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Ali S, Tyerman J. Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis. Am J Hosp Palliat Care 2024; 41:1061-1075. [PMID: 37963548 PMCID: PMC11318222 DOI: 10.1177/10499091231213606] [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] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. OBJECTIVE This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. DESIGN The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. RESULTS The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. CONCLUSION Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.
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Affiliation(s)
- Sana Ali
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
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Deng LR, Doyon KJ, Masters KS, Steinhauser KE, Langner PR, Siler S, Bekelman DB. How Does Spiritual Well-Being Change Over Time Among US Patients with Heart Failure and What Predicts Change? JOURNAL OF RELIGION AND HEALTH 2024; 63:3050-3065. [PMID: 36478542 DOI: 10.1007/s10943-022-01712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Few studies have examined how spiritual well-being changes over time in patients with heart failure. We conducted a secondary analysis of data from the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial (N = 314). Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) at baseline and 12-month follow-up. Of the 165 patients with spiritual well-being data at follow-up, 65 (39%) experienced probable clinically meaningful changes (> 0.5 SD) in spiritual well-being (35 improved, 30 declined). Increased pain (p = 0.04), decreased dyspnea (p < 0.01), and increased life completion (p = 0.02) were associated with improvement in overall spiritual well-being. Exploratory analyses found different predictors for FACIT-Sp subscales.
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Affiliation(s)
- Lubin R Deng
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA.
- Department of Statistics, Columbia University, New York, NY, USA.
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Katherine J Doyon
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin S Masters
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Karen E Steinhauser
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Paula R Langner
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA
| | - Shaunna Siler
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David B Bekelman
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Khajehpoor MH, Shahrbabaki PM, Nouhi E. Effects of a home-based palliative heart failure program on quality of life among the elderly: a clinical trial study. BMC Palliat Care 2023; 22:130. [PMID: 37674146 PMCID: PMC10481455 DOI: 10.1186/s12904-023-01245-x] [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: 11/03/2022] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION One of the frequent issues that lowers elderly people's quality of life is chronic heart failure, a progressive and life-limiting disease. The purpose of this study was to evaluate the effects of home-based palliative care (HBPC) on the quality of life of elderly patients with heart failure who received discharge orders from hospitals affiliated with Kerman University of Medical Sciences in 2022. METHODS One hundred heart failure patients were divided into two intervention and control groups for this randomized clinical trial study. The patients were then given the pre-test questionnaires, such as the demographic questionnaire and the Quality of Life Index (QLI) by Ferrans and Powers. The intervention group was given the home care plan. To measure the quality of life one month after the intervention, the quality of life questionnaire was lastly filled out by both groups following the last care session. Software called SPSS 22 was used to enter and analyze the patient data. RESULTS The mean age for the elderly in the intervention and in the control groups were 69.46 ± 11.61 and 66.14 ± 12.09 years, respectively. The palliative care program at home made a statistically significant difference in the quality of life and all of its components in the elderly with heart failure in the intervention group immediately after the intervention and one month after the intervention compared to before (P < 0.001). As a result, its scores improved compared to the stage before the intervention. Additionally, a significant difference between the quality of life score and all of its components between the intervention's immediate aftermath and one month later was noted (P < 0.05). CONCLUSION Home-based palliative care has a positive effect on the quality of life for elderly people who have heart failure, making it a worthwhile intervention to enhance their quality of life. TRIAL REGISTRATIONS (IRCT20211213053389N1). Date of registration: (19/02/2022).
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Affiliation(s)
| | - Parvin Mangolian Shahrbabaki
- Department of Critical Care Nursing, Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Department of Medical-Surgical Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Haft-Bagh Highway, PO Box 7716913555, Kerman, Iran.
