| 1. |
- Barbareschi, Giorgio, et al.
(författare)
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Educational Level and the Quality of Life of Heart Failure Patients: A Longitudinal Study
- 2011
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Ingår i: Journal of Cardiac Failure. - : Elsevier Science B.V., Amsterdam. - 1071-9164 .- 1532-8414. ; 17:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lower education in heart failure (HF) patients is associated with high levels of anxiety, limited physical functioning, and an increased risk of hospitalization. We examined whether educational level is related to longitudinal differences in quality of life (QoL) in HF patients. Methods and Results: This research is a substudy of the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH). QoL of 553 HF patients (mean age 69, 38% female, mean left ventricular ejection fraction 33%) was assessed during their hospitalization and at 4 follow-up measurements after discharge. In total 32% of the patients had very low, 24% low, 32% medium, and 12% high education. Patients with low educational levels reported the worst QoL. Significant differences between educational groups (P less than .05) were only reported in physical functioning, social functioning, energy/fatigue, pain, and limitations in role functioning related to emotional problems. Longitudinal results show that a significantly higher proportion of high-educated patients improved in functional limitations related to emotional problems over time compared with lower-educated patients (P less than .05). Conclusions: Patients with low educational levels reported the worst physical and functional condition. High-educated patients improved more than the other patients in functional limitations related to emotional problems over time. Low-educated patients may require different levels of intervention to improve their physical and functional condition.
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| 2. |
- Hoekstra, Tialda, et al.
(författare)
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Nurse-led interventions in heart failure care : Patient and nurse perspectives.
- 2010
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 9:4, s. 226-32
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes. AIM: To describe the perspectives of patients and nurses on delivered care in two DMPs. METHODS: In total 442 patients (62% male; age 68±12years; LVEF 33%±14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs. RESULTS: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III-IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses. CONCLUSION: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals.
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| 3. |
- Hoekstra, Tialda, et al.
(författare)
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Perceived sexual difficulties and associated factors in patients with heart failure
- 2012
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Ingår i: American Heart Journal. - : Elsevier. - 0002-8703 .- 1097-6744. ; 163:2, s. 246-251
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Tidskriftsartikel (refereegranskat)abstract
- Background Sexual dysfunction is a common problem of increasing incidence in patients with heart failure (HF). However, there is no knowledge on which demographic, clinical, and quality of life (QoL) aspects are related to difficulties in sexual activity nor on the course of sexual difficulties in patients with HF. less thanbrgreater than less thanbrgreater thanMethods Data on sexual difficulties were collected at 1 and 18 months after an HF hospitalization (n = 792, mean age 69 +/- 12 years, 35% female, mean left ventricular ejection fraction 33% +/- 14%) by the question on sexuality of the Minnesota living with HF questionnaire. Demographic and clinical factors were assessed from medical records and QoL by Minnesota living with HF questionnaire, Medical Outcome Study 36-item General Health Survey, and Ladder of Life. less thanbrgreater than less thanbrgreater thanResults In total, 48% (n = 380) of the patients perceive difficulties in sexual activity at 1 month after discharge, and 70% continued to perceive this at 18 months. Furthermore, 27% of the patients without difficulties at 1 month developed them during follow-up. Living with a partner (OR 3.76, 95% CI 2.58-5.48), younger age (OR 0.96, 95% CI 0.94-0.97)), male gender (OR 3.08, 95% CI 2.10-4.43), overall well-being (OR 1.13, 95% CI 1.00-1.27), and physical (OR 1.06, 95% CI 1.06-1.08) and emotional (OR 1.07, 95% CI 1.03-1.10) QoL were independently associated with perceived difficulties in sexual activity. less thanbrgreater than less thanbrgreater thanConclusions Perceived difficulties in sexual activity are common in patients with HF, particularly in younger and male patients and continue over time. Patients who perceive difficulties in sexual activity report a significant lower QoL and overall well-being than those who do not.
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| 4. |
- Hoekstra, Tialda, et al.
