1
|
Higa H, Lennie TA, Chung ML, Tsuchihashi-Makaya M. Associations of multidimensional fatigue with the physical, psychological, and situational factors in outpatients with heart failure: a cross-sectional study. Eur J Cardiovasc Nurs 2023; 22:647-654. [PMID: 36509707 DOI: 10.1093/eurjcn/zvac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
AIMS Fatigue, a distressing symptom in patients with heart failure (HF), is associated with progress and health outcomes. Fatigue has been identified as having multidimensions, but a few studies have used a multidimensional fatigue scale. Many factors related to HF, including physical, psychological, and situational factors, may impact fatigue. However, there is limited knowledge about how these HF-related factors are associated with multidimensional fatigue in outpatients with HF in Japan. The aim of this study was to identify HF-related factors [physical; clinical characteristics, New York Heart Association (NYHA) functional class and physical function, psychological; depressive symptoms and anxiety, situational; health literacy and perceived control] associated with the five dimensions of fatigue in outpatients with HF. METHODS AND RESULTS Outpatients with HF (N = 165, mean age = 69.5 years, 78.8% male) completed the survey and physical assessment of gait speed. Fatigue was assessed using five dimensions of the Multidimensional Fatigue Inventory-20. Multiple linear regression analysis was conducted for each dimension of fatigue. General fatigue was predicted by age, NYHA, and perceived control. Physical fatigue was predicted by NYHA, depressive symptoms, and perceived control. Reduced activity was predicted by NYHA, gait speed, depressive symptoms, communicative health literacy, and critical health literacy. The reduced motivation was predicted by depressive symptoms and perceived control. Mental fatigue was predicted by depressive symptoms. CONCLUSION Different factors were significantly associated with each fatigue dimension. Further research is needed to alleviate fatigue in patients with HF.
Collapse
Affiliation(s)
- Hiroko Higa
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
| | - Terry A Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Miyuki Tsuchihashi-Makaya
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
| |
Collapse
|
2
|
Okada A, Tsuchihashi-Makaya M, Nagao N, Ochiai R. Somatic Changes Perceived by Patients With Heart Failure During Acute Exacerbation: A Qualitative Study Using Text Mining. J Cardiovasc Nurs 2023; 38:23-32. [PMID: 35467568 DOI: 10.1097/jcn.0000000000000915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with heart failure (HF) often inadequately perceive their symptoms. This may be because the medical terms do not match the somatic changes experienced by patients. To improve symptom perception, healthcare professionals must understand the somatic changes as perceived by patients. OBJECTIVE This study aims to analyze patients' narratives about somatic changes in patients with HF by text mining and to clarify the overall description of somatic changes using patients' expressions. METHODS Semistructured interviews were conducted on 21 patients hospitalized for acute exacerbation of HF. Qualitative data obtained from the interviews were analyzed by content analysis through text mining. RESULTS Among the 21 patients, 76.2% were men. The mean (SD) age was 71.3 (13.7) years. The most frequently used terms were "breath," "distressed," "feet," and " ha-ha (gasping sound)" (46, 40, 29, and 28 times, respectively). The somatic changes noticed by patients could be categorized into medical jargon such as "dyspnea on exertion," "exercise intolerance," "fatigue," "paroxysmal nocturnal dyspnea," "frequent urination," "increased sputum," "weight gain," "feet and face edema," "abdominal edema," and "ankle edema." However, the expressions of somatic changes used by the patients were diverse. CONCLUSIONS The findings of patient-specific expressions of symptoms suggest that there is a need to assess symptoms not only using medical jargon but also by focusing on patient-specific expressions.
Collapse
|
3
|
Gharaibeh B, Al-Absi I, Abuhammad S, Gharaibeh M. Dimensions of sleep characteristics and predictors of sleep quality among heart failure patients: A STROBE compliant cross-sectional study in Jordan. Medicine (Baltimore) 2022; 101:e32585. [PMID: 36596068 PMCID: PMC9803448 DOI: 10.1097/md.0000000000032585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Awareness of poor sleep quality and sleep disturbances, as some of the factors that affect negatively quality of life for patients with the different classes of heart failure (HF) would enable health care providers to offer more comprehensive care. The purposes of this study were to describe sleep quality and predictors of disturbances in sleep in heart failure patients in Jordan. An explanatory cross- sectional design was employed to examine sleep quality, dimensions of sleep characteristics, types of disturbances in sleep within the different classes of HF in Jordan. Data were collected from 2 cardiac clinics and 2 medical clinics at 3 hospitals in Jordan. The most common types of disturbances in sleep in all classes of HF were waking up for urination, waking in the middle of the night or early morning, waking up due to cough and snoring, and difficulty to fall asleep within the 30 minutes. However, waking up due to feeling cold or hot were rarely reported in all classes of patients with HF. Regression analysis revealed that significant correlations were found between sleep quality and gender, disease duration, number of medications currently taken and ejection fraction (P < .05). Our findings indicated that sleep quality and disturbances in sleep were worsening with the increase of the New York heart association functional classification sheet class. Moreover, sleep quality had a significant association with gender, disease duration, ejection fraction, and the number of medications currently taken.
Collapse
Affiliation(s)
- Besher Gharaibeh
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- * Correspondence: Besher Gharaibeh, Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan (e-mail: )
| | - Ilham Al-Absi
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Monther Gharaibeh
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
4
|
Fatigue in Heart Failure. J Cardiovasc Nurs 2022. [DOI: 10.1097/jcn.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Austin RC, Schoonhoven L, Richardson A, Kalra PR, May CR. Qualitative interviews results from heart failure survey respondents on the interaction between symptoms and burden of self-care work. J Clin Nurs 2022. [PMID: 35945903 DOI: 10.1111/jocn.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Following a cross-sectional survey, a sub-sample of participants was interviewed to explore the interaction between symptoms and burden of treatment. BACKGROUND Burden of treatment considers both the work associated with illness and treatment, including self-care work, as well as the individuals' capabilities and resources to engage in that work. The recent survey revealed the existence of a complex interaction. DESIGN Qualitative abductive analysis of semi-structured interviews. METHODS Adults with heart failure who participated in the survey were purposely sampled and invited to participate in semi-structured interviews. Location and mode of interview varied by participant choice. Excerpts from the verbatim transcripts were assessed for interactions between symptoms and burden of treatment, and when identified these were characterised and explained. We followed COREQ checklist for reporting. The patient research ambassador group was involved from research design to dissemination. RESULTS Participants (n = 32) consistently discussed how symptoms altered their capability to engage in self-care work. As symptom intensity increased the difficultly of their self-care work increased. A number of intervening factors appeared to influence the relationship between symptoms and burden of treatment. Intervening factors included illness pathology, illness identity, the value of the tasks attempted and available support structures. These factors may change how symptoms and burden of treatment are perceived; a model was constructed to explain and summarise these interactions. CONCLUSIONS The interaction between symptoms and burden of treatment is complex. Intervening factors-illness identity and pathology, task value and performance, and available support structures-appear to exert a strong influence on the interaction between symptoms and burden of treatment. RELEVANCE TO CLINICAL PRACTICE These intervening factors present clinicians and researchers with opportunities to develop interventions that might reduce burden of treatment and improve symptoms and quality of life. CLINICAL TRIAL REGISTRATION SYMPACT was registered with ISRCTN registry: ISRCTN11011943.
