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Chen X, Qin Y, Chaimongkol N. Effectiveness of a phone-based support program on self-care self-efficacy, psychological distress, and quality of life among women newly diagnosed with breast cancer: A randomized controlled trial. Eur J Oncol Nurs 2024; 71:102643. [PMID: 38889503 DOI: 10.1016/j.ejon.2024.102643] [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: 03/25/2024] [Revised: 06/02/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to determine the effectiveness of a Phone-Based Support Program (PBSP) for newly diagnosed women with breast cancer. METHODS A two-group repeated measures randomized controlled trial was designed. Participants included 94 patients aged 18-60 years who were newly diagnosed with breast cancer and undergoing chemotherapy in a tertiary hospital in China. They were randomly assigned to the intervention and the control groups. Participants in the intervention group were enrolled in a four-session PBSP, consisting of four interactive sections: learning, discussion, ask-the-expert, and personal stories, plus the routine care. Outcomes included patients' self-care self-efficacy, psychological distress (including symptom distress, anxiety, and depression), and quality of life. These were assessed at three time points: pre-intervention (T1), post-intervention (T2), and follow-up (T3) by using the self-care self-efficacy scale, the M.D. Anderson Symptom Inventory, the hospital anxiety and depression scale, and the global health status scale. RESULTS After completion of the intervention, participants in the intervention group had significantly (p < .001) higher self-care self-efficacy (T2: Mdiff = 11.49, T3: Mdiff = 22.33), better quality of life (T2: Mdiff = 8.18, T3: Mdiff = 17.19), lower symptom distress (T2: Mdiff = -26.68, T3: Mdiff = -54.76), less anxiety (T2: Mdiff = -2.52, T3: Mdiff = -5.11), and less depression (T2: Mdiff = -3.61, T3: Mdiff = -6.71) than those in the control group. CONCLUSION These findings indicate that the PBSP is effective. Healthcare professionals, especially nurses, could utilize it to enhance self-care self-efficacy and quality of life, as well as decrease psychological distress among women newly diagnosed breast cancer. REGISTRATION The Thai Clinical Trial Registry #TCTR20230321010.
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Affiliation(s)
- Xi Chen
- The First People's Hospital of Yancheng in Jiangsu, Tinghu District, Yancheng City, Jiangsu Province, China.
| | - Yang Qin
- Jiangsu Vocational College of Medicine in Jiangsu, Yancheng City, Jiangsu Province, China.
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Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev 2024; 3:CD003331. [PMID: 38451843 PMCID: PMC10919451 DOI: 10.1002/14651858.cd003331.pub6] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND People with heart failure experience substantial disease burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous 2018 Cochrane review reported that exercise-based cardiac rehabilitation (ExCR) compared to no exercise control shows improvement in HRQoL and hospital admission amongst people with heart failure, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane review include the following: (1) most trials were undertaken in patients with heart failure with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with heart failure with preserved (≥ 45%) ejection fraction (HFpEF) were under-represented; and (2) most trials were undertaken in a hospital or centre-based setting. OBJECTIVES To assess the effects of ExCR on mortality, hospital admission, and health-related quality of life of adults with heart failure. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science without language restriction on 13 December 2021. We also checked the bibliographies of included studies, identified relevant systematic reviews, and two clinical trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ExCR interventions (either exercise only or exercise as part of a comprehensive cardiac rehabilitation) with a follow-up of six months or longer versus a no-exercise control (e.g. usual medical care). The study population comprised adults (≥ 18 years) with heart failure - either HFrEF or HFpEF. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause mortality, mortality due to heart failure, all-cause hospital admissions, heart failure-related hospital admissions, and HRQoL. Secondary outcomes were costs and cost-effectiveness. