| 1. |
- Granger, B. B., et al.
(författare)
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Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial
- 2005
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Ingår i: Lancet. - 1474-547X. ; 366:9502, s. 2005-11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme. METHODS: CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups. FINDINGS: We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0.65, 95% CI 0.57-0.75, p<0.0001). The adjusted HR for good adherence was similar in the candesartan (0.66, 0.55-0.81, p<0.0001) and placebo (0.64, 0.53-0.78, p<0.0001) groups. INTERPRETATION: Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.
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| 2. |
- Granger, B. B., et al.
(författare)
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Adherence to medication according to sex and age in the CHARM programme
- 2009
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Ingår i: European Journal of Heart Failure. - 1879-0844. ; 11:11, s. 1092-8
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although many patients with heart failure have incomplete adherence to prescribed medications, predisposing factors remain unclear. This analysis investigates factors associated with adherence, with particular emphasis on age and sex. METHODS AND RESULTS: A multivariable regression analysis of 7599 heart failure patients from the CHARM trial was done to evaluate factors associated with adherence. Adherence was measured as the proportion of time patients took more than 80% of study medication. The mean age was 66 years (SD 11) and 31.5% (n = 2400) were women. Women were slightly less adherent than men (87.3 vs. 89.8%, P = 0.002), even in adjusted, multivariable models (treatment, P = 0.006; placebo P = 0.004; and overall P < 0.001). However, all-cause mortality was lower in women (21.5%) than in men (25.3%) (adjusted hazard ratio, 0.77; 95% CI, 0.69-0.86; P < 0.001), but patients with a low adherence regardless of sex had a higher mortality. Age, severity of heart failure, number of medications, and smoking status were not associated with adherence. CONCLUSION: Women, particularly those <75 years of age, were less likely to be adherent in this large sample of patients with symptomatic heart failure. Understanding factors associated with adherence may provide opportunities for intervention.
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| 3. |
- Ekman, Inger, 1952, et al.
(författare)
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Standard medication information is not enough : poor concordance of patient and nurse perceptions
- 2007
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 60:2, s. 181-186
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Tidskriftsartikel (refereegranskat)abstract
- AIM:This paper is a report of a study to describe patient and nurse perceptions of patient satisfaction with information about the medicines at two heart failure clinics after medication up-titration and information-giving.BACKGROUND:Chronic heart failure is a major cause of hospitalization. Poor adherence to medications increases mortality and heart failure-related hospitalizations. To achieve mutual goal-setting (concordance) regarding medication-taking behaviours, health providers need to understand patient information needs regarding the prescribed medicines.METHODS:A convenience sample of 56 patients with chronic heart failure referred for an up-titration of medicines and information-giving about the condition and treatment completed the Satisfaction about Information about Medicines Scale at their first and last visits. Nurses completed the same questionnaire after each patient's final visit, assessing the patient's need for further information. The data were collected between 2002 and 2004.RESULTS:Patient scores indicated statistically significantly more satisfaction with their information at the final visit compared with the first visit (P = 0.005). However, at the programme conclusion, nurses (n = 7) rated patients to be appropriately informed while patients reported a persistent need for further information (P = 0.011).CONCLUSION:Further research should evaluate more advanced pedagogical strategies such as how to address patients' expectations about the effect of medicines when actual effects of the treatment are related to mortality and morbidity at the population level and may not result directly in symptom relief at an individual level.
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| 4. |
- Falk, Kristin, 1949, et al.
(författare)
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Breaking the vicious circle of fatigue in patients with chronic heart failure
- 2007
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Ingår i: Qualitative health research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 17:8, s. 1020-7
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Tidskriftsartikel (refereegranskat)abstract
- Fatigue is a common symptom in patients with chronic heart failure (CHF). Characteristics of the experience and consequences of fatigue might be unique in these patients. The authors interviewed 15 patients with CHF and analyzed focused online observations of the content discussed in an Internet patient discussion group concerning CHF using grounded theory. The results suggest that fatigue is a circular process in which the consequences of fatigue further exaggerate the experience. However, fatigue could be alleviated by restorative activities. The bodily experience of fatigue was defined as lacking strength and energy and feeling sleepy. Patients reported the mental aspects of fatigue as demoralizing and that they frequently experienced intellectual deficiency. Fatigue leads to sacrificing, which was manifested as refraining, denying oneself, and being isolated. The restoring activities included the categories involuntarily attentive, socially interactive, and mentally absorbed. Interventions aimed to relieve fatigue should focus on restorative activities.
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| 7. |
- Ekman, Inger, 1952, et al.