Collapse
Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Portsmouth, UK.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Portsmouth, UK.,College of Medical, Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
| |
Collapse
|
6
|
Gingele AJ, Brandts L, Brunner-La Rocca HP, Cleuren G, Knackstedt C, Boyne JJJ. Introduction of a new scoring tool to identify clinically stable heart failure patients. Neth Heart J 2022; 30:402-410. [PMID: 34988879 PMCID: PMC9402836 DOI: 10.1007/s12471-021-01654-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care. Supplementary Information The online version of this article (10.1007/s12471-021-01654-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A J Gingele
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - L Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - G Cleuren
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C Knackstedt
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure. J Cardiovasc Nurs 2021; 35:116-125. [PMID: 31985701 DOI: 10.1097/jcn.0000000000000642] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined. OBJECTIVE The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL. METHODS We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose. RESULTS Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL. CONCLUSION Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.
Collapse
|
8
|
Cavalcante VN, Cavalcanti ACD, Tinoco JDMVP, Figueiredo LDS, Mesquita ET. Effectiveness of Mindfulness Meditation Programs in the Promotion of Quality of Life in Patients with Heart Failure: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
9
|
Sethares KA, Chin E. Age and gender differences in physical heart failure symptom clusters. Heart Lung 2021; 50:832-837. [PMID: 34311226 DOI: 10.1016/j.hrtlng.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gender differences exist in structure and function of the heart resulting in HF symptom variation. Previous HF symptom cluster research described symptom clusters that were linked to functional status, mortality, quality of life and rehospitalization. Age and gender differences between cluster groups were described in one study. OBJECTIVES Identify physical HF symptom clusters and explore age and gender differences between clusters. METHODS Secondary analysis study of adults with HF. Cluster analysis was conducted using hierarchical agglomerative clustering techniques. A pictorial dendrogram output displays clusters. RESULTS Three symptom clusters were identified in this sample of 133 older HF patients that differed by gender (p = 0.04), age (p = 0.00) and beta blocker use (p = 0.01). Symptom clusters were consistent with worsening HF, acute HF and chronic HF. CONCLUSION Symptom clusters differ by age and gender. Education should be directed at increasing patient awareness of their individual symptom clusters.
Collapse
Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States.
| | - Elizabeth Chin
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States
| |
Collapse
|
10
|
Anker MS, Tschöpe C. Reply to 'Heart failure with preserved ejection fraction and COVID-19: which comes first, the chicken or the egg?'. Eur J Heart Fail 2021; 23:2092-2093. [PMID: 34263996 PMCID: PMC8426823 DOI: 10.1002/ejhf.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Markus S. Anker
- Department of Cardiology CharitéUniversitätsmedizin Berlin, Campus Benjamin‐FranklinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
- Department of Internal Medicine and CardiologyCharité ‐ Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany
- Berlin Institute of Health (BIH) at Charite (BIH)Universitätsmedizin BerlinBerlinGermany
| |
Collapse
|
11
|
Gok Metin Z, Gulbahar M. The Prevalence of Complementary and Integrative Health Approach Use and Quality of Life Among Patients With Heart Failure: A Cross-sectional, Descriptive, and Comparative Study. Holist Nurs Pract 2021; 35:123-132. [PMID: 33853096 DOI: 10.1097/hnp.0000000000000442] [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: 11/26/2022]
Abstract
This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL.
Collapse
Affiliation(s)
- Zehra Gok Metin
- Internal Medicine Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
12
|
Sethares KA, Viveiros JD, Ayotte B. Uncertainty levels differ by physical heart failure symptom cluster. Appl Nurs Res 2021; 60:151435. [PMID: 34247783 DOI: 10.1016/j.apnr.2021.151435] [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: 01/13/2021] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF. AIMS Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster. METHODS Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group. RESULTS One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033). CONCLUSIONS Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.
Collapse
Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States.
| | - Jennifer D Viveiros
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States
| | - Brian Ayotte
- Department of Psychology, College of Arts and Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States
| |
Collapse
|
13
|
HFpEF without elevated right ventricular systolic pressure is a favorable prognostic indicator in patients with IPF requiring hospitalization for heart failure. PLoS One 2021; 16:e0245778. [PMID: 33481923 PMCID: PMC7822325 DOI: 10.1371/journal.pone.0245778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background Some patients with idiopathic pulmonary fibrosis (IPF) must be hospitalized because of heart failure (HF), including HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF). The association between IPF and HF has not been clarified. We retrospectively investigated the clinical features and outcomes of patients with IPF who required nonelective hospitalization because of HF. Methods We examined data from IPF patients who required nonelective hospitalization for HF at the Kindai University Hospital from January 2008 to December 2018. We divided the patients into 3 groups: those with HFpEF without elevated right ventricular systolic pressure (RVSP), those with HFpEF and elevated RVSP, and those with HFrEF. The recurrence rates of HF after discharge and the 30- and 90-day mortality rates of the patients were evaluated. Results During the study period, 37 patients with IPF required hospitalization because of HF. Among the 34 patients included in the study, 17 (50.0%) were diagnosed with HFpEF without elevated RVSP, 11 (32.3%) with HFpEF and elevated RVSP, and 6 (17.6%) with HFrEF. Patients with HFrEF had significantly higher values for B-type natriuretic peptide (BNP) and left ventricular (LV) end-systolic and end-diastolic diameters than patients with the 2 types of HFpEF (BNP: P = 0.01 and P = 0.0004, LV end-systolic diameter: P <0.0001 and P <0.0001, and LV end-diastolic diameter: P = 0.01 and P = 0.0004, respectively). Notably, the difference between the LVEFs of the patients with 2 types of HFpEF was not significant. The patients with HFpEF without elevated RVSP had the lowest 30- and 90-day mortality rates (0%, P = 0.02 and 11.7%, P = 0.11, respectively). Conclusions Among patients with IPF, HFpEF without elevated RVSP was the most common type of HF that required hospitalization. Patients with HFpEF without elevated RVSP survived longer than the patients with the other 2 types of HF.
Collapse
|
14
|
Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Fail 2020; 7:2193-2207. [PMID: 32757363 PMCID: PMC7524132 DOI: 10.1002/ehf2.12875] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic heart failure (CHF) is a chronic, progressive disease that has detrimental consequences on a patient's quality of life (QoL). In part due to requirements for market access and licensing, the assessment of current and future treatments focuses on reducing mortality and hospitalizations. Few drugs are available principally for their symptomatic effect despite the fact that most patients' symptoms persist or worsen over time and an acceptance that the survival gains of modern therapies are mitigated by poorly controlled symptoms. Additional contributors to the failure to focus on symptoms could be the result of under‐reporting of symptoms by patients and carers and a reliance on insensitive symptomatic categories in which patients frequently remain despite additional therapies. Hence, formal symptom assessment tools, such as questionnaires, can be useful prompts to encourage more fidelity and reproducibility in the assessment of symptoms. This scoping review explores for the first time the assessment options and management of common symptoms in CHF with a focus on patient‐reported outcome tools. The integration of patient‐reported outcomes for symptom assessment into the routine of a CHF clinic could improve the monitoring of disease progression and QoL, especially following changes in treatment or intervention with a targeted symptom approach expected to improve QoL and patient outcomes.