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 60 trials (8728 participants) with a median of six months' follow-up. For this latest update, we identified 16 new trials (2945 new participants), in addition to the previously identified 44 trials (5783 existing participants). Although the existing evidence base predominantly includes patients with HFrEF, with New York Heart Association (NYHA) classes II and III receiving centre-based ExCR programmes, a growing body of trials includes patients with HFpEF with ExCR undertaken in a home-based setting. All included trials employed a usual care comparator with a formal no-exercise intervention as well as a wide range of active comparators, such as education, psychological intervention, or medical management. The overall risk of bias in the included trials was low or unclear, and we mostly downgraded the certainty of evidence of outcomes upon GRADE assessment. There was no evidence of a difference in the short term (up to 12 months' follow-up) in the pooled risk of all-cause mortality when comparing ExCR versus usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.71 to 1.21; absolute effects 5.0% versus 5.8%; 34 trials, 36 comparisons, 3941 participants; low-certainty evidence). Only a few trials reported information on whether participants died due to heart failure. Participation in ExCR versus usual care likely reduced the risk of all-cause hospital admissions (RR 0.69, 95% CI 0.56 to 0.86; absolute effects 15.9% versus 23.8%; 23 trials, 24 comparisons, 2283 participants; moderate-certainty evidence) and heart failure-related hospital admissions (RR 0.82, 95% CI 0.49 to 1.35; absolute effects 5.6% versus 6.4%; 10 trials; 10 comparisons, 911 participants; moderate-certainty evidence) in the short term. Participation in ExCR likely improved short-term HRQoL as measured by the Minnesota Living with Heart Failure (MLWHF) questionnaire (lower scores indicate better HRQoL and a difference of 5 points or more indicates clinical importance; mean difference (MD) -7.39 points, 95% CI -10.30 to -4.77; 21 trials, 22 comparisons, 2699 participants; moderate-certainty evidence). When pooling HRQoL data measured by any questionnaire/scale, we found that ExCR may improve HRQoL in the short term, but the evidence is very uncertain (33 trials, 37 comparisons, 4769 participants; standardised mean difference (SMD) -0.52, 95% CI -0.70 to -0.34; very-low certainty evidence). ExCR effects appeared to be consistent across different models of ExCR delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes. AUTHORS' CONCLUSIONS This updated Cochrane review provides additional randomised evidence (16 trials) to support the conclusions of the previous 2018 version of the review. Compared to no exercise control, whilst there was no evidence of a difference in all-cause mortality in people with heart failure, ExCR participation likely reduces the risk of all-cause hospital admissions and heart failure-related hospital admissions, and may result in important improvements in HRQoL. Importantly, this updated review provides additional evidence supporting the use of alternative modes of ExCR delivery, including home-based and digitally-supported programmes. Future ExCR trials need to focus on the recruitment of traditionally less represented heart failure patient groups including older patients, women, and those with HFpEF.
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Affiliation(s)
- Cal Molloy
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Long
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charlene Bridges
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Edward J Davies
- Department of Cardiology, Royal Devon & Exeter Healthcare Foundation Trust, Exeter, UK
| | | | - Hasnain Dalal
- Department of Primary Care, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Wen M, Chen Y, Yu J, Li J, Wen X, OuYang X, He P. Effects of a PRECEDE-PROCEED Model-Based Intervention on Fatigue in Patients With Coronary Heart Disease: A Randomized Controlled Trial. West J Nurs Res 2024; 46:68-80. [PMID: 38146221 DOI: 10.1177/01939459231215727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This research aimed to determine how a 12-week PRECEDE-PROCEED model-based intervention affected fatigue in patients with coronary heart disease. METHODS This cluster randomized controlled trial recruited participants diagnosed with coronary heart disease at 2 community health centers in China. Participants in the control group (n = 36) received routine health education, whereas those in the intervention group (n = 38) were given a 12-week PRECEDE-PROCEED model-based intervention and routine health education. The intervention consisted of 6 training sessions on coronary heart disease, fatigue, fatigue management, self-management skills and social support. A primary outcome (fatigue) and 4 secondary outcomes (knowledge of fatigue, self-management, quality of life and body mass index) were assessed using the Fatigue Scale-14, Fatigue Cognitive Questionnaire for Patients with Coronary Heart Disease, Coronary Artery Disease Self-Management Scale, Chinese Cardiovascular Questionnaire of Quality of Life, and electronic weighing scale, respectively. Data were collected 3 times over 12 weeks. RESULTS Compared with the control group, the intervention group showed a statistically significant improvement in the level of fatigue (8.72 vs 7.06, P < .001), knowledge of fatigue (P < .001), self-management skills (P < .001), and quality of life (P < .001). However, there was no significant difference in body mass index between the 2 groups (P = .504). CONCLUSIONS The findings suggest that a well-designed intervention based on the PRECEDE-PROCEED model could alleviate fatigue symptoms and increase knowledge of fatigue, self-management skills and quality of life in patients with coronary heart disease.