(författare)
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Impact of device-guided slow breathing on symptoms of chronic heart failure: a randomized, controlled feasibility study
- 2011
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Ingår i: European journal of heart failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 13:9, s. 1000-5
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: In many patients with chronic heart failure (CHF) even normal daily life activities cause dyspnoea and fatigue, well-being might be considerably improved by even a modest decrease in such symptoms. The aim of this study was to investigate if lowering breathing rate with the help of a respiratory modulation (RM) device could improve symptoms in patients with CHF. METHODS AND RESULTS: Stable CHF patients with symptoms of dyspnoea were randomized to twice-daily 20 min sessions using an RM device or to music listening (ML) using a CD player, for a 4-week study period. Respiratory modulation guides the user to achieve a slow breathing rate (<10 breaths/min) while increasing exhalation time (Tex) relative to inhalation time (Tin). Lower breathing rate was accomplished by synchronizing respiratory movements with musical tones generated in response to breathing movements monitored with a belt-type sensor. Endpoints were reduced breathlessness and New York Heart Association (NYHA) class. Seventy-two patients (52 male, age 73 +/- 11 years, NYHA 3.1 +/- 0.9) were randomized and 65 completed the study (30 RM and 35 ML, respectively). There was no in-between group improvement in breathlessness and NYHA class. Patients in the RM group who displayed an average increase in Tex/Tin of >0.2 and a reduction in the average respiration rate during 30 sessions were considered responders. Responders reported reduced breathlessness (-0.86 +/- 0.23 units, P < 0.005) and improved NYHA class (-0.64 +/- 0.20, P < 0.01) compared with non-responders. CONCLUSION: Device-guided RM might have the potential to relieve symptoms of heart failure in outpatients by changing their breathing pattern.
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| 8. |
- Ekman, Inger, 1952, et al.
(författare)
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Measuring shortness of breath in heart failure (SOB-HF): development and validation of a new dyspnoea assessment tool
- 2011
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Ingår i: European journal of heart failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 13:8, s. 838-45
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Tidskriftsartikel (refereegranskat)abstract
- Aim To validate a previously developed instrument for measurement of breathlessness in patients with acute heart failure (HF). METHODS AND RESULTS: We tested descriptors of breathlessness among 190 patients seeking care at the emergency department (ED) for acute shortness of breath. Out of 115 patients with confirmed HF, 107 (94%) had dyspnoea as their main symptom. There were no significant differences between those patients with HF and those who were not diagnosed as heart failure (NHF) (n = 75) in the descriptors of breathlessness, although patients with HF scored significantly (P = 0.03) higher on a visual analogue scale (VAS). In addition, they had significantly (P = 0.03) higher breathing frequency than NHF patients and they were significantly (P < 0.001) more likely to be treated with >40 mg furosemide. CONCLUSION: Assessment of acute dyspnoea using a VAS is useful in distinguishing HF from NHF, and may be a more valid approach as compared with using descriptors of intensity of breathlessness in the acute setting.
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| 9. |
- Granger, Bradi B., et al.
(författare)
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A Qualitative Descriptive Study of the Work of Adherence to a Chronic Heart Failure Regimen Patient and Physician Perspectives
- 2009
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Ingår i: JOURNAL OF CARDIOVASCULAR NURSING. - 0889-4655. ; 24:4, s. 308-315
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND RESEARCH OBJECTIVE:: Despite the known benefit of self-care strategies for symptom management in heart failure (HF), most patients are unable to perform self-care activities successfully. This study therefore examined how communication about the HF regimen between patients and their physicians is experienced and understood by both partners. SUBJECTS AND METHODS:: Six pairs (n = 12) of adult patients with HF who were admitted for acute symptom exacerbation and their physicians were interviewed for this qualitative descriptive study in the inpatient setting. Semistructured in-depth interviews were conducted. Data were analyzed using content analysis. RESULTS:: Both patients and providers described adherence to the HF regimen as "work." Both reported the same list of tasks and knowledge requirements as key components of the HF regimen, and both reported delegating their own regimen-related work to others. Despite these similarities, perceptions of the nature and complexity of the work of the HF regimen differed. Patients described the regimen as "hard work," but physicians perceived patients as nonparticipatory in self-care, in spite of the instructions being "easy." Patients perceived themselves as understanding what to do but needing help with how to carry out self-care. By contrast, physicians perceived patients as not understanding what the regimen requires and therefore needing more repetition of knowledge-based instructions. CONCLUSION:: The self-care regimen in chronic HF is characterized by both patients and physicians as work, but patient-physician dyads show divergent understandings of that work. Future research to improve adherence should move beyond the patient to look at the nature of the work itself and the relationship of the patient and caregivers to the work.
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| 10. |
- Lewandowski, R. A., et al.
(författare)
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Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 18:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Person-Centered Care (PCC) is a promising approach towards improved quality of care and cost containment within health systems. It has been evaluated in Sweden and England. This feasibility study examines initial PCC implementation in a rehabilitation hospital for children in Poland. Methods: The WE-CARE Roadmap of enablers was used to guide implementation of PCC for patients with moderate scoliosis. A multi-disciplinary team of professionals were trained in the PCC approach and the hospital Information Technology (IT) system was modified to enhance PCC data capture. Semi-structured interviews were conducted with the nine health care professionals involved in the pilot study and three patients/parents receiving care. Transcribed data were analyzed via content analysis. Results: 51 patients and their families were treated via a PCC approach. High proportions of new PCC data fields were completed by the professionals. The professionals were able to implement the three core PCC routines and perceived benefits using the PCC approach. Patients and their families also perceived improved quality care. The WE-CARE framework enablers facilitated PCC implementation in this setting. Conclusions: This feasibility pilot study indicates that the Gothenburg PCC approach can be successfully transferred to a rehabilitation hospital in Poland with favorable perceptions of implementation by both professionals and patients/their families.
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