Collapse
Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Elisha R Gallivan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Melanie McGinlay
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Anet G Toms
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| |
Collapse
|
15
|
Abstract
BACKGROUND Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF. OBJECTIVE The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status. METHODS A total of 115 patients with HF were included. Data on symptom status (Memorial Symptom Assessment Scale-HF), perceived control (Control Attitudes Scale-Revised), and self-care (Self-Care of Heart Failure Index) were collected. Other covariates included were age, gender, New York Heart Association class, comorbidity burden, and depressive symptoms. Multiple regression analyses were performed to analyze the data. RESULTS Lower perceived control predicted worse symptom status after controlling for covariates (P = .009). Other covariates predictive of worse symptom status were younger age, New York Heart Association class III/IV, and higher levels of depressive symptoms. Higher levels of perceived control were associated with better self-care (P = .044). Better self-care was associated with better symptom status (P = .038). CONCLUSIONS Lower levels of perceived control were independently associated with worse symptom status in patients with HF. Intervention strategies targeting perceived control should be tested to determine whether they could improve symptom status.
Collapse
|
16
|
Abstract
BACKGROUND In patients with heart failure (HF), high dietary sodium intake is common and associated with HF symptoms, poor health-related quality of life (HRQOL), and high hospitalization rates. PURPOSE The aims of this study were to examine the feasibility of a tailored dietary intervention with a practical tool (MyFitnessPal) and to obtain preliminary data about the effects on sodium intake, factors affecting sodium intake (knowledge, skills, experiences, confidence, perceived benefits and barriers, and depressive symptoms), HF symptoms, and HRQOL. METHODS A 6-session intervention was delivered to 11 participants. Paired t tests were used to compare the baseline outcomes with those at 3 months. RESULTS Participants completed 98% of intervention sessions, and 91% used MyFitnessPal. Sodium intake was reduced, and factors affecting sodium intake, symptoms, and HRQOL were improved (all P < .05). CONCLUSION The intervention was feasible and warrants further research to test the effects of the intervention on the outcomes using larger, heterogeneous samples.
Collapse
|
17
|
Alghalayini KW. Using Atlanta Heart Failure Questionnaire in ambulatory heart failure patients with preserved ejection fraction HFPEF. JRSM Cardiovasc Dis 2020; 9:2048004020927642. [PMID: 32528670 PMCID: PMC7265075 DOI: 10.1177/2048004020927642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/15/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The present study uses the Atlanta Heart Failure Questionnaire as a tool to evaluate and design a tailored education material for ambulatory heart failure patients with preserved ejection fraction, highlighting the strengths and weakness toward the planning of education programs. METHODS A total of 450 patients were screened; 112 patients were recruited, and 27-item was used to evaluate the usefulness of this questionnaire. All patients received education by a dedicated medical education about the nature of the disease, risk factors and management including prevention of complications. Descriptive statistics were used for assessing the sample characteristics. RESULTS In the assessment of patient disease knowledge, in a 7-item questionnaire, the most well-understood item was correctly identified in 95% patients, whereas the least-understood item was identified in 1.8% of patients. In the assessment of patient management knowledge, in a 6-item questionnaire, the most well-understood item was correctly identified in 50% of patients and the least-understood item was identified in 10% of patients. In the assessment of patient medication intake knowledge, in a 3-item questionnaire, the most well-understood item was correctly identified in 97.3% of patients and the least-understood item was identified in 26.6% of patients. CONCLUSION For a disease not fully understood, the study has concluded the usefulness of Atlanta Heart Failure Questionnaire for filling the gaps, setting a base line and follow-up in the process of educating ambulatory heart failure patients with preserved ejection fraction HFPF.
Collapse
|
18
|
Ceron DM, Garcia Rosa ML, Jorge AJ, Correia DM, Kang HC, Mesquita ET, Grijalba Velasco JC, Gismondi R, de Andrade Martins W. Characterization of dyspnea in chronic diseases and heart failure in patients in a Family Health Program. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
19
|
Santos VB, Lopes CT, dos Anjos LD, Begot I, Cassiolatto F, Guizilinni S, Moreira RSL. Accuracy of the Defining Characteristics of Fatigue in Patients with Heart Failure as Identified by the 6‐Minute Walking Test. Int J Nurs Knowl 2019; 31:188-193. [DOI: 10.1111/2047-3095.12270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/07/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Isis Begot
- Nursing Paulista SchoolFederal University of São Paulo São Paulo Brazil
| | | | | | | |
Collapse
|
20
|
Castro RRT, Joyce E, Lakdawala NK, Stewart G, Nohria A, Givertz MM, Desai A, Lewis EF, Stevenson LW. Patients report more severe daily limitations than recognized by their physicians. Clin Cardiol 2019; 42:1181-1188. [PMID: 31571248 PMCID: PMC6906987 DOI: 10.1002/clc.23269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class. OBJECTIVES To determine the extent of patient-reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group. METHODS AND RESULTS While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician-assigned NYHA class during the same visit. Patient-reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7). CONCLUSIONS Activity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.
Collapse
Affiliation(s)
- Renata R T Castro
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.,School of Medicine, Universidade Iguaçu, Rio de Janeiro, Brazil
| | - Emer Joyce
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Neal K Lakdawala
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Garrick Stewart
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Nohria
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Akshay Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eldrin F Lewis
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lynne W Stevenson
- Cardiomyopathy & Advanced Heart Disease Training, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| |
Collapse
|
21
|
Riganello F, Napoletano G, Cortese MD, Arcuri F, Solano A, Lucca LF, Tonin P, Soddu A. What impact can hospitalization environment produce on the ANS functioning in patients with Unresponsive Wakefulness Syndrome? - 24-hour monitoring. Brain Inj 2019; 33:1347-1353. [PMID: 31335209 DOI: 10.1080/02699052.2019.1641841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: Studies showed that the recovery of patients with Unresponsive Wakefulness Syndrome (UWS) is also correlated to the recovery of circadian rhythms. In this study, we observed the correlations between patients with UWS biometrical and ambient parameters. Methods: A dedicated monitoring system was realized to record and correlate the level of noise and luminosity with biometric Heart Rate (HR), Heart Rate Variability (HRV) and Breath Rate (BR) parameters. Eleven patients with UWS were recruited and monitored for 13 ± 7 days. Correlation of ambient and biometric parameters was analyzed by Spearman's test. Wilcoxon's test was used to compare the biometric parameters in two different moments of daily activity in the rehabilitation unit (night and day). Patients showed a moderate negative or positive correlation between biometric and ambient parameters. Results: Significant differences between night and morning (0.0001 < p ≤ 0.001) were found for HR, HRV and BR in seven, five and four patients, respectively, at Wilcoxon's test. HR and BR were higher during the night while HRV was lower. Conclusion: In patients with UWS, lower HRV and higher HR and BR during the night might be indicative of interference in sleep/wake cycles. The modifications of the environment surrounding the patient due to the unit procedures of the staff and/or some interaction modalities of the relatives may have an effect on residual endogenous mechanisms of self-regulation. However, differences between night and day in the biometrical parameters are not necessarily linked to the changes in the environment care unit.