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Affiliation(s)
- Min Wen
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
- School of Nursing, Yueyang Vocational Technical College, Yueyang, China
| | - Yeshi Chen
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Juping Yu
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Junyi Li
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaohui Wen
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Xinping OuYang
- Medical College, Hunan Normal University, Changsha, China
| | - Pingping He
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
- Medical College, Hunan Normal University, Changsha, China
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Cheng CH, Hsu CH, Sie JR, Tsay SL, Tung HH. The Relationship Between Resilience and Health-Related Quality of Life Among Heart Failure Patients in New York Heart Association Functional Classes II and III. J Nurs Res 2024; 32:e312. [PMID: 38271064 DOI: 10.1097/jnr.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Heart failure is an intense, unpredictable, and stressful chronic disease caused by the decline in cardiac pumping function. The influence of heart failure affects patients not only in terms of physical capabilities but also in terms of their emotional and social dimensions, with patients in different functional classes experiencing different levels of effect. Although resilience and health-related quality of life have been studied in populations with heart failure, the scholarly understanding of different functional classes is limited. PURPOSE This study was designed to investigate the relationship between resilience and health-related quality of life among patients with heart failure in different physical functional classes in Taiwan. METHODS A cross-sectional design was applied to study patients with heart failure in northern Taiwan. Two structured questionnaires, including the Resilience Scale for Adults and the 12-item Short Form Health Survey, were used to assess resilience and health-related quality of life. New York Heart Association functional class was used to determine physical function status, and canonical correlation analysis was used to determine the weight of each resilience and quality-of-life domain for the different functional classes. RESULTS The 100 participants had an average age of 65.52 years. Slightly over half (56%) were classified as Functional Class II. A group difference in health-related quality of life was observed. Personal strength (rs = .759) and social competence (rs = -.576) were found to influence the resilience and emotional role dimension of quality of life (rs = -.996) in the Functional Class II group. In addition, family cohesion (rs = -.922), dominant resilience, physical function (rs = .467), and bodily pain (rs = .465) were found to influence quality of life in the Functional Class III group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The efficacy of measures taken to increase resilience to heart failure varied in patients in different functional classes. Functional Class II individuals were better able to manage the disease using their personal strength, whereas Functional Class III individuals relied more heavily on family support and assistance for this effort. Furthermore, participant feelings about quality of life also varied by functional class, with physical function and bodily pain taking on significantly more importance for Functional Class III individuals.
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Affiliation(s)
- Ching-Hui Cheng
- MSN, RN, Deputy Chief of Cardiac Nursing Department, Heart Center, Cheng-Hsin General Hospital, Taiwan, ROC
| | - Ching-Hwa Hsu
- PhD, RN, NP, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC
| | - Jia-Rong Sie
- MSN, RN, NP, Doctoral Student, Department of Nursing, National Yang Ming Chiao Tung University, and Nurse Practitioner, Department of Emergency Medicine, National Taiwan University Hospital, Taiwan, ROC
| | - Shiow-Luan Tsay
- PhD, RN, APN, Professor, College of Nursing & Health Sciences, Da-Yeh University, Taiwan, ROC
| | - Heng-Hsin Tung
- PhD, RN, FNP, DNP, Distinguished Professor, Department of Nursing, National Yang Ming Chiao Tung University, and Adjunct Nursing Consultant, Tungs' Taichung MetroHarbor Hospital, Taiwan, ROC
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [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: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Zhao Q, Mei J, Zhang X, Dong X, Zhang Y, Fan X. Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure. Clin Nurs Res 2023; 32:359-365. [PMID: 36068938 DOI: 10.1177/10547738221121437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (β = .222, p = .011) and physical symptoms (β = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (β = -.241, p < .01) and family functioning (β = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.