(författare)
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Quality of life and survival in patients with heart failure
- 2013
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Ingår i: European Journal of Heart Failure. - : Oxford University Press (OUP): Policy B. - 1388-9842 .- 1879-0844. ; 15:1, s. 94-102
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Tidskriftsartikel (refereegranskat)abstract
- To examine whether self-rated disease-specific and generic quality of life predicts long-term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well-defined heart failure (HF) population. less thanbrgreater than less thanbrgreater thanA cohort of 661 patients (62 male; age 71 years; left ventricular ejection fraction 34) was followed prospectively for 3 years. Quality of life questionnaires (Ladder of Life, RAND36, and Minnesota Living with Heart Failure Questionnaire) and BNP levels were assessed at discharge after a hospital admission for HF. Three-year mortality was 42. After adjustment for demographic variables, clinical variables, and BNP levels, poor quality of life scores predicted higher mortality; per 10 units on the physical functioning [hazard ratio (HR) 1.08, 95 confidence interval (CI) 1.021.14] and general health (HR 1.08, 95 CI 1.011.16) dimensions of the RAND36. Patients with low scores on these dimensions were more likely to be in New York Heart Association class IIIIV, diagnosed with co-morbidities, have suffered longer from HF, have lower estimated glomerular filtration rates, and have fewer beta-blocker prescriptions. less thanbrgreater than less thanbrgreater thanQuality of life was independently related to survival in a cohort of hospitalized patients with HF. less thanbrgreater than less thanbrgreater thanNCT 98675639.
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| 5. |
- Hoekstra, Tialda, et al.
(författare)
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Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction
- 2011
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Ingår i: European Journal of Heart Failure. - : Oxford University Press (OUP). - 1388-9842 .- 1879-0844. ; 13:9, s. 1013-1018
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Tidskriftsartikel (refereegranskat)abstract
- Aims To compare quality of life (QoL) in heart failure (HF) patients with preserved ejection fraction (HF-PEF) and HF patients with reduced ejection fraction (HF-REF) in a well-defined HF population. less thanbrgreater than less thanbrgreater thanMethods and results Patients with HF-PEF [left ventricular ejection fraction (LVEF) andgt;= 40%] were matched by age and gender to patients with HF-REF (LVEF,40%). In the current study, we only included HF patients with a B-type natriuretic peptide level (BNP) andgt; 100 pg/mL. Quality of life was assessed by Cantrils Ladder of Life, RAND-36, and the Minnesota Living with Heart Failure questionnaire, and impairment of QoL was adjusted for by BNP as a marker for severity of HF. We examined a total of 290 HF patients, of whom 145 had HF-PEF (41% female; age 72 +/- 10; LVEF 51 +/- 8%) and 145 had HF-REF (41% female; age 73 +/- 10, LVEF 26 +/- 7%). All HF patients reported markedly low scores of QoL, both on the general and disease-specific QoL questionnaires. Quality of life between patients with HF-PEF and HF-REF did not differ significantly. When adjusting the QoL scores for BNP, an association between QoL and LVEF was not found, i.e. patients with HF-PEF and HF-REF with similar BNP levels had the same impairment in QoL. less thanbrgreater than less thanbrgreater thanConclusion Quality of life is similarly impaired in patients with HF-PEF as in HF-REF. These findings further support the need for more pharmacological and non-pharmacological studies in patients with HF-PEF.
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| 6. |
- Hoekstra, Tialda, et al.
(författare)
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Sexual problems in elderly male and female patients with heart failure
- 2012
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Ingår i: Heart. - : BMJ Publishing Group. - 1355-6037 .- 1468-201X. ; 98:22, s. 1647-1652
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate perceived sexual problems in a large group of younger and older patients with heart failure (HF), with and without a partner, focusing on a broad range of perceived sexual problems, and compare this with a sample of healthy community-dwelling elderly people. less thanbrgreater than less thanbrgreater thanDesign Cross-sectional study. less thanbrgreater than less thanbrgreater thanSetting 17 HF clinics and general practices in The Netherlands. less thanbrgreater than less thanbrgreater thanParticipants 438 patients with HF and 459 healthy community-dwelling elderly people. less thanbrgreater than less thanbrgreater thanMain Outcome Measures Differences in sexual functioning, related factors and perceived causes of sexual problems between patients with HF and healthy community controls. less thanbrgreater than less thanbrgreater thanResults In total, 59% of HF patients reported sexual problems, mostly problems with erectile function. HF patients with a partner (67%) and younger patients (65%) reported significantly more sexual problems than healthy community controls (58%, p=0.011 and 53%, p=0.011, respectively). Multivariate analyses show that sexual problems in HF patients with a partner were more common in men (OR 2.73, 95% CI 1.572 to 4.753) and in those with a prescription of beta-blockers (OR 2.00, 95% CI 1.10 to 3.586). In younger patients, sexual problems were independently associated with male gender (OR 3.21, 95% CI 2.099 to 4.908) and having a partner (OR 2.00, 95% CI 1.283 to 3.110). HF patients mainly attribute their sexual problems to symptoms of HF. less thanbrgreater than less thanbrgreater thanConclusion Sexual problems are common in patients with HF, particularly in younger patients and those with a partner. As patients attribute their sexual problems mostly to HF symptoms, adequate treatment and education of HF patients is needed.