Collapse
Affiliation(s)
- F Riganello
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - G Napoletano
- b Department of Engineering, Modelling, Electronics and Systemistics, University of Calabria , Arcavacata di Rende (CS) , Italy
| | - M D Cortese
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - F Arcuri
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - A Solano
- b Department of Engineering, Modelling, Electronics and Systemistics, University of Calabria , Arcavacata di Rende (CS) , Italy
| | - L F Lucca
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - P Tonin
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - A Soddu
- c Brain and Mind Institute, Physics and Astronomy Department, Western University , London , ON , Canada
| |
Collapse
|
22
|
Pucciarelli G, Greco A, Paturzo M, Jurgens CY, Durante A, Alvaro R, Vellone E. Psychometric evaluation of the Heart Failure Somatic Perception Scale in a European heart failure population. Eur J Cardiovasc Nurs 2019; 18:484-491. [DOI: 10.1177/1474515119846240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The Heart Failure Somatic Perception Scale (HFSPS) is a four-factor instrument used to assess how bothersome are 18 physical signs and symptoms of heart failure. To date, construct validity and reliability of the HFSPS have been evaluated in only one American study and never in a European population. Aim: To evaluate psychometric properties (validity and reliability) of the HFSPS in a European heart failure population. Methods: This was an Italian multicentre study in which the HFSPS factorial structure was assessed using confirmatory factor analysis. Criterion related validity of the HFSPS was evaluated by correlating its factor scores with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using Pearson’s r. The HFSPS internal consistency reliability was evaluated using the factor score determinacy coefficient, Cronbach’s α and model-based internal consistency index. Results: Most of the participants ( n=321) were male (56.6%), with a mean age of 71.48 years (SD, 12.75) and in New York Heart Association class II (61.8%). The confirmatory factor analysis, testing the original HFSPS four-factor structure (dyspnoea, chest discomfort, early and subtle, and oedema), resulted in the following supportive fit indices: χ2 (126, N=321)=337.612, p<0.001, comparative fit index =0.920, Tucker–Lewis index =0.903, root mean square error of approximation =0.072 and standardized root mean square residual =0.045. With regard to the criterion related validity, all the correlations with the KCCQ were statistically significant. The HFSPS reliability resulted in factor score determinacy coefficients ⩾ 0.87 and Cronbach’s α ⩾ 0.75, with the exception of the two-item chest discomfort subscale; the model-based reliability coefficient was 0.914. Conclusion: The validity and reliability of the HFSPS were supportive in this European sample. The HFSPS can be used to assess how bothersome heart failure signs and symptoms are in order to improve their management.
Collapse
Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Italy
| | - Marco Paturzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Angela Durante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
23
|
Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure. J Cardiovasc Nurs 2019; 34:36-43. [DOI: 10.1097/jcn.0000000000000526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Nepomuceno E, Silva LN, Cunha DCPD, Furuya RK, Simões MV, Dantas RAS. Comparison of tools for assessing fatigue in patients with heart failure. Rev Bras Enferm 2018; 71:2404-2410. [DOI: 10.1590/0034-7167-2017-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/06/2017] [Indexed: 12/28/2022] Open
Abstract
ABSTRACT Objective: To compare the distributions of measurements of the Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS), and Fatigue Pictogram tools, according to the New York Heart Association (NYHA) Functional Classification and left ventricular ejection fraction (LVEF). Method: Methodological, cross-sectional study with 118 patients with heart failure. Variance analysis, Pearson's correlation, and Fisher's exact tests were carried out, with a significance level of 0.05. Results: There was an increase in the DUFS and DEFS means with worsening of the NYHA-FC (p<0.001, for both tools). Correlations among the LVEF resulted in positive and weak magnitude for the DEFS (r=0.18; p=0.05) and for the DUFS (r=0.16; p=0.08). Just the item A on the Fatigue Pictogram had an association with the NYHA-FC (p<0.001) and the LVEF (p=0.03). Conclusion: Three tools detected worsening in fatigue levels according to the illness severity assessed by the NYHA-FC.
Collapse
|
25
|
Changes in Heart Failure Symptoms are Associated With Changes in Health-related Quality of Life Over 12 Months in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:460-466. [DOI: 10.1097/jcn.0000000000000493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
26
|
Psychosocial needs and interventions for heart failure patients and families receiving palliative care support: a systematic review. Heart Fail Rev 2018; 22:565-580. [PMID: 28217818 DOI: 10.1007/s10741-017-9596-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although diseases of the heart are the leading cause of death in the USA, palliative care research has largely focused on populations of cancer patients. However, a diagnosis of heart failure differs substantially than that of cancer. They differ in terms of signs and symptoms, disease trajectories, treatment options, stigma, and prognosis. Additionally, the populations affected by these differing illnesses are also unique in a number of fundamental ways. Based on these differences, it is reasonable to hypothesize that palliative care patients with heart failure, and their families, have a distinct set of psychosocial needs. The purpose of this review is to describe the psychosocial needs of palliative care heart failure patients, and their families, as well as the interventions that address those needs. Six electronic databases were searched in June 2016 resulting in 962 identified abstracts. After removal of 388 duplicates, 574 abstracts were screened based on the following criteria: (1) available in English, (2) peer-reviewed, (3) empirical data reported, (4) patient receiving palliative or hospice care, and (5) measured psychosocial needs of heart failure patients and/or their family caregivers. After screening 574 abstracts and conducting a full-text review of 150 articles, a total of 17 studies were identified in our review. Only three intervention studies were identified, two of which evaluated the impact of palliative care over usual care. The remaining study was a clinical trial of a psycho-educational support intervention, which failed to demonstrate beneficial outcomes. Heart failure patients and their family caregivers receiving palliative or hospice care have unique psychosocial needs that are largely unexamined by previous research. The need for further research is discussed.
Collapse
|
27
|
Kalhan R, Mutharasan RK. Reducing Readmissions in Patients With Both Heart Failure and COPD. Chest 2018; 154:1230-1238. [PMID: 29908152 DOI: 10.1016/j.chest.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 01/27/2023] Open
Abstract
Patients with both COPD and heart failure (HF) pose particularly high costs to the health-care system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Here we present 10 practical tips to reduce readmissions in this challenging population: (1) diagnose the population accurately, (2) detect admissions for exacerbations early and consider risk stratification, (3) use specialist management in hospital, (4) modify the underlying disease substrate, (5) apply and intensify evidence-based therapies, (6) activate the patient and develop critical health behaviors, (7) setup feedback loops, (8) arrange an early follow-up appointment prior to discharge, (9) consider and address other comorbidities, and (10) consider ancillary support services at home. The multidisciplinary care teams needed to support these care models pose expense to the health-care system. Although these costs may more easily be recouped under financial models such as accountable care organizations and bundled payments, the opportunity cost of an admission for COPD or HF may represent an underrecognized financial lever.