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Affiliation(s)
- Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | | | - Xiuting Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyu Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Yang Y, Hoo J, Tan J, Lim L. Multicomponent integrated care for patients with chronic heart failure: systematic review and meta‐analysis. ESC Heart Fail 2022; 10:791-807. [PMID: 36377317 PMCID: PMC10053198 DOI: 10.1002/ehf2.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the effectiveness of multicomponent integrated care on clinical outcomes among patients with chronic heart failure. We conducted a meta-analysis of randomized clinical trials, published in English language from inception to 20 April 2022, with at least 3-month implementation of multicomponent integrated care (defined as two or more quality improvement strategies from different domains, viz. the healthcare system, healthcare providers, and patients). The study outcomes were mortality (all-cause or cardiovascular) and healthcare utilization (hospital readmission or emergency department visits). We pooled the risk ratio (RR) using Mantel-Haenszel test. A total of 105 trials (n = 37 607 patients with chronic heart failure; mean age 67.9 ± 7.3 years; median duration of intervention 12 months [interquartile range 6-12 months]) were analysed. Compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality [RR 0.90, 95% confidence interval (CI) 0.86-0.95], cardiovascular mortality (RR 0.73, 95% CI 0.60-0.88), all-cause hospital readmission (RR 0.95, 95% CI 0.91-1.00), heart failure-related hospital readmission (RR 0.84, 95% CI 0.79-0.89), and all-cause emergency department visits (RR 0.91, 95% CI 0.84-0.98). Heart failure-related mortality (RR 0.94, 95% CI 0.74-1.18) and cardiovascular-related hospital readmission (RR 0.90, 95% CI 0.79-1.03) were not significant. The top three quality improvement strategies for all-cause mortality were promotion of self-management (RR 0.86, 95% CI 0.79-0.93), facilitated patient-provider communication (RR 0.87, 95% CI 0.81-0.93), and e-health (RR 0.88, 95% CI 0.81-0.96). Multicomponent integrated care reduced risks for mortality (all-cause and cardiovascular related), hospital readmission (all-cause and heart failure related), and all-cause emergency department visits among patients with chronic heart failure.
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Affiliation(s)
- Ya‐Feng Yang
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Jia‐Xin Hoo
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Jia‐Yin Tan
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Lee‐Ling Lim
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Hong Kong SAR China
- Asia Diabetes Foundation Hong Kong SAR China
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Bohmke NJ, Billingsley HE, Kirkman DL, Carbone S. Nonpharmacological Strategies in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:491-506. [PMID: 36210133 PMCID: PMC10280381 DOI: 10.1016/j.ccl.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) suffer from a high rate of cardiometabolic comorbidities with limited pharmaceutical therapies proven to improve clinical outcomes and cardiorespiratory fitness (CRF). Nonpharmacologic therapies, such as exercise training and dietary interventions, are promising strategies for this population. The aim of this narrative review is to present a summary of the literature published to date and future directions related to the efficacy of nonpharmacologic, lifestyle-related therapies in HFpEF, with a focus on exercise training and dietary interventions.
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Affiliation(s)
- Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
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Tegegne TK, Rawstorn JC, Nourse RA, Kibret KT, Ahmed KY, Maddison R. Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis. Open Heart 2022; 9:openhrt-2021-001949. [PMID: 35680170 PMCID: PMC9185675 DOI: 10.1136/openhrt-2021-001949] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/02/2022] [Indexed: 12/26/2022] Open
Abstract
Background This review aimed to compare the relative effectiveness of different exercise-based cardiac rehabilitation (ExCR) delivery modes (centre-based, home-based, hybrid and technology-enabled ExCR) on key heart failure (HF) outcomes: exercise capacity, health-related quality of life (HRQoL), HF-related hospitalisation and HF-related mortality. Methods and results Randomised controlled trials (RCTs) published through 20 June 2021 were identified from six databases, and reference lists of included studies. Risk of bias and certainty of evidence were evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Bayesian network meta-analysis was performed using R. Continuous and binary outcomes are reported as mean differences (MD) and ORs, respectively, with 95% credible intervals (95% CrI). One-hundred and thirty-nine RCTs (n=18 670) were included in the analysis. Network meta-analysis demonstrated improvements in VO2peak following centre-based (MD (95% CrI)=3.10 (2.56 to 3.65) mL/kg/min), home-based (MD=2.69 (1.67 