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| 7. |
- Hoekstra, Tialda, et al.
(författare)
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What keeps nurses from the sexual counseling of patients with heart failure?
- 2012
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Ingår i: Heart & Lung. - : Elsevier. - 0147-9563 .- 1527-3288. ; 41:5, s. 492-499
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We sought to examine the current practice of discussing sexual health by heart failure (HF) nurses, and to explore which barriers prevent nurses from discussing sexuality. less thanbrgreater than less thanbrgreater thanMETHODS: The Nurses Survey of Sexual Counseling of Myocardial Infarction Patients and a list of barriers were used to form a questionnaire, which was sent to all HF clinics (n = 122) in the Netherlands. less thanbrgreater than less thanbrgreater thanRESULTS: The majority (75%) of nurses (n = 146) felt a certain responsibility to discuss patients sexual health. However, in practice, 61% of the nurses rarely or never addressed sexuality. Barriers that prevented nurses from addressing sexuality and that differed between nurses who do (n = 58) and do not (n = 88) discuss sexuality include a lack of organizational policy (49% vs. 79%, respectively; P andlt; .001) and lack of training (43% vs. 80%, respectively; P andlt; .001), and not knowing how to initiate the subject (24% vs. 72%, respectively; P andlt; .001). Nurses preferred to address sexuality during a follow-up visit or when discussing medication. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Although HF nurses feel responsible for discussing sexuality, this topic is rarely addressed in clinics. Several barriers were identified, relating to personal, patient, and organizational factors.
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| 8. |
- Huzen, Jardi, et al.
(författare)
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Telomere length and psychological well-being in patients with chronic heart failure.
- 2010
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 39:2, s. 223-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: psychological stress and depressive symptoms have been implicated with accelerated ageing and increased progression of diseases. Shorter telomere length indicates a more advanced biological age. It is unknown whether psychological well-being is associated with telomere length in patients with the somatic condition of chronic heart failure (CHF). DESIGN: a cross-sectional analysis was used. SETTING: patients were admitted to the hospital with signs and symptoms of CHF. OBJECTIVE: the study aimed to assess the association between telomere length and psychological well-being in patients with CHF. METHODS: telomere length was determined by quantitative polymerase chain reaction in 890 patients with New York Heart Association functional class II to IV CHF. We evaluated the perceived mental health by the validated RAND-36 questionnaire. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D), and the presence of type D personality was evaluated by the DS14. RESULTS: a lower perceived mental health on the RAND-36 score was associated with shorter telomere length. Adjustment for age and gender did not change our findings (standardised beta, 0.11; P-value, 0.002). Telomere length was not associated with the CES-D or DS14 score. CONCLUSION: decreased perceived mental health is associated with shorter leukocyte telomere length in patients with CHF. Future work should determine whether psychological stress accelerates biological ageing.
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| 9. |
- Jaarsma, Tiny, et al.
(författare)
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Depression and the usefulness of a disease management program in heart failure : insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.
- 2010
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 55:17, s. 1837-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients. BACKGROUND: Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs. METHODS: From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program. RESULTS: Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98). CONCLUSIONS: Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).
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| 10. |
- Jaarsma, Tiny, et al.
(författare)
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Effect of moderate or intensive disease management program on outcome in patients with heart failure : Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH).
- 2008
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 168:3, s. 316-24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent. METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization. RESULTS: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60). CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.
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| 11. |
- Jaarsma, Tiny, et al.
(författare)
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The value of the quality of life
- 2010
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 12:9, s. 901-902
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This editorial refers to Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality by J. Iqbal et al., published in this issue on pages 1002-1008.
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| 12. |
- Johansson, Peter, et al.
(författare)
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Depression and the delay between symptom onset and hospitalization in heart failure patients.