Collapse
Affiliation(s)
- Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Raja Kannan Mutharasan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
28
|
Testing a Holistic Meditation Intervention to Address Psychosocial Distress in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:126-134. [DOI: 10.1097/jcn.0000000000000435] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
29
|
|
30
|
Abstract
BACKGROUND Health monitoring within a telehealth program is a strategy to efficiently care for older adults with heart failure (HF). Limited description is identified in the literature for the extent participant submissions trigger an alert or monitoring nurses transfer telehealth alert-range data to the medical record. INTRODUCTION The aim was to describe the initial 90 days of participant submissions measuring within alert range and nurse response to alerts with documentation to the medical record. MATERIALS AND METHODS Review of telehealth and medical records of 187 older veterans with HF participating at one Veterans Administration Care Coordination Home Telehealth program led to reporting the proportion of participant telehealth submissions measuring within alert range and nurse response to alert-range data. RESULTS Less than 2.5% of self-rated health status and nearly one-quarter of physiologic submissions measured within alert range. Timely nurse response averaged 28.7% and increased when submissions for vital signs, weight, or medication alerted for consecutive days. Neither alert nor nurse response data were significantly associated with characteristic measures. DISCUSSION Clinical relevance of alert-range telehealth data is uncertain partly due to frequent alerts triggered by physiologic submissions, few health status changes noted by the participant or the monitoring nurse, and the nonsignificant association between the proportion of alerts or nurse response, respectively, with demographic or clinical baseline measures. CONCLUSIONS Future studies are needed to identify telehealth program measures that decrease alerting data not associated with clinical worsening and increase recognition-of-change in HF health status by the participant and monitoring nurse.
Collapse
Affiliation(s)
- Mary M Murphy
- Egan School of Nursing and Health Studies, Fairfield University , Fairfield, Connecticut
| |
Collapse
|
31
|
Validation of the Symptom Status Questionnaire-Heart Failure in Korean patients. Appl Nurs Res 2017; 38:141-146. [DOI: 10.1016/j.apnr.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 01/06/2023]
|
32
|
van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 958] [Impact Index Per Article: 136.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
Collapse
|
33
|
Heo S, Moser DK, Pressler SJ, Dunbar SB, Lee KS, Kim J, Lennie TA. Association between obesity and heart failure symptoms in male and female patients. Clin Obes 2017; 7:77-85. [PMID: 28117927 PMCID: PMC6106864 DOI: 10.1111/cob.12179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/14/2016] [Accepted: 09/18/2016] [Indexed: 11/30/2022]
Abstract
In patients with heart failure (HF), higher body mass index (BMI) has been associated with lower rates of hospitalization and mortality (obesity paradox). Symptoms are antecedents of hospitalizations, but little is known about the relationship between BMI and symptoms and gender differences. To examine the association of BMI with symptoms in male and female patients with HF, controlling for covariates (sample characteristics, depressive symptoms and sodium intake). In this cross-sectional correlational study, patients (N = 247) provided data on BMI, symptoms and covariates. BMI was categorized into four groups: normal/underweight (<25 kg/m2 ), overweight (25-29.9 kg/m2 ), obese I (30-34.9 kg/m2 ) and obese II/III (≥35 kg/m2 ). General linear regression was used to analyse the data. The Obese II/III group had more severe HF symptoms than other groups only in male patients. In male patients, older age, Caucasian race, more comorbidities and more severe depressive symptoms were also associated with more severe symptoms. In female patients, more severe depressive symptoms, more comorbidities and higher sodium intake were associated with more severe symptoms. The obesity paradox does not fully extend to symptoms, and gender has a role in the relationship between obesity and symptoms.
Collapse
Affiliation(s)
- S Heo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - S J Pressler
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - S B Dunbar
- School of Nursing, Emory University, Atlanta, GA, USA
| | - K S Lee
- College of Nursing, Chungnam National University, Dea Jeon, South Korea
| | - J Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - T A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
34
|
Associação dos tipos de dispneia e da “flexopneia” com as patologias cardiopulmonares nos cuidados de saúde primários. Rev Port Cardiol 2017; 36:179-186. [DOI: 10.1016/j.repc.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/21/2022] Open
|
35
|
Martínez Cerón DM, Garcia Rosa ML, Lagoeiro Jorge AJ, de Andrade Martins W, Tinoco Mesquita E, Di Calafriori Freire M, da Silva Correia DM, Kang HC. Association of types of dyspnea including ‘bendopnea’ with cardiopulmonary disease in primary care. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
36
|
Heo S, McSweeney J, Tsai PF, Ounpraseuth S. Differing Effects of Fatigue and Depression on Hospitalizations in Men and Women With Heart Failure. Am J Crit Care 2016; 25:526-534. [PMID: 27802954 PMCID: PMC6169317 DOI: 10.4037/ajcc2016909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In patients with heart failure, worsening of signs and symptoms and depression can affect hospitalization and also each other, resulting in synergistic effects on hospitalizations. A patient's sex may play a role in these effects. OBJECTIVES To determine the effects of fatigue and depression on all-cause hospitalization rates in the total sample and in subgroups of men and women. METHODS A secondary analysis was done of data collected January 1, 2010, through December 31, 2012 (N = 582; mean age, 63.2 years [SD, 14.4]). Data were collected on fatigue, depression, sample characteristics, vital signs, results of laboratory tests, medications, and frequency of hospitalization. Patients were categorized into 4 groups on the basis of the International Classification of Diseases, Ninth Revision: no fatigue or depression, fatigue only, depression only, and both fatigue and depression. General linear regression was used to analyze the data. RESULTS In both the total sample and the subgroups, the number of hospitalizations in patients with both fatigue and depression was greater than the number in patients without either symptom. Among women, the number of hospitalizations in the fatigue-only group and in the depression-only group was greater than that in the group with neither symptom. In men, the number of hospitalizations in the fatigue-only group was greater than that in the group without either symptom. CONCLUSION Fatigue and depression do not have synergistic effects on hospitalization, but men and women differ in the effects of these symptoms on hospitalization.
Collapse
Affiliation(s)
- Seongkum Heo
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health.
| | - Jean McSweeney
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
| | - Pao-Feng Tsai
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
| | - Songthip Ounpraseuth
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
| |
Collapse
|
37
|
Albert NM, Dinesen B, Spindler H, Southard J, Bena JF, Catz S, Kim TY, Nielsen G, Tong K, Nesbitt TS. Factors associated with telemonitoring use among patients with chronic heart failure. J Telemed Telecare 2016; 23:283-291. [PMID: 26869144 DOI: 10.1177/1357633x16630444] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background In adults with chronic heart failure (HF; defined as people with previously diagnosed left ventricular dysfunction) telemonitoring randomized controlled trials (RCTs) failed to consistently demonstrate improved clinical outcomes. We aimed to examine if patient and HF characteristics are associated with device preferences and use. Methods Using a cross-sectional, multicenter, international design, ambulatory and hospitalized adults with HF in Ohio, California, and Denmark viewed a six-minute video of telemonitoring configurations (tablet, smart phone, and key fob) and completed questionnaires. Comparative analyses were performed and when significant, pairwise comparisons were performed using Bonferroni-adjusted significance levels. Results Of 206 participants, 48.2% preferred smart phones for telemonitoring, especially when traveling (54.8%), with new/worsening symptoms (50%), for everyday use (50%), and connecting with doctors (48.5%). Participants preferred two-way communication and a screen with words over voice or number pads. Of device purposes, allowing for nurse communication ranked highest, followed by maintaining overall health. Very few patient and HF factors were associated with device preferences. Patients with higher health literacy ( p = 0.007), previous/current device use history ( p = 0.008), higher education level ( p = 0.035), and married/cohabitating status ( p = 0.023) had higher perceptions of ease of using devices. Those who were asymptomatic or had mild HF had higher self-confidence for health devices ( p = 0.024) and non-white patients perceived devices as more useful ( p = 0.033). Conclusion Telemonitoring use may be enhanced by simple plug-and-play type devices, two-way communication, and features that meet patients' personal learning and use needs.