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Zhang X, Zhang J, Liu F, Li W, Zhang T, Fang B, Zhang Z, Xie Q, Yang Y, Li X. Prognostic Nutritional Index (PNI) as a Predictor in Patients with Metabolic Syndrome and Heart Failure. Diabetes Metab Syndr Obes 2023; 16:2503-2514. [PMID: 37614379 PMCID: PMC10443633 DOI: 10.2147/dmso.s420924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose There is a lack of research on nutritional status and poor prognosis in patients with metabolic syndrome and heart failure. This study evaluated the relationship between nutritional status as defined by the PNI and adverse outcomes in patients with metabolic syndrome and heart failure. Methods A total of 1048 heart failure patients with metabolic syndrome admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2019 were consecutively. PNI was used to assess their nutritional status. Results A total of 51.0% of the patients were in the nonmalnutrition group (PNI≥45), 27.9% were in the mild malnutrition group (40≤PNI<45), and 21.1% of patients were in the malnutrition group (PNI<40). At 36 months of follow-up, after adjusting for other confounding factors, malnutrition (PNI<40) was independently associated with all-cause death (HR: 1.787, 95% CI: 1.451-2.201, P<0.001) and cardiovascular death (HR: 1.837, 95% CI: 1.467-2.301, P<0.001). PNI showed additional prognostic predictive value when included in the established risk factor model, both for all-cause death (AUC: 0.620, 95% CI: 0.579-0.661, P<0.001) and cardiovascular death (AUC: 0.596, 95% CI: 0.555-0.636, P<0.001). Conclusion In patients with metabolic syndrome and heart failure, malnutrition assessed by PNI is an independent predictor for all-cause death and cardiovascular death, and PNI is negatively correlated with the occurrence of adverse outcomes.
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Affiliation(s)
- Xuehe Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Jixin Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Wenling Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Tong Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Binbin Fang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhiyang Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Qian Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yining Yang
- Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
| | - Xiaomei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
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Hu Y, Lan XH, Cao YJ, Duan JQ, Ren QT, Jin Y, Yin QX, Deng RB. Palliative care and Chinese medicine in a centenarian with primary hepatocellular carcinoma and 27-month follow-up: A case report. Heliyon 2023; 9:e17340. [PMID: 37501950 PMCID: PMC10368764 DOI: 10.1016/j.heliyon.2023.e17340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
The number of centenarians with cancer is increasing as the global population ages. The diagnosis and treatment for centenarians with tumor sometimes are specific, and there are currently less appropriate guidelines as references. We report a 104-year-old man with asymptomatic primary liver cancer (PLC) whose family decided to receive conservative and palliative care. The patient has been followed up for 27 months. He has been mainly received Chinese herbal medicine (CHM), nutritional support and thymalfasin injection intermittently, etc. During the 27-month follow-up, the patient has showed good compliance and tolerance without any complications of the tumor. Conclusion: Individualized palliative care and complementary medicine, based on multidisciplinary evaluation, traditional Chinese medicine, consultation with patients and their families about treatment options, etc., may help improve the life quality of centenarians with end-stage tumors.
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Affiliation(s)
- Yue Hu
- Air Force Medical Center, PLA, Beijing, China
- Graduate School of China Medical University, Shenyang, Liao Ning Province, China
| | - Xiao-hua Lan
- Graduate School of Hebei North University, Zhangjiakou, Hebei Province, China
| | - Yan-jie Cao
- Air Force Medical Center, PLA, Beijing, China
| | | | - Qi-tao Ren
- Air Force Medical Center, PLA, Beijing, China
- Graduate School of China Medical University, Shenyang, Liao Ning Province, China
| | - Ying Jin
- Air Force Medical Center, PLA, Beijing, China
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Loripoor M, Esmaeili F, Vazirinejad R, Dan S. The Effect of Palm Pollen Extract on Sexual Disorders in Postmenopausal Women: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:14-22. [PMID: 36650842 PMCID: PMC9839974 DOI: 10.30476/ijcbnm.2022.95809.2086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 01/19/2023]
Abstract
Background Considering the numerous nutritional and estrogenic compounds of palm pollen and their effect on sexual function, this study was performed to investigate the effect of palm pollen extract on sexual disorders in postmenopausal women. Methods In this three-blind clinical trial, 110 postmenopausal women from December 2019 to December 2020 from Rafsanjan comprehensive health service centers were randomly assigned to two groups, using a lottery method. The intervention group received 300 mg capsule of palm pollen extract, and the control group received placebo for 4 weeks. Sexual disorders were assessed with a 6-item female sexual function index before, at the end of the intervention, and 4 weeks after the end of the intervention. Independent t-test, Chi-square and repeated measures ANOVA were used to analyze the data through SPSS software version 21. The statistically significant level was considered P value less than 0.05. Results The mean scores of sexual disorders before the intervention in the intervention and control groups were 15.36±5.01 and 14.13±4.67 (P=0.68); at the end of the intervention, they were 15.18±4.50 and 14.22±3.91 (P=0.43) and 4 weeks after the end of the intervention we obtained 15.7±4.77 and 14.44±3.78, respectively (P=0.90). Conclusions According to the results, daily consumption of 300 mg of date pollen extract had no effect on improving sexual disorders in postmenopausal women. Further studies in this field are suggested.Trial Registration Number: IRCT20160308026971N1.
