| 1. |
- Hare, David L., et al.
(författare)
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Depression and cardiovascular disease : a clinical review
- 2014
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 35:21, s. 1365-1372
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Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes.
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| 2. |
- Jaarsma, Tiny, et al.
(författare)
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beta-Blockers and sexual problems
- 2004
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 25:7, s. 617; author reply 617-8
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Jaarsma, Tiny, et al.
(författare)
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Effects of education and support on self-care and resource utilization in patients with heart failure
- 1999
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 20:9, s. 673-682
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure. METHODS: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'. The supportive educative intervention consisted of intensive, systematic and planned education by a study nurse about the consequences of heart failure in daily life, using a standard nursing care plan developed by the researchers for older patients with heart failure. Education and support took place during the hospital stay and at a home visit within a week of discharge. Data were collected on self-care abilities, self-care behaviour, readmissions, visits to the emergency heart centre and use of other health care resources. RESULTS: Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure. Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge, but the increase in the intervention group was significantly more after 1 month. Although self-care behaviour in both groups decreased during the following 8 months, the increase from baseline remained statistically significant in the intervention group, but not in the control group. No significant effects on resource utilization were found. CONCLUSIONS: Intensive, systematic, tailored and planned education and support by a nurse results in an increase in patients' self-care behaviour. No significant effects were found on use of health care resources. Additional organisational changes, such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support.
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| 5. |
- Jaarsma, Tiny, et al.
(författare)
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Heart failure management : how much COACH-ing is needed?
- 2005
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 26:3, s. 314; author reply 314-5
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Tidskriftsartikel (refereegranskat)abstract
- We were glad to find two interesting articles and an editorial in the September 2004 issue of the European Heart Journal on management of patients with heart failure (HF) in specialized programmes, e.g. HF clinics or home-based HF programmes.1–3 HF management programmes are increasingly implemented and considered as a promising method of improving the quality of HF care.1 Both papers and the editorial note that HF management programmes can be effective in improving patient outcomes with regard to readmission.1–3 The authors also point out that there still is a lack of clarity on the necessary components of an HF management programme. Most interventions described in the meta-analysis, and in the review, are heterogeneous and report on combined interventions as one treatment modality comparing this with a ‘care as usual group’. The authors of both papers conclude that ‘clinical trials in future should be conducted to compare different interventions directly’2 and that effectiveness remains to be proved in a clinical trial comparing usual HF clinic care with the combination of HF clinic with home care.3 We are happy to inform the authors that at this moment such information is gathered in a large multi-centre study conducted in the Netherlands evaluating Outcomes of Advising and Counselling in Heart Failure (COACH), financed by the Netherlands Heart Foundation.4 Patients included in COACH are randomized in (i) care as usual (regular follow-up without HF nurse); (ii) an HF clinic (scheduled visits at the HF clinic with an HF nurse added to follow-up by a cardiologist); or (iii) an HF clinic + home care (care at the HF clinic, a multidisciplinary approach, and scheduled home visits).4 Patients are recruited from 17 centres in the Netherlands and patients are followed up for 18 months after discharge. Endpoints of the study are time to first event, readmission, mortality, costs, and quality of life. At this moment (October 2004), more then 900 patients are included in the study and final results are expected at the end of 2006. With this large-scale trial we hope to contribute further to the unanswered questions noted by the groups of Gustafsson3 and Gonseth2 regarding the dose of the intervention, and thereby contribute to the development of an optimal approach for chronic HF patients.
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| 7. |
- Jaarsma, Tiny, et al.
(författare)
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Searching for dose-response in HF clinics
- 2004
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 25:2, s. 182; author reply 182-3
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Tidskriftsartikel (refereegranskat)
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