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- Amofah, Hege A., et al.
(författare)
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Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 15:2, s. 168-177
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Tidskriftsartikel (refereegranskat)abstract
- Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.
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| 3. |
- Eide, Leslie S. P., et al.
(författare)
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Delirium as a predictor of physical and cognitive function in individuals aged 80 and older after transcatheter aortic valve implantation or surgical aortic valve replacement
- 2016
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 64:6, s. 1178-1186
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine how development of delirium after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) could predict activity of daily living (ADL) and instrumental ADLs (IADL) disability, cognitive function, and self-reported health in individuals aged 80 and older.Design: Prospective cohort study. Setting: Tertiary university hospital.Participants: Individuals aged 80 and older undergoing elective SAVR or TAVI (N = 136).Measurements: Delirium was assessed for 5 days using the Confusion Assessment Method. The Barthel Index, Nottingham Extended ADL Scale, and SF-12 were used to determine ADL and IADL ability and self-reported health at baseline and 1- and 6-month follow-up. Cognition was assessed using the Mini-Mental State Examination at baseline and 6-month follow-up.Results: Participants had lower IADL scores 1 month after SAVR than at baseline (baseline 58, 1 month: delirium 42, no delirium 50, P ≤.02), but scores had returned to baseline levels at 6 months. The Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) Physical Component Summary (PCS) score was higher at 6-month follow-up (48) than at baseline (39), especially in participants who did not develop delirium (P <.001). No differences in other outcomes were found. Regression models suggest that delirium may help predict IADL disability 1 month after baseline (P ≤.07) but does not predict large differences in ADL disability, cognitive function, or SF-12-scores. Individuals who underwent TAVI and developed delirium had lower ADL (baseline 19, 1-month 16, P <.001) and IADL (baseline 49, 1-month 40, P =.003) scores at 1-month follow-up. SF-12 PCS score (baseline 30) increased from baseline to 1- (35, P =.04) and 6- (35, P =.02) month follow-up in individuals who underwent TAVI and did not develop delirium. Delirium after TAVI predicted greater ADL and IADL disability at 1-month but not at 6-month follow-up.Conclusion: Individuals who develop delirium after SAVR and TAVI have poorer short-term IADL function but do not seem to have long-term reductions in physical, mental, or self-reported health.
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| 5. |
- Frantzen, Astri Tafjord, et al.
(författare)
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Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement
- 2021
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Ingår i: Heart, Lung and Circulation. - : Elsevier. - 1443-9506 .- 1444-2892. ; 30:8, s. 1221-1231
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFrailty status and patient-reported outcomes are especially pertinent in octogenarians following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to guide treatment decisions and promote patient-centred care.AimWe aimed to determine if frailty changed 6 months after aortic valve replacement (AVR) in octogenarians, and to describe changes in self-rated health according to frailty status in patients who underwent TAVI or SAVR.MethodIn a prospective cohort study, frailty and self-rated health were measured one day prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic Fracture index. Self-rated health was measured comprehensively with the disease-specific Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study Short Form-12 questionnaire (SF-12), and two global questions from The World Health Organization Quality of Life Instrument Abbreviated.ResultsData were available for 143 consecutive patients (mean age 83 +/- 2.7 years, 57% women; 45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall, there was no change in the distribution of frailty status 6 months after baseline (p=0.13). However, on an individual level 65 patients changed frailty status after AVR (40 patients improved and 25 declined). Improvement in frailty status was common in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated health after AVR, with significant differences between frailty states both at baseline (SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental: 51.9 [robust], 50.8 [prefrail], 44.5 [frail], p<0.001); and at the 6-month follow-up (SF-12 physical: 45.4 [robust], 38.3 [prefrail], 32.1 [frail], p<0.001); SF-12 mental: 54.9 [robust], 49.6 [prefrail], 46.8 [frail], p=0.002).ConclusionsAdvanced treatment performed in a high-risk population allowed people to improve their self-rated health. Although frailty is associated with poor self-rated health, frailty status does not equal negative outcomes. The frail patients were those who improved most in self-rated physical and mental health. They had the lowest baseline self-rated health scores and had therefore the most to gain.
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| 6. |
- Fålun, Nina, et al.
(författare)
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Patients’ goals, resources, and barriers to future change : A qualitative study of patient reflections at hospital discharge after myocardial infarction
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 15:7, s. 495-503
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Tidskriftsartikel (refereegranskat)abstract
- Background: Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients’ ability to effect lifestyle changes at the time of discharge is limited.Aim: The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients.Methods: We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis.Findings: Three themes suggested that, at the time of discharge, patients’ views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going.Conclusions and implications: There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.
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| 7. |
- Fålun, Nina, et al.
(författare)
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Patients' reflections on prehospital symptom recognition and timely treatment of myocardial infarction
- 2021
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 20:6, s. 526-533
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Tidskriftsartikel (refereegranskat)abstract
- AimsEarly treatment is crucial to successful therapy in patients with acute myocardial infarction (MI). Prehospital delay is associated with increased morbidity and mortality. There is little empirical evidence of patients' reflections on prehospital symptoms of MI and timely treatment at the time of discharge from hospital. To explore patients' reflections on prehospital symptoms of MI and their experiences of interaction with local hospitals, general practitioners, and laypersons.Methods and resultsAn inductive explorative design with a qualitative method approach was used to conduct in-depth interviews of patients after confirmed MI. Twenty patients were purposefully selected based on age and gender. Face-to-face, semi-structured interviews were conducted prior to hospital discharge. The interviews were organized around a set of predetermined, open-ended questions, transcribed verbatim and analysed using qualitative content analysis. There were patients who acted upon severe symptoms of MI by seeking medical assistance. Patients commonly experienced that the time from the onset of symptoms to treatment posed a transitional challenge. They did not take subtle signs of MI seriously; they underestimated symptoms of MI and delayed seeking medical assistance. Patients frequently experienced that healthcare professionals did not take them seriously, as they struggled to gain access to healthcare services.ConclusionThis study highlights patients' unique experiences of the pathway from symptom onset to confirmed MI. Severe chest pain is associated with MI and triggers an immediate need for care. However, patients often underestimated moderate chest pain or subtle signs and symptoms of MI. Existing knowledge gaps concerning the misinterpretation of symptoms in primary care need to be addressed in order to reduce this clinical challenge.
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| 10. |
- Norekvål, Tone M, et al.
(författare)
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Sense of coherence—a determinant of quality of life over time in older female acute myocardial infarction survivors
- 2010
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 19:5-6, s. 820-831
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up.Background: Myocardinal infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardinal infraction survivors is scant.Design: Survey.Methods: A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used.Results: We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p < 0 center dot 001). Sense of coherence contributed to the level of all quality of life domains (p < 0 center dot 001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p < 0 center dot 001), previous myocardial infarction (p = 0 center dot 013), ejection fraction (p < 0 center dot 011), length of hospital stay (p = 0 center dot 005) symptoms and function (p < 0 center dot 001); (2) psychological domain: previous myocardial infarction (p = 0 center dot 031) and symptoms and function (p < 0 center dot 001); and (3) environmental domain: education (p = 0 center dot 033) and symptoms and function (p = 0 center dot 003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p < 0 center dot 001), not major life events, influenced quality of life during the six-month follow-up.Conclusion: Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life.Relevance to clinical practice: These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.
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