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Affiliation(s)
- Marzeyeh Loripoor
- Department of Midwifery, School of Nursing and Midwifery, Elderly Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Esmaeili
- Department of Midwifery, School of Nursing and Midwifery, Larestan University of Medical Sciences, Larestan, Iran
| | - Reza Vazirinejad
- Department of Epidemiology and Statistics, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Sasan Dan
- Department of Chemical Engineering, School of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran
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7
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Yi M, Jiang D, Jia Y, Xu W, Wang H, Li Y, Zhang Z, Wang J, Chen O. Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles. Int J Chron Obstruct Pulmon Dis 2021; 16:2245-2255. [PMID: 34376977 PMCID: PMC8349532 DOI: 10.2147/copd.s311772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life. Methods We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson’s method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds. Results Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles. Conclusion In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.
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Affiliation(s)
- Mo Yi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Di Jiang
- Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Yuanmin Jia
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Xu
- Department of Psychology, Shanghai Normal University, Shanghai, 200234, People's Republic of China
| | - Haixia Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yizhang Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Zeyi Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jingjing Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
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Moradi M, Daneshi F, Behzadmehr R, Rafiemanesh H, Bouya S, Raeisi M. Quality of life of chronic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2021; 25:993-1006. [PMID: 31745839 DOI: 10.1007/s10741-019-09890-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite various individual studies on the quality of life (QOL) in patients with CHF, a comprehensive study has not yet been conducted; therefore, this study aims to assess the QOL of CHF patients. In the present systematic review and meta-analysis, PubMed, Scopus, and the Web of science databases were searched from January 1, 2000, to December 31, 2018, using QOL and heart failure as keywords. The searches, screenings, quality assessments, and data extractions were conducted separately by two researchers. A total of 70 studies including 25,180 participants entered the final stage. The mean QOL score was 44.1 (95% confidence interval (CI) 40.6, 47.5; I2 = 99.3%) using a specific random effects method in 40 studies carried out on 12,520 patients. Moreover, according to the geographical region, heart failure patients in the Americas had higher scores. In 14 studies, in which a general SF-36 survey was implemented, the average physical component score (PCS) and mental component score (MCS) were 33.3 (95% CI 31.9, 34.7; I2 = 88.0%) and 50.6 (95% CI 43.8, 57.4; I2 = 99.3%), respectively. The general and specific tools used in this study indicated moderate and poor QOL, respectively. Therefore, it is necessary to carry out periodic QOL measurements using appropriate tools as part of the general care of CHF patients.
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Affiliation(s)
- Mandana Moradi
- Clinical Pharmacy Department, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Fereshteh Daneshi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Razieh Behzadmehr
- Associate Professor of Radiology, Department of Radiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Hosien Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salehoddin Bouya
- Internal Medicine and Nephrology, Clinical Immunology Research Center, Ali-ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mohammad Raeisi
- Varamin-Pishva Branch, Islamic Azad University, Varamin, Iran
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9
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Zhao S, Wang X. Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25891. [PMID: 34106645 PMCID: PMC8133117 DOI: 10.1097/md.0000000000025891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND : Published studies investigating enteral nutrition's effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure (HF) are of poor quality, with small sample sizes, and involve a homogeneous population. Therefore, in order to provide new medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with HF. METHODS : The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, Cochrane Library will be searched in April 2021 by 2 independent reviewers. The primary outcome is body mass index, triceps skin fold thickness, upper arm muscle circumference, serum total protein, albumin, and hemoglobin's change in index; secondary outcomes include left ventricular ejection fraction, B-type natriuretic peptide, interleukin-6, C-reactive protein, and tumor necrosis factor-α. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We will perform meta-analysis using Review Manager Software. RESULTS : The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. CONCLUSION : Its findings will provide helpful evidence for the application of enteral nutrition in elderly patients with HF. OSF REGISTRATION NUMBER 10.17605/OSF.IO/RTYBP.