- 2011
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 13:2, s. 214-219
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Heart failure (HF) patients frequently suffer from episodes of deterioration and may need medical treatment. An adequate reaction from the patient is needed to decrease the delay between the onset of deterioration and consulting a medical professional (i.e. consulting behaviour). The aim of the present study was to evaluate whether depressive symptoms are associated with the duration of the delay between the onset of symptoms of worsening HF and hospitalization, and to examine how consulting behaviour correlates to depressive symptoms and delay in HF patients. METHODS AND RESULTS: Data on the time between the onset of symptoms of worsening HF and hospitalization, depressive symptoms, and self-care behaviour were collected in 958 HF patients (37% female; age 71 ± 11 years; New York Heart Association functional class II-IV), using validated questionnaires. The median delay time of the total sample was 72 h (ranging from 0 to 243 days). Patients with depressive symptoms delayed longer compared with those without depressive symptoms (120 vs. 54 h, P= 0.001). Patients with depressive symptoms had a 1.5 times higher risk for a delay of ≥72 h, independent of demographic and clinical variables (P= 0.008). Consulting behaviour did not correlate with depressive symptoms but was weakly associated with delay (r= -0.07, P= 0.03). CONCLUSIONS: Heart failure patients with depressive symptoms have a significantly longer delay between HF deterioration and hospital admission. Interventions designed to improve the consulting behaviour in HF patients with depressive symptoms may have a limited effect on delay. Further research is needed to obtain more insight into the mechanisms underlying the relationship between delay and depression.
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| 13. |
- Johansson, Peter, et al.
(författare)
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Depressive symptoms and inflammation in patients hospitalized for heart failure
- 2011
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Ingår i: American Heart Journal. - : Elsevier Science B.V., Amsterdam. - 0002-8703 .- 1097-6744. ; 161:6, s. 1053-1059
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Tidskriftsartikel (refereegranskat)abstract
- Background Depressive symptoms in patients with heart failure (HF) are common and might be associated with inflammation. No studies have examined both the cross-sectional and prospective association between inflammation and depressive symptoms in patients with HF with adequate correction for disease severity. The aim of this study was to describe if the cytokines interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with depressive symptoms in hospitalized HF patients. Methods Data from 517 patients hospitalized for HF from the COACH study were analyzed on inflammation markers (IL-6 and CRP) and depressive symptoms (Center for Epidemiological Studies Depression-Scale). Results Heart failure patients with depressive symptoms (n = 208, 40%) had significantly higher plasma values of IL-6 (median 12.8 pg/mL vs median 11.0 pg/mL, P = .018) and CRP (median 2.4 mg/mL vs median 2.1 mg/mL, P = .03) compared with the nondepressed patients. Structural equation modelling showed that the factor inflammation (including IL-6 and CRP) was associated with depressive symptoms (beta = 0.18, P less than .05) when left ventricular ejection fraction and plasma values brain natriuretic peptides were included in the model. A small negative (beta = -0.18, P less than .05) effect was found between inflammation at baseline and the change in depressive symptoms during the 18 months of follow-up. Conclusions Higher levels of inflammatory markers are independently associated with depressive symptoms in HF patients, even after correcting for disease severity. There is no clear relationship between inflammation at baseline and depressive symptoms during the 18 months of follow-up.
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| 14. |
- Johansson, Peter, et al.
(författare)
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Time-course of depressive symptoms in patients with heart failure
- 2013
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Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 74:3, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Background It is unclear how depressive symptoms in patients with heart failure developover time and whether this trajectory of depressive symptoms is associated with hospital admission and prognosis.Aim To describe the time-course of depressive symptoms and determine the relationship with hospital admission and mortality.Method Data was analysed using 611 patients with completed CES-D questionnaires at baseline and at 18 months. Data on hospital readmission was collected 18 months after discharge and data on mortality was collected 18 and 36 months post-discharge.Results The prevalence of depressive symptoms was 38% (n=229) at discharge and 26% (n=160) after 18 months. A total of 140 (61%) of the 229 patients with depressive symptoms at discharge had recovered from depressive symptoms after 18 months whereas 71 (18%) of the 382 non-depressed developed depressive symptoms and 89 (39%) of the 229 depressed remained depressed. Depressive symptoms at discharge were not associated with mortality after 18 months but patients with recently (i.e. during 18 months) developed depressive symptoms showed a significantly higher risk for cardiovascular readmissions (HR 1.7, p=0.016). After 36 months, patients with developed depressive symptoms after discharge were at a higher risk of all-cause mortality (HR 2.0, p=0.012) and there was a trend towards a higher risk of all-cause mortality in patients with ongoing depressive symptoms (HR 1.7, p=0.056).Conclusion A significant proportion of patients with HF, who were reported depressive symptoms at discharge recovered from depressive symptoms during the following 18 months. However, patients who remained having depressive symptoms or patients who developed depressive symptoms had a worse prognosis.
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| 15. |
- Lesman-Leegte, Ivonne, et al.
(författare)
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Depressive symptoms and outcomes in patients with heart failure : data from the COACH study.
- 2009
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 11:12, s. 1202-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level. METHODS AND RESULTS: We studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 +/- 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% +/- 14%, and median BNP level: 454 pg/mL (75% CI, 195-876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score >or=16] and 200 (21%) had severe depressive symptoms (score >or=24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P = 0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P = 0.02) and mortality (HR 1.169, P = 0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death. CONCLUSION: In patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes. The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.