to 3.70) mL/kg/min) and technology-enabled ExCR (MD=1.76 (0.27 to 3.26) mL/kg/min). Similarly, 6 min walk distance was improved following hybrid (MD=84.78 (31.64 to 138.32) m), centre-based (MD=50.35 (30.15 to 70.56) m) and home-based ExCR (MD=36.77 (12.47 to 61.29) m). Incremental shuttle walk distance did not improve following any ExCR delivery modes. Minnesota living with HF questionnaire improved after centre-based (MD=−10.38 (−14.15 to –6.46)) and home-based ExCR (MD=−8.80 (−13.62 to –4.07)). Kansas City Cardiomyopathy Questionnaire was improved following home-based ExCR (MD=20.61 (4.61 to 36.47)), and Short Form Survey 36 mental component after centre-based ExCR (MD=3.64 (0.30 to 6.14)). HF-related hospitalisation and mortality risks reduced only after centre-based ExCR (OR=0.41 (0.17 to 0.76) and OR=0.42 (0.16 to 0.90), respectively). Mean age of study participants was only associated with changes in VO2peak. Conclusion ExCR programmes have broader benefits for people with HF and since different delivery modes were comparably effective for improving exercise capacity and HRQoL, the selection of delivery modes should be tailored to individuals’ preferences.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia .,Department of Public Health, Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Amy Nourse
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | | | - Kedir Yimam Ahmed
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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11
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The Effects of Exercise-Based Interventions on Fluid Overload Symptoms in Patients with Heart Failure: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10051111. [PMID: 35625848 PMCID: PMC9138396 DOI: 10.3390/biomedicines10051111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with heart failure are subjected to a substantial burden related to fluid overload symptoms. Exercise can help the lymphatic system function more effectively to prevent fluid build-up in tissues and interstitium, thus potentially mitigating the symptoms due to fluid overload. The objective of this systematic review was to examine the effects of exercise-based interventions on fluid overload symptoms among patients with heart failure. MEDLINE, Embase, Cochrane Library, and CINAHL databases were systematically searched for relevant studies published from inception to August 2021. We included randomized controlled trials that compared exercise-based interventions of different modalities and usual medical care for adult patients with heart failure and reported the effects of interventions on any symptoms related to fluid overload. A random-effects meta-analysis was used to estimate the effectiveness, and a subgroup analysis and univariate meta-regression analysis were used to explore heterogeneity. Seventeen studies covering 1086 participants were included. We found robust evidence indicating the positive effect of exercises in dyspnea relief (SMD = −0.48; 95%CI [−0.76, −0.19]; p = 0.001); the intervention length also influenced the treatment effect (β = 0.033; 95%CI [0.003, 0.063]; p = 0.04). Initial evidence from existing limited research showed that exercise-based intervention had positive effect to alleviate edema, yet more studies are needed to verify the effect. In contrast, the exercise-based interventions did not improve fatigue compared with usual care (SMD = −0.27; 95%CI [−0.61, 0.06]; p = 0.11). Findings regarding the effects of exercises on bodily pain, gastro-intestinal symptoms, and peripheral circulatory symptoms were inconclusive due to limited available studies. In conclusion, exercise-based interventions can be considered as an effective nonpharmacological therapy for patients with heart failure to promote lymph flow and manage fluid overload symptoms. Exercise-based interventions seem to have very limited effect on fatigue. More research should investigate the mechanism of fatigue related to heart failure. Future studies with high methodological quality and comprehensive assessment of symptoms and objective measure of fluid overload are warranted.
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12
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Yingtong M, Wei Z, Hanjun H, Tingting Z, Xiaohua G. The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: a systematic review and meta-analysis. Int J Nurs Stud 2022; 130:104237. [DOI: 10.1016/j.ijnurstu.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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13
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Alonso WW, Kupzyk KA, Norman JF, Lundgren SW, Fisher A, Lindsey ML, Keteyian SJ, Pozehl BJ. The HEART Camp Exercise Intervention Improves Exercise Adherence, Physical Function, and Patient-Reported Outcomes in Adults With Preserved Ejection Fraction Heart Failure. J Card Fail 2022; 28:431-442. [PMID: 34534664 PMCID: PMC8920955 DOI: 10.1016/j.cardfail.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%-80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group. CONCLUSIONS A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670.