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Affiliation(s)
- Shutang Zhao
- Department of Cardiology, Weihaiwei People's Hospital
| | - Xiren Wang
- Department of Laboratory, Weihai Municipal Hospital, Shandong, China
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10
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Kaufman BG, Granger BB, Sun JL, Sanders G, Taylor DH, Mark DB, Warraich H, Fiuzat M, Steinhauser K, Tulsky JA, Rogers JG, O'Connor C, Mentz RJ. The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial. J Card Fail 2021; 27:662-669. [PMID: 33731305 DOI: 10.1016/j.cardfail.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure-related quality of life, though cost-effectiveness remains unknown. The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial, which provided outpatient palliative care to patients with advanced heart failure. METHODS AND RESULTS Outcomes for usual care and PAL-HF strategies were compared using a Markov cohort model over 36 months from a payer perspective. The model parameters were informed by PAL-HF trial data and supplemented with meta-analyses and Medicare administrative data. Outcomes included hospitalization, place of death, Medicare expenditures, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Simulated mortality rates were the same for PAL-HF and usual care cohorts, at 89.7% at 36 months. In the base case analysis, the PAL-HF intervention resulted in an incremental gain of 0.03 QALYs and an incremental cost of $964 per patient for an incremental cost-effectiveness ratio of $29,041 per QALY. In 1-way sensitivity analyses, an intervention cost of up to $140 per month is cost effective at $50,000 per QALY. Of 1000 simulations, the PC intervention had a 66.1% probability of being cost effective at a $50,000 willingness-to-pay threshold assuming no decrease in hospitalization. In a scenario analysis, PAL-HF decreased payer spending through reductions in noncardiovascular hospitalizations. CONCLUSIONS These results from this single-center trial are encouraging that palliative care for advanced heart failure is an economically attractive intervention. Confirmation of these findings in larger multicenter trials will be an important part of developing the evidence to support more widespread implementation of the PAL-HF palliative care intervention.
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Affiliation(s)
- Brystana G Kaufman
- Margolis Center for Health Policy, Duke University, Durham, North Carolina.
| | - Bradi B Granger
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, North Carolina
| | - Gillian Sanders
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Donald H Taylor
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Daniel B Mark
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Mona Fiuzat
- Duke University School of Medicine, Durham, North Carolina
| | | | - James A Tulsky
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
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11
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Remawi BN, Gadoud A, Murphy IMJ, Preston N. Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis. Heart Fail Rev 2020; 26:137-155. [PMID: 32748015 PMCID: PMC7769784 DOI: 10.1007/s10741-020-10011-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with heart failure have comparable illness burden and palliative care needs to those with cancer. However, few of them are offered timely palliative care. One main barrier is the difficulty in identifying those who require palliative care. Several palliative care needs-assessment/measurement tools were used to help identify these patients and assess/measure their needs, but it is not known which one is the most appropriate for this population. This review aimed to identify the most appropriate palliative care needs-assessment/measurement tools for patients with heart failure. Cochrane Library, MEDLINE Complete, AMED, PsycINFO, CINAHL Complete, EMBASE, EThOS, websites of the identified tools, and references and citations of the included studies were searched from inception to 25 June 2020. Studies were included if they evaluated palliative care needs-assessment/measurement tools for heart failure populations in terms of development, psychometrics, or palliative care patient/needs identification. Twenty-seven papers were included regarding nineteen studies, most of which were quantitative and observational. Six tools were identified and compared according to their content and context of use, development, psychometrics, and clinical applications in identifying patients with palliative care needs. Despite limited evidence, the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) is the most appropriate palliative care needs-assessment tool for use in heart failure populations. It covers most of the patient needs and has the best psychometric properties and evidence of identification ability and appropriateness. Psychometric testing of the tools in patients with heart failure and evaluating the tools to identify those with palliative care needs require more investigation.