Collapse
Affiliation(s)
- Nancy M Albert
- 1 Office of Nursing Research and Innovation-Nursing Institute and Kaufman Center for Heart Failure-Heart and Vascular Institute, Cleveland Clinic Health System, USA
| | - Birthe Dinesen
- 2 Laboratory of Telehealth and Telerehabilitation, SMI, Department of Health Science and Technology, Aalborg University, Denmark
| | | | - Jeffrey Southard
- 4 Department of Cardiology, University of California, Davis and University of California, Davis Medical Center, USA
| | - James F Bena
- 5 Quantitative Health Sciences, Cleveland Clinic Health System, USA
| | - Sheryl Catz
- 6 Betty Irene Moore School of Nursing, University of California, Davis, USA
| | - Tae Youn Kim
- 6 Betty Irene Moore School of Nursing, University of California, Davis, USA
| | - Gitte Nielsen
- 7 Department of Cardiology, Vendsyssel Hospital, Denmark
| | - Katherine Tong
- 4 Department of Cardiology, University of California, Davis and University of California, Davis Medical Center, USA
| | - Thomas S Nesbitt
- 8 Strategic Technologies and Alliances, University of California, Davis and University of California Davis Medical Center, and The Center for Information Technology Research in the Interest of Society, University of California, Berkeley, USA
| |
Collapse
|
38
|
da Silva Alves Souza LM, Cotait Ayoub A, Ruiz Zimmer Cavalcante AM. Nursing Diagnosis for People With Heart Failure Based on the Hemodynamic Profiles. Int J Nurs Knowl 2016; 28:199-203. [DOI: 10.1111/2047-3095.12151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Affiliation(s)
| | - Andrea Cotait Ayoub
- Nursing II Division, Dante Pazzanese Institute of Cardiology; São Paulo-SP Brazil
| | | |
Collapse
|
39
|
Gardner CL, Flanagan MC, Franklin C, John-Swayers C, Walsh-Pouch S, Bryant FJ, Romano CA, Gibbons S, De Jong M, Hoang A, Becher D, Burke HB. Electronic physiologic and subjective data acquisition in home-dwelling heart failure patients: An assessment of patient use and perception of usability. Int J Med Inform 2016; 93:42-8. [PMID: 27435946 DOI: 10.1016/j.ijmedinf.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The current approach to the outpatient management of heart failure involves patients recollecting what has happened to them since their last clinic visit. But patients' recollection of their symptoms may not be sufficiently accurate to optimally manage their disease. Most of what is known about heart failure is related to patients' diurnal symptoms and activities. Some mobile electronic technologies can operate continuously to collect data from the time patients go to bed until they get up in the morning. We were therefore interested to evaluate if patients would use a system of selected patient-facing devices to collect physiologic and subjective state data in and around the patients' period of sleep, and if there were differences in device use and perceptions of usability at the device level METHODS This descriptive observational study of home-dwelling patients with heart failure, between 21 and 90 years of age, enrolled in an outpatient heart failure clinic was conducted between December 2014 and June 2015. Patients received five devices, namely, body weight scale, blood pressure device, an iPad-based subjective states assessment, pulse oximeter, and actigraph, to collect their physiologic (body weight, blood pressure, heart rate, blood oxygen saturation, and physical activity) and subjective state data (symptoms and subjective states) at home for the next six consecutive nights. Use was defined as the ratio of observed use over expected use, where 1.0 is observed equals expected. Usability was determined by the overall System Usability Scale score. RESULTS Participants were 39 clinical heart failure patients, mean age 68.1 (SD, 12.3), 72% male, 62% African American. The ratio of observed over expected use for the body weight scale, blood pressure device, iPad application, pulse oximeter and actigraph was 0.8, 1.0, 1.1, 0.9, and 1.9, respectively. The mean overall System Usability Scale score for each device were 84.5, 89.7, 85.7, 87.6, and 85.2, respectively. CONCLUSIONS Patients were able to use all of the devices and they rated the usability of all the devices higher than expected. Our study provides support for at-home patient-collected physiologic and subjective state data. To our knowledge, this is the first study to assess the use and usability of electronic objective and subjective data collection devices in heart failure patients' homes overnight.
Collapse
Affiliation(s)
- Cubby L Gardner
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| | - Michael C Flanagan
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Cathy Franklin
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Cherly John-Swayers
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Stacy Walsh-Pouch
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - F Joyce Bryant
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Carol A Romano
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Susanne Gibbons
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Marla De Jong
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Albert Hoang
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Dorothy Becher
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Harry B Burke
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| |
Collapse
|
40
|
DiNino E, Stefan MS, Priya A, Martin B, Pekow PS, Lindenauer PK. The Trajectory of Dyspnea in Hospitalized Patients. J Pain Symptom Manage 2016; 51:682-689.e1. [PMID: 26620232 PMCID: PMC4833602 DOI: 10.1016/j.jpainsymman.2015.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT The trajectory of dyspnea for patients hospitalized with acute cardiopulmonary disease, who are not terminally ill, is poorly characterized. OBJECTIVES To investigate the natural history of dyspnea during hospitalization and examine the role that admission diagnosis, and patient factors play in altering symptom resolution. METHODS Prospective cohort study of patients hospitalized for an acute cardiopulmonary condition at a large tertiary care center. Dyspnea levels and change in dyspnea score were the main outcomes of interest and were assessed at admission, 24 and 48 hours, and at discharge using the verbal 0-10 numeric scale. RESULTS Among 295 patients enrolled, the median age was 68 years, and the most common admitting diagnoses were heart failure (32%), chronic obstructive pulmonary disease (COPD) (39%), and pneumonia (13%). The median dyspnea score at admission was 9 (interquartile range [IQR] 7-10); decreased to 4 (IQR 2-7) within the first 24 hours; and subsequently plateaued at 48 hours. At discharge, the median score had decreased to 2.75 (IQR 1-4). Compared to patients with heart failure, patients with COPD had higher median dyspnea score at baseline and admission and experienced a slower resolution of dyspnea symptoms. After adjusting for patient characteristics, the change in dyspnea score from admission to discharge was not significantly different between patients hospitalized with congestive heart failure, COPD, or pneumonia. CONCLUSION Most patients admitted with acute cardiopulmonary conditions have severe dyspnea on presentation, and their symptoms improve rapidly after admission. The trajectory of dyspnea is associated with the underlying disease process. These findings may help set expectations for the resolution of dyspnea symptoms in hospitalized patients with acute cardiopulmonary diseases.
