thirst. There are limited data on the association between thirst and fluid intake and clinical variables. Therefore, the aim of this study was to describe severe thirst in stable HF patients and assess factors related to severe thirst, including actual fluid intake and sodium intake. Methods and results The study had a cross‐sectional design. Stable HF patients from two HF clinics in the Netherlands were included and assessed thirst by a visual analogue scale ranging from 0 to 100. They also completed questionnaires on thirst distress, self‐care behaviour, and HF symptoms. A 3 day food diary was completed to assess actual fluid intake and sodium intake. Finally, patients collected urine for 24 h. Patients were divided into severe and low thirst based on thirst score and thirst distress. T‐tests, Mann–Whitney tests, and χ2 tests were conducted to assess differences between both groups. Multivariable logistic regression analysis was performed to assess factors associated with severe thirst. A total of 100 patients were included (40% female, mean age 72 ± 12) of which 68 completed the food diary. The mean thirst score was 28 ± 25, and 25% experienced severe thirst. The majority of patients (94%) were prescribed a fluid restriction, 37% had a restriction between 1500 and 2000 mL, and 32% a restriction of 1500 mL. Severe thirst in the total group with 100 patients was associated with a higher dose of loop diuretics [odds ratio (OR) 3.25; 95% confidence interval (CI) 1.01–10.45; P = 0.048] and a higher urine output over 24 h (OR 1.002; 95% CI 1.00–1.003; P = 0.010). In the group of patients who completed the food diary (N = 68), severe thirst was associated with a higher sodium intake (OR 1.002; 95% CI 1.001–1.003; P = 0.003), a higher dose of loop diuretics (OR 22.69; 95% CI 2.78–185.04; P = 0.004), and more fatigue (OR 11.2; 95% CI 1.54–82.12; P = 0.017). Conclusions A quarter of all stable HF patients experienced severe thirst. A higher dose of loop diuretics was associated with more thirst; therefore, it might be important to review the dose of loop diuretics critically and try to decrease it in order to relieve severe thirst. Because all patients were prescribed a fluid restriction, a reconsideration of this restriction is also suggested.
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Affiliation(s)
- Martje H L van der Wal
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente (Almelo and Hengelo), Almelo, The Netherlands
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14
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Gong J, Waldréus N, Hu S, Luo Z, Xu M, Zhu L. Thirst and factors associated with thirst in hospitalized patients with heart failure in China. Heart Lung 2022; 53:83-88. [DOI: 10.1016/j.hrtlng.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/04/2022]
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15
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Flim M, Hofhuis J, Spronk P, Jaarsma T. Measuring thirst distress of patients in the intensive care unit. Nurs Crit Care 2021; 27:576-582. [PMID: 34612559 DOI: 10.1111/nicc.12719] [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: 11/12/2020] [Revised: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thirst is one of the most intense and distressing symptoms experienced by patients in the intensive care unit (ICU), and no validated measurement tools exist. Validating a thirst measurement tool for the ICU population could be a first step in gaining a better understanding of thirst in ICU patients and aid the development and implementation of strategies regarding the prevention and control of thirst. AIM The objective of this study was to determine the validity and reliability of the "Thirst distress scale for patients with heart failure (TDS-HF)" in measuring thirst distress in adult ICU patients. METHODS Content validity was established by an expert panel consisting of ICU nurses, intensivists and five ICU patients. Concurrent validity, known-groups validity and internal consistency were determined in a consecutive sample of 56 awake and oriented ICU patients with a median age of 70 years (IQR: 57-74). RESULTS Content validity of the TDS-HF in the ICU population was low, with item-content validity indexes between 0.25 and 0.75. Concurrent validity was high as Spearman's correlation between TDS-HF and the numeric rating score (0-10) for thirst distress was 0.71. Internal consistency was high (Cronbach's alpha 0.78). When comparing groups, only higher blood urea nitrogen was significantly related to higher scores on the TDS-HF (P = .003). CONCLUSION The TDS-HF has high concurrent validity and reliability in measuring thirst distress in ICU patients. Nevertheless, questions remain regarding the applicability and content validity of the scale, which should be further explored before the TDS-HF can be used in the ICU. RELEVANCE FOR CLINICAL PRACTICE The TDS-HF can be used to explore thirst distress and to evaluate interventions. Individual items of the scale can be used to explore the nature of thirst distress in individual patients.