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Affiliation(s)
- Windy W Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph F Norman
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Scott W Lundgren
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alfred Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Merry L Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, Omaha, Nebraska; Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | | | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
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14
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Klompstra L, Jaarsma T, Piepoli MF, Ben Gal T, Evangelista L, Strömberg A, Bäck M. Objectively measured physical activity in patients with heart failure: a sub-analysis from the HF-Wii study. Eur J Cardiovasc Nurs 2022; 21:499-508. [PMID: 34993536 DOI: 10.1093/eurjcn/zvab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Physical activity (PA) is important in patients with heart failure (HF) to improve health outcomes. The adherence to PA is low, and therefore, novel approaches are necessary to increase PA. We aimed to determine the difference in PA in patients with HF who have access to exergaming compared to patients who received motivational support and to explored predictors of a clinically relevant change in non-sedentary time between baseline and 3 months. METHODS AND RESULTS In total, 64 patients (mean age 69 ± 9 years, 27% female) wore an accelerometer 1 week before and 1 week after the intervention. Data were analysed using logistic regression analysis. Patients spent 9 h and 43 min (±1 h 23 min) during waking hours sedentary. There were no significant differences in PA between patients who received an exergame intervention or motivational support. In total, 30 of 64 patients achieved a clinically relevant increase in non-sedentary time. Having grandchildren [odds ratio (OR) 7.43 P = 0.03], recent diagnosis of HF (OR 0.93 P = 0.02), and higher social motivation (OR 2.31 P = 0.03) were independent predictors of a clinically relevant increase of non-sedentary time. CONCLUSION Clinicians should encourage their patients to engage in alternative approaches to improve PA and reduce sedentary habits. Future exergaming interventions should target individuals with chronic HF who have low social motivation and a low level of light PA that may benefit most from exergaming. Also (non-familial), intergenerational interaction is important to enabling patients in supporting patients in becoming more active.
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Affiliation(s)
- Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Massimo F Piepoli
- UO Scompenso e Cardiomiopatie, Ospedale G da Saliceto, Piacenza, Italy
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Alonso WW, Kupzyk K, Norman J, Bills SE, Bosak K, Dunn SL, Deka P, Pozehl B. Negative Attitudes, Self-efficacy, and Relapse Management Mediate Long-Term Adherence to Exercise in Patients With Heart Failure. Ann Behav Med 2021; 55:1031-1041. [PMID: 33580663 DOI: 10.1093/abm/kaab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Exercise is safe and provides considerable benefits for patients with heart failure (HF) including improved function, quality of life, and symptoms. However, patients with HF have difficulty initiating and adhering to an exercise regimen. To improve adherence, our team developed Heart Failure Exercise and Resistance Training (HEART) Camp, a multicomponent, theory-driven intervention that was efficacious in a randomized controlled trial of long-term adherence to exercise in patients with HF. Identifying active components of efficacious interventions is a priority. PURPOSE The purpose of this study is to use mediation analysis to determine which interventional components accounted for long-term adherence to exercise in patients with HF. METHODS This study included 204 patients with HF enrolled in a randomized controlled trial. Instruments measuring interventional components were completed at baseline, 6, 12, and 18 months. Hierarchical linear models generated slope estimates to be used as predictors in logistic regression models. Significant variables were tested for indirect effects using path analyses with 1,000 bootstrapped estimates. RESULTS Significant mediation effects were observed for the interventional components of negative attitudes (β NA = 0.368, s.e. = 0.062, p < .001), self-efficacy (β SE = 0.190, s.e. = 0.047, p < .001), and relapse management (β RM = 0.243, s.e. = 0.076, p = .001). CONCLUSIONS These findings highlight improving attitudes, self-efficacy, and managing relapse as key interventional components to improve long-term adherence to exercise in patients with HF. Future interventions targeting adherence to exercise in patients with HF and other chronic illnesses should consider the incorporation of these active components.