Collapse
Affiliation(s)
- Ernest DiNino
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Mihaela S Stefan
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA; Tufts Clinical and Translational Science Institute, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Aruna Priya
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Benjamin Martin
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Penelope S Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Peter K Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA; Tufts Clinical and Translational Science Institute, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
| |
Collapse
|
41
|
Seo Y, Yates B, LaFramboise L, Pozehl B, Norman JF, Hertzog M. A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure. West J Nurs Res 2016; 38:270-91. [PMID: 25956151 DOI: 10.1177/0193945915584201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η(2)) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η(2) = .015) and functional status (η(2) = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η(2) = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention's underlying physiological effect is needed.
Collapse
Affiliation(s)
- Yaewon Seo
- University of Nebraska Medical Center, Omaha, USA
| | | | | | - Bunny Pozehl
- University of Nebraska Medical Center, Omaha, USA
| | | | | |
Collapse
|
42
|
Srisuk N, Cameron J, Ski CF, Thompson DR. Heart failure family-based education: a systematic review. PATIENT EDUCATION AND COUNSELING 2016; 99:326-338. [PMID: 26519992 DOI: 10.1016/j.pec.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To systematically review evidence for the efficacy of family-based education for heart failure (HF) patients and carers. METHOD A systematic review was conducted. Databases CINAHL, MEDLINE Complete, Cochrane, PubMed, Web of Science, EMBASE, PsycINFO, and Scopus were searched between 1 January 2005 and 1 May 2015. Randomised controlled trials included HF patient and carer dyads or carers alone. The primary outcome was HF knowledge. Secondary outcomes included self-care behaviour, dietary and treatment adherence, quality of life, depression, perceived control, hospital readmissions, and carer burden. RESULT Six trials reported in nine papers were included. Wide variation in the quality of the studies was found. Two studies only examined HF knowledge; a significant improvement among patients and carers was reported. Other significant findings were enhanced patient self-care, boosted dietary and treatment adherence, enriched patient quality of life, improved perceived control among patients but not carers, and reduced carer burden CONCLUSION Modest evidence was found for family-based education among HF patients and carers. Methodological shortcomings of trials signify the need for empirically sound future research. PRACTICE IMPLICATION Family-based HF education needs to include strategies that are tailored to the HF patient and carer, and sustainable in nature.
Collapse
Affiliation(s)
- Nittaya Srisuk
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Faculty of Nursing, Surat Thani Rajabhat University, Surat Thani, Thailand
| | - Jan Cameron
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Chantal F Ski
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - David R Thompson
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
43
|
Albert NM. A systematic review of transitional-care strategies to reduce rehospitalization in patients with heart failure. Heart Lung 2016; 45:100-13. [PMID: 26831374 DOI: 10.1016/j.hrtlng.2015.12.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 01/19/2023]
Abstract
The objective of this review was to evaluate existing transition-of-care models and identify common themes that may minimize exacerbation and rehospitalization, and improve quality of life for patients with heart failure (HF). HF is a significant burden in the United States and a common reason for recurrent hospitalizations. When multidisciplinary health care providers function as liaisons and educators during transition from hospital to home, they help prepare patients for life with chronic HF and mitigate the need for readmission. Systematic literature searches were performed to identify research papers relevant to transition-of-care themes in HF. Eight common themes were identified that can be applied to patients with HF to improve long-term outcomes. This paper emphasizes ways in which health care providers can implement theme-based transitional care, including providing patients and caregivers with practical skills and services that promote knowledge and engagement in self-care and stimulate active communication with health care providers.
Collapse
Affiliation(s)
- Nancy M Albert
- Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland, OH 44195, USA.
| |
Collapse
|
44
|
The association between regular symptom monitoring and self-care management in patients with heart failure. J Cardiovasc Nurs 2015; 30:145-51. [PMID: 24434828 DOI: 10.1097/jcn.0000000000000128] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Symptom monitoring is considered the first step toward self-care management (actions to manage altered symptom status) to avert worsening heart failure (HF). However, empirical evidence demonstrating that symptom monitoring leads to adequate self-care management is lacking. We examined the relationship of adherence to regular symptom monitoring with adequate self-care management in HF patients. METHODS AND RESULTS A total of 311 HF patients (60 years, 35% women) were divided into 3 groups by adherence to 2 symptom monitoring behaviors (monitoring daily weights and lower extremity edema). Patients who were adherent to both symptom monitoring behaviors formed the adherent group (15.1%). Those adherent to either of the symptom monitoring behaviors formed the partially adherent group (28.9%). Those adherent to neither of the symptom monitoring behaviors formed the nonadherent group (56.0%). The adjusted odds of performing adequate self-care management were increased by 225% (95% confidence interval, 1.13-4.48) and 344% (95% confidence interval, 1.55-7.62) for the partially adherent and adherent symptom monitoring groups, respectively, compared with the nonadherent group. CONCLUSION Adequacy of self-care management was predicted by adherence to symptom monitoring behaviors. This finding suggests that regular symptom monitoring facilitates performance of adequate self-care management, which may contribute to a decrease in preventable hospitalizations in HF.
Collapse
|
45
|
Stefan MS, Au D, Mularski R, Krishnan J, Naureckas ET, Carson S, Godwin P, Priya A, Pekow P, Lindenauer PK. Hospitalist attitudes toward the assessment and management of dyspnea in patients with acute cardiopulmonary diseases. J Hosp Med 2015. [PMID: 26199095 PMCID: PMC4624477 DOI: 10.1002/jhm.2422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dyspnea is a common symptom in patients hospitalized with acute cardiopulmonary diseases. Routine assessment of dyspnea severity is recommended by clinical guidelines based on the evidence that patients are not treated consistently for dyspnea relief. OBJECTIVE To evaluate attitudes and beliefs of hospitalists regarding the assessment and management of dyspnea. DESIGN Cross-sectional survey. SETTINGS Nine hospitals in the United States. MEASUREMENTS Survey questions assessed the following domains regarding dyspnea: importance in clinical care, potential benefits and challenges of implementing a standardized assessment, current approaches to assessment, and how awareness of severity affects management. A 5-point Likert scale was used to assess the respondent's level of agreement; strongly agree and agree were combined into a single category. RESULTS Of the 255 hospitalists invited to participate, 69.8% completed the survey; 77.0% agreed that dyspnea relief is an important goal when treating patients with cardiopulmonary conditions. Approximately 90% of respondents stated that awareness of dyspnea severity influences their decision to intensify treatment, to pursue additional diagnostic testing, and the timing of discharge. Of the respondents, 61.0% agreed that standardized assessment of dyspnea should be part of the vital signs, and 64.6% agreed that awareness of dyspnea severity influences their decision to prescribe opioids. Hospitalists who appreciated the importance of dyspnea in clinical practice were more likely to support the implementation of a standardized scale. CONCLUSIONS Most hospitalists believe that routine assessment of dyspnea severity would enhance their clinical decision making and patient care. Measurement and documentation of dyspnea severity may represent an opportunity to improve dyspnea management.