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Affiliation(s)
- Marleen Flim
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - José Hofhuis
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - Peter Spronk
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - Tiny Jaarsma
- Utrecht University, Utrecht, The Netherlands.,Clinical Health Sciences, Nursing Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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16
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Ho V, Goh G, Tang XR, See KC. Underrecognition and undertreatment of thirst among hospitalized patients with restricted oral feeding and drinking. Sci Rep 2021; 11:13636. [PMID: 34211006 PMCID: PMC8249500 DOI: 10.1038/s41598-021-93048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/21/2021] [Indexed: 11/08/2022] Open
Abstract
Thirst is distressing but overlooked by healthcare professionals. Patients experience thirst due to comorbidities, physical or cognitive limitations, and iatrogenesis. Nasogastric tube (NGT) use and nil-by-mouth(NBM) orders are common practices that can lead to thirst. However, thirst in these populations has never been formally studied. We aim to examine prevalence of recognition and treatment of thirst among NGT + NBM and NBM patients. Our descriptive study was conducted intermittently over 25 weeks, across 1.5 years, in 12 adult general medicine wards of a tertiary hospital. Cognitively intact NGT + NBM or NBM inpatients, defined as Abbreviated Mental Test score ≥ 8, were studied. One-time questionnaire was administered. Variables included: demography, co-morbidities, clinical condition, feeding route, thirst defined by thirst distress and/or intensity ≥ 3, pain, hunger and volume status. 88 NGT + NBM and NBM patients were studied. 69.3% suffered from thirst. Thirsty patients experienced significant thirst-related distress (mean score ± SD: 5.7 ± 2.5). Subjects with previous stroke and who were euvolemic tended towards thirst. 13.6% were asked about thirst by doctors or nurses. Thirst was a major source of patient distress in our study. We suggest that thirst needs to be actively identified and targeted to achieve person-centred care.
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Affiliation(s)
- Vanda Ho
- Department of Geriatric Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
| | - Gordon Goh
- Yong Loo Lin School of Medicine, National University, Singapore, Singapore
| | - Xuan Rong Tang
- Yong Loo Lin School of Medicine, National University, Singapore, Singapore
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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17
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Eng SH, Waldréus N, González B, Ehrlin J, Díaz V, Rivas C, Velayos P, Puertas M, Ros A, Martín P, Lupón J, Bayes-Genis A, Jaarsma T. Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain. ESC Heart Fail 2021; 8:2492-2501. [PMID: 33942551 PMCID: PMC8318476 DOI: 10.1002/ehf2.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
Aims This study aimed to evaluate psychometric properties of the Spanish version of the Thirst Distress Scale for patients with Heart Failure (TDS‐HF) and to describe thirst distress‐associated factors in outpatients at a heart failure (HF) clinic in Spain. Thirst is common in patients with HF, but thirst distress has rarely been addressed and may significantly decrease quality of life. Methods and results A cross‐sectional study was performed assessing perceived thirst distress by patients with HF during the preceding 3 days, with the TDS‐HF (scores 8 to 40). Univariable and multivariable linear regression analyses were performed to identify variables independently associated with thirst distress. Three‐hundred two HF outpatients were included (age 67 ± 12 years, 74% male, HF duration 82 ± 75 months, left ventricular ejection fraction 42 ± 14%). Most patients were on treatment with fluid restriction (99%), sodium restriction (99%), and diuretics (70%). The psychometric evaluation of the Spanish version of the TDS‐HF showed satisfactory item‐total and inter‐item correlations (range from 0.77 to 0.85 and 0.60 to 0.84, respectively), and internal consistency was 0.95 (Cronbach's alpha). The majority perceived mild to moderate thirst distress, and 18% perceived it as high or severe. The mean score obtained was 16.2 ± 9.3 (median 13, Q1–Q3 8–20). Higher serum urea {beta coefficient 1.6 [95% confidence interval (CI) 0.267 to 2.92], P = 0.019} and lower potassium [beta coefficient −3.63 (85% CI −6.32 to −0.93), P = 0.009] remained significantly associated with thirst distress in the multivariable analysis, together with the dose of diuretics [beta coefficient 2.98 (95% CI 1.37 to 4.59), P < 0.001]. Treatment with angiotensin receptor blocker showed an independent protective effect [beta coefficient −3.62 (95% CI −6.89 to −0.345), P = 0.03]. Conclusions The psychometric evaluation of the Spanish version of the TDS‐HF showed good psychometric properties. One in five patients experienced severe distress by thirst, but the majority had mild to moderate thirst distress. The dose of diuretics and angiotensin receptor blocker treatment influence thirst distress and could be clinically important targets to relieve thirst distress in patients with HF.