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Affiliation(s)
- Windy W Alonso
- University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE
| | - Kevin Kupzyk
- University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE
| | - Joseph Norman
- University of Nebraska Medical Center, College of Allied Health, Omaha, NE
| | - Sara E Bills
- University of Nebraska Medical Center, College of Allied Health, Omaha, NE
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing, Kansas City, KS
| | - Susan L Dunn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI
| | - Bunny Pozehl
- University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE
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16
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Elpida K, Constantinos PH, Ioannis V, Athena K, Sotirios K, Eleftherios K, Serafeim N. A constructivist approach to teaching patients with heart failure: results from an intervention study. Eur J Cardiovasc Nurs 2021; 20:331-341. [PMID: 33620499 DOI: 10.1093/eurjcn/zvaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022]
Abstract
AIMS Despite published guidelines emphasizing the importance of education in the management of heart failure (HF), the most effective method of education remains unknown. The aim of this study was to test the efficacy of constructivist teaching method (CTM) on the patients with HF. METHODS AND RESULTS This is a single-centre, randomized controlled trial. Patients in the intervention group were educated using the CTM in five phases: orientation, elicitation, restructuring, application, and review. The duration of intervention was 6 months. For the study outcome measures, five questionnaires were used: Atlanta Heart Failure Knowledge Test (AHFK), Minnesota Living with Heart Failure (HMLHFQ), Self-Efficacy for Appropriate Medication Use Scale (SEAMS), European Heart Failure Self-care Behaviour Scale (EHFScBS-9), and Duke Activity Status Index (DASI). A total of 122 adults (83.6% male, mean age ± standard deviation 67.1 ± 12.3 years) were enrolled in the study; 61 in the intervention group and 61 in the control group. At 6 months, the knowledge, the quality of life, the self-efficacy for appropriate medication use, the self-care behaviour, and the activity were improved in both groups but the degree of change was greater in the intervention group as indicated from the results of repeated measurements analysis of variance (P < 0.001). Significantly lower proportion of readmission at hospital at 1 month (8.2% vs. 23%, P = 0.025), and 6 months (13.1% vs. 36.1%, P = 0.003) were found for the intervention group. CONCLUSIONS Training of HF patients through the CTM helps effectively manage the disease while significantly reducing hospital readmissions due to decompensation.
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Affiliation(s)
- Kroustalli Elpida
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | | | - Vasileiadis Ioannis
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | - Kalokairinou Athena
- Department of Nursing, National and Kapodistrian of University of Athens, Athens 11527, Greece
| | - Kiokas Sotirios
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece.,Cardiology Department, "Korgialenio-Benakio Hellenic Red Cross" General Hospital, Athens 11526, Greece
| | - Karatzanos Eleftherios
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | - Nanas Serafeim
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
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17
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Moradi M, Doostkami M, Behnamfar N, Rafiemanesh H, Behzadmehr R. Global Prevalence of Depression among Heart Failure Patients: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2021; 47:100848. [PMID: 34006389 DOI: 10.1016/j.cpcardiol.2021.100848] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
The present study aimed to evaluate the prevalence of depression among heart failure (HF) patients. Depression is one of the main risk factors of mortality and reduction in quality of life in patients with HR. Despite individual studies, there is no comprehensive study on depression in HF patients. In the present systematic review and meta-analysis, databases (Web of Science, Scopus, and PubMed) were searched from January 1, 2000, to December 15, 2020. The keywords used included: depression and heart failure. The research stages including search, screening, quality evaluation, and extraction of study data were performed separately by two researchers. A total of 149 studies performed on 305,407 HF patients entered the final stage. The global prevalence of any severity and moderate to severe severity of depression was 41.9% and 28.1%, respectively. The results of the subgroup analysis showed that the prevalence of depression was higher in women (45.5%) than in men. Also, according to the NHYA classification, the prevalence of depression in patients in stages three and four (54.7%) was higher than stages 1 and 2. The prevalence of depression was higher in the EMRO region (70.1%) and lower economic status countries (56.7%).The high prevalence of depression among HF patients indicates the importance of paying more attention and providing the necessary training for patients to reduce depression.
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Affiliation(s)
- Mandana Moradi
- Clinical Pharmacy Department, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahboobeh Doostkami
- Department of Nursing, Tohid Hospital, Zahedan University of Medical Sciences, Zhedan, Iran
| | - Niaz Behnamfar
- Department of Nursing, Kurdistan University of Medical Sciences, Kurdistan, Iran
| | - Hosein Rafiemanesh
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Behzadmehr
- Associate Professor of Radiology, Department of Radiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
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18
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Sense of Coherence and Quality of Life in Patients Treated with Antivitamin K Oral Anticoagulants: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041668. [PMID: 33572412 PMCID: PMC7916212 DOI: 10.3390/ijerph18041668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze the correlation between the participants’ self-reported quality of life and their sense of coherence in a sample (n = 85) of patients on treatment with oral antivitamin K anticoagulants. A cross-sectional design was used. The measurement instruments included a questionnaire on sociodemographic variables, the Spanish version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF), an oral-anticoagulant-treatment-specific quality-of-life questionnaire, and the sense-of-coherence (SOC) scale. We analyzed the correlations between the participants’ characteristics and the results from the quality-of-life and SOC scales. Age, level of education, employment status, living arrangement, and treatment length were the determinants of the quality of life in people treated with oral anticoagulants. We found a significant association between the four domains of the WHOQOL-BREF questionnaire and general treatment satisfaction (p < 0.01); no significant correlations were found between the SOC subscales and the oral-anticoagulant-treatment-specific quality of life in our sample. Women had a worse level of self-management than men. Nursing interventions should be tailored to the needs of the populations on treatment with oral anticoagulants in order to facilitate a higher level of self-management.