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| 16. |
- Lesman-Leegte, Ivonne, et al.
(författare)
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Depressive symptoms are prominent among elderly hospitalised heart failure patients.
- 2006
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 8:6, s. 634-40
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There are limited data on the prevalence of depressive symptoms in hospitalised elderly HF patients and demographic and clinical characteristics associated with depressive symptoms are not known. METHODS: A sample of 572 HF patients (61% male; age 71+/-12 years; LVEF 34%+/-15) was recruited from 17 Dutch hospitals during HF admission. Depressive symptoms were assessed by the CES-D. Demographic, clinical variables and HF symptoms were collected from patient chart and interview. RESULTS: Forty one percent of the patients had symptoms of depression with women significantly more often reporting depressive symptoms than men 48% vs. 36% (chi(2)=8.1, p<0.005). HF patients with depressive symptoms reported more clinical HF symptoms than patients without depressive symptoms. Even after deleting HF related symptoms (sleep disturbances and loss of appetite) from the CES-D scale, 36% of patients were still found to have symptoms of depression. Multivariable logistic regression analyses revealed that depressive symptoms were associated with female gender (odds 1.68, 95% CI 1.14-2.48), COPD (odds 2.11, 95% CI 1.35-3.30), sleep disturbance (odds 3.45, 95% CI 2.03-5.85) and loss of appetite (odds 2.61, 95% CI 1.58-4.33). CONCLUSIONS: Depressive symptoms are prominent in elderly hospitalised HF patients especially in women. Depressive symptoms are associated with more pronounced symptomatology, despite the fact that other indices of severity of left ventricular dysfunction are similar.
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| 17. |
- Lesman-Leegte, Ivonne, et al.
(författare)
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Determinants of depressive symptoms in hospitalised men and women with heart failure.
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:2, s. 121-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depressive symptoms are prominent and related to an increased risk on cardiovascular disease outcomes and all cause mortality in HF patients. AIM: To intervene effectively, factors related to depressive symptoms in men and women should be identified. METHODS: Depressive symptoms of 921 hospitalised HF patients (61% male; age 71+/-11; LVEF 33%+/-14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). RESULTS: Overall 40% of the patients had depressive symptoms (CES-D >or=16), which were more common in women than in men (47% versus 36%, p<0.001). Multivariable analysis in men revealed that depressive symptoms were related to age (OR 0.84, 95% CI 0.71-0.98, p=0.03, per 10 years), physical health (OR 0.76, 95% CI 0.71-0.83, p<0.001, per 10 units) and HF symptoms. In women depressive symptoms were also related to NYHA II-III versus IV (OR 0.60, 95% CI 0.37-0.95, p<0.03) and COPD (OR 2.33, 95% CI 1.20-4.53, p<0.012). CONCLUSION: Depressive symptoms are more common in women than in men. In both men and women depressive symptoms are related to age and physical health. For clinical factors: In men only HF symptoms, but in women also NYHA and COPD were related to depressive symptoms.
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| 18. |
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| 19. |
- Lesman-Leegte, Ivonne, et al.
(författare)
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Quality of life and depressive symptoms in the elderly : a comparison between patients with heart failure and age- and gender-matched community controls.
- 2009
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 15:1, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Comparisons of heart failure (HF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly. METHODS AND RESULTS: Data were collected from 781 HF patients (36% female; age 72 +/- 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D >or=16: 39% vs. 21%, P < .001). HF patients had more chronic conditions-specifically diabetes and asthma/chronic obstructive pulmonary disease. Impaired QoL and depressive symptoms were most prevalent among HF patients with comorbidities. Prevalence was also higher in HF patients in the absence of these conditions. CONCLUSIONS: HF has a large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls.
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- Ski, Chantal F., et al.
(författare)
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Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial
- 2019
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Ingår i: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- Objective To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. Design and participants A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Setting Seventeen hospitals located across the Netherlands. Outcomes measures Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years. Results Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95%CI 1.27 to 6.28, p=0.011; OR 2.24, 95%CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95%CI 1.61 to 4.84, pamp;lt;0.001; OR 2.00, 95%CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95%CI 1.05 to 3.11, p=0.034; OR 2.87, 95%CI 1.61 to 5.11, pamp;lt;0.0011) and HF management adherence (OR 0.39, 95%CI 0.18 to 0.81, p=0.012; OR 0.35, 95%CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95%CI 1.07 to 1.91, p=0.016) at 3 years. Conclusions Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.
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