Collapse
Affiliation(s)
- Mihaela S. Stefan
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
- Division of General Internal Medicine, Baystate Medical Center, Springfield, MA, USA
- Tufts Clinical and Translational Science Institute and Tufts University School of Medicine, Boston, MA, USA
| | - David Au
- Pulmonary Division, Harborview Medical Center University of Washington Medicine, Seattle, WA, USA
| | - Richard Mularski
- Center for Health Research & Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jerry Krishnan
- University of Illinois – Jesse Brown VAMC, Chicago, IL, USA
| | - Eduard T. Naureckas
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
| | - Shannon Carson
- Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Patrick Godwin
- University of Illinois – Jesse Brown VAMC, Chicago, IL, USA
| | - Aruna Priya
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
| | - Penelope Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
- University of Massachusetts Amherst, School of Public Health Sciences, Amherst, MA, USA
| | - Peter K. Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
- Division of General Internal Medicine, Baystate Medical Center, Springfield, MA, USA
- Tufts Clinical and Translational Science Institute and Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
46
|
Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, Delville C, Davila A. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs 2015; 30:S3-13. [PMID: 24978157 PMCID: PMC4276559 DOI: 10.1097/jcn.0000000000000169] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
Collapse
Affiliation(s)
- Angela P Clark
- Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Heo S, Moser DK, Pressler SJ, Dunbar SB, Mudd-Martin G, Lennie TA. Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardiovasc Nurs 2015; 30:136-44. [PMID: 24598550 PMCID: PMC4391745 DOI: 10.1097/jcn.0000000000000102] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with heart failure (HF) experience physical symptoms, poor health-related quality of life (HRQOL), and high rates of hospitalization. Physical symptoms are associated with HRQOL and are major antecedents of hospitalization. However, reliable and valid physical symptom instruments have not been established. Therefore, this study examined the psychometric properties of the Symptom Status Questionnaire-Heart Failure (SSQ-HF) in patients with HF. METHOD Data on symptoms using the SSQ-HF were collected from 249 patients (aged 61 years, 67% male, 45% in New York Heart Association functional class III/IV). Internal consistency reliability was assessed using Cronbach's α. Item homogeneity was assessed using item-total and interitem correlations. Construct validity was assessed using factor analysis and testing hypotheses on known relationships. Data on depressive symptoms (Beck Depression Inventory II), HRQOL (Minnesota Living With Heart Failure Questionnaire), and event-free survival were collected to test known relationships. RESULTS Internal consistency reliability was supported: Cronbach's α was .80. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Factor analysis supported the construct validity of the instrument. More severe symptoms were associated with more depressive symptoms, poorer HRQOL, and more risk for hospitalization, emergency department visit, or death, controlling for covariates. CONCLUSIONS The findings of this study support the reliability and validity of the SSQ-HF. Clinicians and researchers can use this instrument to assess physical symptoms in patients with HF.
Collapse
Affiliation(s)
- Seongkum Heo
- Seongkum Heo, PhD, RN Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock Debra K. Moser, DNSc, RN, FAAN Professor and Gill Chair of Nursing, College of Nursing, University of Kentucky, Lexington. Susan J. Pressler, PhD, RN Professor, School of Nursing, University of Michigan, Ann Arbor Sandra B. Dunbar, DSN, RN Professor, School of Nursing, Emory University, Atlanta, Georgia Gia Mudd-Martin, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington Terry A. Lennie, PhD, RN Professor, University of Kentucky, College of Nursing, Lexington
| | | | | | | | | | | |
Collapse
|
48
|
Kim HM, Kim J, Hwang SY. Health-related quality of life in symptomatic postmyocardial infarction patients with left ventricular dysfunction. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:47-52. [PMID: 25829210 DOI: 10.1016/j.anr.2014.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/22/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Symptoms of postmyocardial infarction (post-MI) patients at risk for progression to heart failure are often ignored, and lack of symptom recognition or misinterpretation may diminish health-related quality of life (HRQoL). This study was conducted to evaluate the differences in HRQoL by symptom experience and determine factors that predict diminished HRQoL in post-MI patients. METHODS Using a descriptive correlational study design, post-MI patients with left ventricular dysfunction (ejection fraction < 50%) completed face-to-face interviews for symptoms, HRQoL, covariates including self-care compliance, New York Heart Association class, and demographic and clinical questionnaires. RESULTS A total of 105 post-MI patients participated (mean age 65 years, 79.0% male, mean ejection fraction 43.6%, New York Heart Association class III/IV 33.3%). Mean length of time after the cardiac event was 48 months. Patients reported four or more symptoms, with fatigue being the most common symptom (63.8%), followed by shortness of breath (56.2%), weakness (54.3%), and dizziness (51.4%). HRQoL was moderately poor, with a mean score of 44.38 ± 27.66. There was no significant relationship between self-care compliance and HRQoL. Patients who were female, with low monthly income, and had lower functional capacity and more symptoms had worse HRQoL, after controlling for age and length of time after the event (adjusted R(2) = 0.53, p < .001). CONCLUSIONS A need for transitional care that assists post-MI patients take an active involvement in symptom monitoring arises so that they can get into the system earlier and benefit from treatment, and eventually achieve desirable HRQoL.
Collapse
Affiliation(s)
- Ha Mi Kim
- Heart Center, Chonnam National University Hospital, Gwangju, South Korea
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | | |
Collapse
|
49
|
Reeder KM, Ercole PM, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs 2015; 30:E1-7. [PMID: 24335834 PMCID: PMC4116472 DOI: 10.1097/jcn.0000000000000117] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with heart failure (HF) are at heightened risk for acute exacerbation requiring hospitalization. Although timely reporting of symptoms can expedite outpatient treatment and avoid the need for hospitalization, few patients recognize and respond to symptoms until acutely ill. OBJECTIVE The purpose of this study was to explore patients' perceptions of symptoms and self-care behaviors for symptom relief, leading up to a HF hospitalization. METHODS To examine prehospitalization symptom scenarios, semistructured interviews were conducted with 60 patients hospitalized for acute decompensated HF. RESULTS Thirty-seven patients (61.7%) said that they had a sense that "something just wasn't quite right" before their symptoms began but were unable to specify further. Signs and symptoms most often recognized by the patients were related to dyspnea (85%), fatigue (53.3%), and edema (41.7%). Few patients interpreted their symptoms as being related to worsening HF and most often attributed symptoms to changes in diet (18.3%) and medications (13.3%). Twenty-six patients (43.3%) used self-care strategies to relieve symptoms before hospital admission. More than 40% of the patients had symptoms at least 2 weeks before hospitalization. CONCLUSIONS Despite the wide dissemination of HF evidence-based guidelines, important components of symptom self-management remain suboptimal. Because most of HF self-management occurs in the postdischarge environment, research is needed that identifies how patients interpret symptoms of HF in the specific contexts in which patients self-manage their HF. These findings suggest the need for interventions that will help patients expeditiously recognize, accurately interpret, and use appropriate and safe self-care strategies for symptoms.
Collapse
Affiliation(s)
- Katherine M Reeder
- Katherine M. Reeder, PhD, RN Research Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Patrick M. Ercole, PhD, MPH Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Gina M. Peek, MSN, RN Assistant Professor, Newman Division of Nursing, Emporia State University, Kansas. Carol E. Smith, PhD, RN, FAAN Professor, School of Nursing & Preventive Medicine, Kansas University Medical Center, Kansas City
| | | | | | | |
Collapse
|
50
|
Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: A cross-sectional study. Int J Nurs Stud 2014; 51:1482-90. [DOI: 10.1016/j.ijnurstu.2014.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 03/15/2014] [Accepted: 03/19/2014] [Indexed: 01/21/2023]
|