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19
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Sampaio F, Gonçalves P, Parola V, Sequeira C, Lluch Canut T. Nursing Process Addressing the Focus "Anxiety": A Scoping Review. Clin Nurs Res 2020; 30:1001-1011. [PMID: 33289397 DOI: 10.1177/1054773820979576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this review was to map the body of literature on data, diagnoses and interventions addressing the nursing focus "anxiety." A scoping review methodology was employed. The Joanna Briggs guidelines for scoping reviews and PRISMA checklist for scoping reviews were followed. Electronic database searches (MEDLINE, CINAHL and Web of Science) located 829 articles. From the total of articles located, 165 were included. The nursing diagnosis "anxiety" can be considered a parent diagnosis, from which other children diagnoses are derived. Data that lead to nursing diagnoses in the anxiety domain can be divided into cognitive and somatic data. Some interventions, such as educational and music-based interventions, seem to be useful to address nursing diagnoses in the anxiety domain. The findings of this review can add substantial value for systematising the nursing process related to the focus "anxiety." Therefore, reaching consensus regarding this nursing process seems highly relevant.
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Affiliation(s)
- Francisco Sampaio
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Higher School of Health Fernando Pessoa, Porto, Portugal.,CINTESIS - NursID "Innovation and Development in Nursing" Research Group, Porto, Portugal
| | - Patrícia Gonçalves
- CINTESIS - NursID "Innovation and Development in Nursing" Research Group, Porto, Portugal.,Hospital de Magalhães Lemos, EPE, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Vítor Parola
- Higher School of Health Fernando Pessoa, Porto, Portugal.,Health Sciences Research Unit: Nursing, Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
| | - Carlos Sequeira
- CINTESIS - NursID "Innovation and Development in Nursing" Research Group, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Teresa Lluch Canut
- University School of Nursing of the University of Barcelona, Barcelona, Spain
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20
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Warehime S, Dinkel D, Alonso W, Pozehl B. Long-term exercise adherence in patients with heart failure: A qualitative study. Heart Lung 2020; 49:696-701. [PMID: 32861888 PMCID: PMC7669664 DOI: 10.1016/j.hrtlng.2020.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Regular exercise is associated with numerous benefits; yet up to 91% of patients with heart failure (HF) do not exercise regularly. This study explored factors supporting long-term exercise adherence in patients with HF. DESIGN This study was a qualitative multiple-case study. METHODS Data were collected via semi-structured interviews from patients with HF at completion of an 18-month exercise intervention in a health care exercise facility and analyzed using a directed content analysis approach. RESULTS Participants (n=22) identified perceived health status, scheduling/making exercise part of a routine, social support from coaches and family, knowledge about exercise, and motivation/perseverance as supports for long-term exercise adherence. CONCLUSIONS Perceived health status may be key when promoting exercise adherence in this population. Knowledge, social support from coaches and family members, and motivation should be considered for long-term exercise adherence.
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Affiliation(s)
- Shane Warehime
- University of Nebraska at Omaha, 6001 Dodge St., Omaha, NE, 68182, USA.
| | - Danae Dinkel
- University of Nebraska at Omaha, 6001 Dodge St., Omaha, NE, 68182, USA.
| | - Windy Alonso
- University of Nebraska Medical Center, S 42(nd) St & Emilie St., Omaha, NE, 68198, USA.
| | - Bunny Pozehl
- University of Nebraska Medical Center, S 42(nd) St & Emilie St., Omaha, NE, 68198, USA.
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