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Affiliation(s)
- Sanna Hagelberg Eng
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Beatriz González
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Jenny Ehrlin
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Violeta Díaz
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Carmen Rivas
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Patricia Velayos
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - María Puertas
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Alba Ros
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Paula Martín
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Tiny Jaarsma
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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18
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Thirst and factors associated with frequent thirst in patients with heart failure in Spain. Heart Lung 2020; 50:86-91. [PMID: 32798064 DOI: 10.1016/j.hrtlng.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Thirst is a troublesome symptom in patients with Heart Failure (HF) and one that might be perceived differently in different countries depending on climate, food and cultural habits. The aims of the study were to describe thirst frequency, duration and intensity and to identify factors associated with frequent thirst in outpatients with HF in a Mediterranean country. METHODS Data was collected in a cross-sectional study involving 302 patients diagnosed with HF (age 67±12 years, 74% male, LVEF 43%±14) in Spain on thirst frequency and duration, and thirst intensity by patient self-report (VAS, 0-100 mm). Clinical variables were collected from the medical files. Regression analysis was used to identify factors independently associated with frequent thirst. RESULTS Of all the patients, 143 (47%) were frequently thirsty, and their median (25th and 75th percentiles) thirst intensity was higher (VAS 50 mm [20-67] vs 7 [0-20], p<.001). Their thirst lasted longer compared to those who never/sometimes were thirsty (p<.001). Less treatment with angiotensin receptor blockers (Odds Ratio [OR] 2.72; 95% Confidence Interval [CI] 1.33-5.58), diuretics >40 mg/day (OR 1.92; 95% CI 1.02-3.64), depression (OR 2.99; CI 1.17-7.62), male gender (OR 1.98; CI 1.08-3.64) and worse New York Heart Association functional class (OR 1.92; 95% CI 1.05-3.52) were independently associated with frequent thirst. CONCLUSIONS About half of patients with HF and fluid restriction experienced frequent thirst in a Mediterranean area of Spain, and their thirst duration and intensity were significantly increased. Frequent thirst was associated with demographic, clinical and therapeutic variables. The results may help to identify patients with a higher risk of frequent thirst and might suggest therapeutic changes in order to diminish this troublesome symptom.
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20
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Sugizaki CSDA, Braga CC, Freitas ATVDS, Peixoto MDRG. Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis. J Bras Nefrol 2020; 42:153-162. [PMID: 32187260 PMCID: PMC7427644 DOI: 10.1590/2175-8239-jbn-2019-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.
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Affiliation(s)
| | - Clarice Carneiro Braga
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa
de Pós-Graduação em Nutrição e Saúde, Goiânia, GO, Brasil
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21
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22
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Moons P. International research in cardiovascular nursing: Getting insight in the role of system factors. Eur J Cardiovasc Nurs 2019; 18:432-434. [PMID: 31023086 DOI: 10.1177/1474515119847031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Moons
- 1 KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium.,2 Institute of Health and Care Sciences, University of Gothenburg, Sweden.,3 Department of Paediatrics and Child Health, University of Cape Town, South Africa
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23
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Waldréus N, Chung ML, van der Wal MH, Jaarsma T. Trajectory of thirst intensity and distress from admission to 4-weeks follow up at home in patients with heart failure. Patient Prefer Adherence 2018; 12:2223-2231. [PMID: 30425459 PMCID: PMC6205128 DOI: 10.2147/ppa.s167724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients' characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression). PATIENTS AND METHODS In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after discharge. Thirst intensity (visual analog scale, 100 mm) and distress (Thirst Distress Scale-HF, score 9-45) were used. Trajectories were examined using growth modeling. RESULTS Trajectory of the thirst intensity was significantly different, for patients with low and high thirst intensity levels (median cut-off 39 mm), from admission to 4 weeks follow up (thirst increased and decreased, respectively). Patients with high level of thirst distress (median score >22) at admission, having fluid restriction and women continued to have higher thirst distress over time. Patients feeling depressed had higher thirst intensity over time. There were no differences in the trajectories of thirst intensity and distress by age, BMI, plasma urea, and anxiety. CONCLUSION Intensity and distress of thirst, having fluid restriction, and feeling depressed at the admission were critical in predicting the trajectory of thirst intensity and distress after discharge to home in patients with HF. Effective intervention relieving thirst should be provided before their discharge to home.
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Affiliation(s)
- Nana Waldréus
- Department of Neurobiology, Division of Nursing, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Martje Hl van der Wal
- Department of Social and Welfare Studies, Division of Nursing Science, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Division of Nursing Science, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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