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| 2. |
- Borregaard, Britt, et al.
(författare)
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Association between frailty and self-reported health following heart valve surgery
- 2020
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Ingår i: IJC Heart & Vasculature. - : ELSEVIER IRELAND LTD. - 2352-9067. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Knowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery. Methods: In a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L). To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Frailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51-7.52), VAS 2.41 (1.13-5.14), and KCCQ 2.84 (1.35-5.97). Conclusion: Frailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk. (C) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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- Eide, L. S. P., et al.
(författare)
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Urinary catheter use and delirium after aortic valve therapy
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S3-S4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Indwelling urinary catheters (IUC) are valuable devices that help to control and monitor urine output under and after invasive procedures. However, adverse outcomes might arise following use of IUC, and several studies show that IUC can be a risk factor for postoperative delirium. Delirium is an acute and fluctuating change in attention and cognition that might lead to extended hospital stay, and more morbidity and mortality. The association between delirium and the duration of IUC use in octogenarians after Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Implantation (TAVI) remains to be established.Purpose: To determine if the duration of IUC use after SAVR or TAVI predicts the development of delirium in older people.Methods: This is a prospective cohort study of octogenarian patients (N=136) in a tertiary university hospital. Inclusion criteria: ⩾80 years, severe aortic stenosis, and elective TAVI or SAVR. Exclusion criteria: Inability to speak Norwegian or declined consent to participate in the study. The Mini-Mental State examination was used to evaluate global cognitive function at baseline. The Confusion Assessment Method allowed the identification of delirium during five postoperative days. The duration of IUC use was collected from patients’ medical records. The predictive effect of IUC in the development of delirium was examined using multiple regression.Results: The majority (57%) of patients was female, and 46% received TAVI. Patients in the TAVI group were older (85 vs. 82 years-old, P<0.001), had more comorbidities (2.5 vs.1.8, P=0.001) and higher logistic EuroSCORE (19.6 vs. 9.4,P<0.001). Delirium was present in 66% of patients treated with SAVR vs. 44% of those receiving TAVI. The average duration of IUC use in SAVR patients with delirium was 66 hours (SD=29) compared to 59 hours (SD=27) in those without delirium (P=0.307), and in TAVI patients with delirium was 58 hours (SD=38) compared to 32 hours (SD=15) for those without delirium (P=0.001). Multivariate regression analysis shows that lower cognitive function (P=0.040), type of aortic valve treatment (P=0.043) and longer of IUC use (P=0.002) predicted the development of delirium.Conclusion: In octogenarian patients undergoing aortic valve treatment, the duration of IUC use can predict delirium. Further research is needed to mitigate the risks of delirium in patients undergoing aortic valve treatment.
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| 4. |
- 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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| 5. |
- Kwon, J. Y., et al.
(författare)
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Growth mixture models: a case example of the longitudinal analysis of patient‐reported outcomes data captured by a clinical registry
- 2021
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Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: An assumption in many analyses of longitudinal patient-reported outcome (PRO) data is that there is a single population following a single health trajectory. One approach that may help researchers move beyond this traditional assumption, with its inherent limitations, is growth mixture modelling (GMM), which can identify and assess multiple unobserved trajectories of patients’ health outcomes. We describe the process that was undertaken for a GMM analysis of longitudinal PRO data captured by a clinical registry for outpatients with atrial fibrillation (AF). Methods: This expository paper describes the modelling approach and some methodological issues that require particular attention, including (a) determining the metric of time, (b) specifying the GMMs, and (c) including predictors of membership in the identified latent classes (groups or subtypes of patients with distinct trajectories). An example is provided of a longitudinal analysis of PRO data (patients’ responses to the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire) collected between 2008 and 2016 for a population-based cardiac registry and deterministically linked with administrative health data. Results: In determining the metric of time, multiple processes were required to ensure that “time” accounted for both the frequency and timing of the measurement occurrences in light of the variability in both the number of measures taken and the intervals between those measures. In specifying the GMM, convergence issues, a common problem that results in unreliable model estimates, required constrained parameter exploration techniques. For the identification of predictors of the latent classes, the 3-step (stepwise) approach was selected such that the addition of predictor variables did not change class membership itself. Conclusions: GMM can be a valuable tool for classifying multiple unique PRO trajectories that have previously been unobserved in real-world applications; however, their use requires substantial transparency regarding the processes underlying model building as they can directly affect the results and therefore their interpretation. © 2021, The Author(s).
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| 6. |
- Lauck, S. B., et al.
(författare)
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Accelerating knowledge translation to improve cardiovascular outcomes and health services: opportunities for bridging science and clinical practice
- 2023
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 22:8
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge translation (KT) is the exchange between knowledge producers and users to understand, synthesize, share, and apply evidence to accelerate the benefits of research to improve health and health systems. Knowledge translation practice (activities/strategies to move evidence into practice) and KT science (study of the methodology and approaches to promote the uptake of research) benefit from the use of conceptual thinking, the meaningful inclusion of patients, and the application of intersectionality. In spite of multiple barriers, there are opportunities to develop strong partnerships and evidence to drive an impactful research agenda and increase the uptake of cardiovascular research.
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