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Affiliation(s)
- Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Amy Gadoud
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Iain Malcolm James Murphy
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,Trinity Hospice and Palliative Care Services, Low Moor Road, Blackpool, FY2 0BG, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
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12
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Source of Social Support and Caregiving Self-Efficacy on Caregiver Burden and Patient's Quality of Life: A Path Analysis on Patients with Palliative Care Needs and Their Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155457. [PMID: 32751147 PMCID: PMC7432213 DOI: 10.3390/ijerph17155457] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Few studies have explored the inter-relationships of sources of social support and caregiving self-efficacy with caregiver burden and patient’s quality of life among patients with palliative care needs and their caregivers. This study tested the associations of two sources of social support (family and friends) and the mediating role of caregiving self-efficacy on caregiver burden and patient’s quality of life. A convenience sample of 225 patient–caregiver dyads recruited between September 2016 and May 2017 from three hospitals in Hong Kong was included in the current analysis. Results showed that the final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (p = 0.326). Significant associations were detected. Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient’s quality of life through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on patient’s quality of life. These findings emphasized (1) the importance of caregiving self-efficacy in improving caregiver burden and patient’s quality of life and that (2) sources of social support may be an important dimension moderating the associations of caregiving self-efficacy with caregiver burden and patient’s quality of life.
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13
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Bagcivan G, Bakitas M, Palmore J, Kvale E, Nichols AC, Howell SL, Dionne-Odom JN, Mancarella GA, Osisami O, Hicks J, Huang CHS, Tucker R. Looking Back, Moving Forward: A Retrospective Review of Care Trends in an Academic Palliative and Supportive Care Program from 2004 to 2016. J Palliat Med 2019; 22:970-976. [PMID: 30855204 DOI: 10.1089/jpm.2018.0410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine a rural-serving HBPC program's 12-year experience and historical trends to inform future program direction and expansion. Background: There is limited information about longitudinal trends in mature hospital-based palliative care (HBPC) programs serving racially diverse rural populations. Methods: This is a retrospective cross-sectional study of operational and patient-reported outcomes from the University of Alabama at Birmingham (UAB) Center for Palliative and Supportive Care (CPSC) inpatient (n=11,786) and outpatient (n=315) databases from October 2004 to March 2016. Results: Inpatients were a mean age of 63.7 years, male (50.1%), white (62.3%), general medicine referred (19.5%), primarily for goals of care (84.4%); 47.1% had "do not resuscitate/do not intubate" status and 46.9% were transferred to the Palliative Care and Comfort Unit (PCCU) after consultation. Median time from admission to consultation was three days, median PCCU length of stay (LOS) was four days, and median hospital LOS was nine days. Increased emergency department and cardiology referrals were notable in later years. Outpatients' mean age was 53.02 years, 63.5% were female, 76.8% were white, and 75.6% had a cancer diagnosis. Fatigue, pain, and disturbed sleep were the most common symptoms at the time of the visit; 34.6% reported mild-to-moderate depressive symptoms. Of patients reporting pain (64.8%), one-third had 50% or less relief from pain treatment. Discussion: The CPSC, which serves a racially diverse rural population, has demonstrated robust growth. We are poised to scale and spread our lessons learned to underserved communities.
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Affiliation(s)
- Gulcan Bagcivan
- 1School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,2Koc University School of Nursing, İstanbul, Turkey
| | - Marie Bakitas
- 1School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jackie Palmore
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth Kvale
- 5Division of Geriatrics and Palliative Care, Department of Medicine, University of Texas, Austin, Texas
| | - Ashley C Nichols
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen L Howell
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - J Nicholas Dionne-Odom
- 1School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gisella A Mancarella
- 1School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Oladele Osisami
- 1School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Jennifer Hicks
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chao-Hui Sylvia Huang
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodney Tucker
- 3Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.,4Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Shu Q, Wu L, Zhang R, Zhang Q, Huang J, Meng Y. Age-dependent changes in cardiac performance, motor function, QoL, and mental status in metoprolol-treated chronic heart failure patients. Sci Rep 2019; 9:453. [PMID: 30679746 PMCID: PMC6345765 DOI: 10.1038/s41598-018-37520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023] Open
Abstract
No previous study reports the effect of age on cardiac performance, motor function and quality of life (QoL) in Chinese chronic heart failure (CHF) patients. This single-center, prospective study enrolled CHF patients with resting heart rate (RHR) > 80 bpm, who were treated with metoprolol and were followed up at 1, 3, 6, and 12 months. Changes in cardiac, motor, and QoL parameters between patients aged ≥60 years and those aged <60 years were compared at all time points. P < 0.05 was considered significant. A total of 154 patients were enrolled (median age: 66.39 years; 116 aged ≥60 years, 38 aged <60 years; 95% New York Heart Association class III-IV). RHR decreased significantly in both patient groups (P < 0.0001 for both groups). Patients aged ≥60 years had a significant improvement in both ejection fraction (EF) at 6 and 12 months and in cardiac index (CI) at 3, 6, and 12 months. However, no major difference was observed in motor function in both groups. Significantly higher SF-8 scores showed greater improvement in QoL in the <60 age group at 12 months (P = 0.0008). Metoprolol demonstrated improvement in cardiac performance, motor function, QoL, and anxiety with increase in depression and burnout in both genders; however, the findings were independent of age.
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Affiliation(s)
- Qiuhong Shu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Liyong Wu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Ran Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Qian Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Jingjing Huang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China.
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15
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Clark CC, Hunter J. Spirituality, Spiritual Well-Being, and Spiritual Coping in Advanced Heart Failure: Review of the Literature. J Holist Nurs 2018. [DOI: 10.1177/0898010118761401] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.
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16
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Zhou H, Qian H. Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure. Clin Interv Aging 2018; 13:397-401. [PMID: 29563779 PMCID: PMC5846300 DOI: 10.2147/cia.s157507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate enteral nutrition’s effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure. Patients and methods A total of 105 elderly patients with heart failure were randomly divided into 3 groups: Treatment Group A, Treatment Group B, and the Control Group (Group C), each group having 35 patients and being administered conventional heart failure treatment. Group A was treated with 500 mL·d−1 of enteral nutrition for 1 month. Group B was given the same dose of enteral nutrition for 3 months. The Control Group was given free diet. Nutritional risk screening 2002 was used to assess the nutritional status before and after the treatment for each group. New York Heart Association status was recorded as were left ventricular ejection fraction, plasma B-type natriuretic peptide, inteleukin-6, C-reactive protein, and tumor necrosis factor-α. Results After the treatment, the body mass index, skinfold thickness of upper arm triceps, muscle circumference of the upper arm, upper arm muscle circumference, total protein, albumin, hemoglobin, and left ventricular ejection fraction in the treatment groups all increased, with relatively obvious relief of symptoms of heart failure. The levels of B-type natriuretic peptide, interleukin-6, tumor necrosis factor-α, and C-reactive protein all rose to different extents (P<0.05) and Treatment Group B showed more obvious improvement (P<0.01). Differences shown by the Control Group in each nutrition indicator, serum levels of inflammatory factors, and cardiac function had no statistical significance (P>0.05). Conclusion The use of enteral nutrition in conventional treatment of elderly patients with heart failure could improve not only patients’ nutritional status and cardiac function, but also their immune function, thus reducing the levels of inflammatory factors. The longer the treatment period is, the more obvious the improvement in patients’ cardiac function and inflammatory factors will be observed.
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Affiliation(s)
- Hong Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - HaiXin Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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17
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Effective management for older people with heart failure: from acute to palliative care paradigms. J Geriatr Cardiol 2016; 13:391-2. [PMID: 27594865 PMCID: PMC4984565 DOI: 10.11909/j.issn.1671-5411.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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