| 1. |
- Annema, Coby, et al.
(författare)
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Do patients with heart failure need a case manager?
- 2009
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Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 24:2, s. 127-31
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Tidskriftsartikel (refereegranskat)abstract
- The management of patients with heart failure (HF) is complex and often benefits from a patient-tailored approach. Since the early 1990s, HF disease management programs have been developed and implemented to improve outcomes of patients with HF. The body of evidence of the effectiveness of these programs is still growing, but meta-analyses of disease management program studies show various results on outcomes. This raises questions regarding the optimal organizational structure and components of a most cost-effective HF management program. Case management has been described as a solution to improve outcomes in complex patients and as a possible link to effective disease management. This raises the question of what case management can add to the disease management of patients with HF and which patients might benefit. The aim of this article is to discuss the potential contribution of case management in the disease management of patients with HF.
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| 2. |
- Annema, Coby, et al.
(författare)
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Reasons for readmission in heart failure : Perspectives of patients, caregivers, cardiologists, and heart failure nurses.
- 2009
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Ingår i: Heart & Lung. - : Elsevier BV. - 0147-9563 .- 1527-3288. ; 38:5, s. 427-34
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are to 1) gain insight into reasons for HF readmission from the perspective of patients, caregivers, cardiologists, and HF nurses; 2) examine similarities and differences in perspectives on the reason for an HF readmission, and 3) describe possibilities to prevent an HF readmission from different perspectives. METHODS AND RESULTS: Data on reasons for readmission were collected on 173 readmissions. Perspectives of patients, caregivers, cardiologists, and HF nurses were collected by interview and questionnaire. Worsening HF as the sole reason for readmission was reported most often; however, 36% of caregivers, 56% of patients, and 63% to 65% of health care providers indicated that other factors, such as comorbidity, nonadherence, and nonoptimal medication, were important contributing factors. In only 34% of readmissions, patients and their caregivers agreed with health care providers on the underlying reason. Respondents reported that 23% to 31% of the readmissions could probably have been prevented if adherence were higher, patients requested help earlier, and adequate multidisciplinary professional help were available. CONCLUSION: To prevent future readmissions of patients with HF, it is important to fully understand the reasons for readmission by gaining insight on the reason for readmission from different perspectives. Also, we may need another approach to prevent adverse outcomes in which other medical problems and new strategies to improve adherence have to be considered.
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| 3. |
- Coyne, James C, et al.
(författare)
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Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients
- 2011
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Ingår i: Psychosomatic Medicine. - : Lippincott, Williams and Wilkins. - 0033-3174 .- 1534-7796. ; 73:7, s. 557-562
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Tidskriftsartikel (refereegranskat)abstract
- Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
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| 4. |
- Gallagher, Robyn, et al.
(författare)
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Social Support and Self-care in Heart Failure
- 2011
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Ingår i: Journal of Cardiovascular Nursing. - : Lippincott, Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 26:6, s. 439-445
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE:: Self-care by heart failure (HF) patients is essential for optimal disease management of their condition. However, as the nature of HF is unrelenting and burdensome, self-care is usually achieved with the support of partners. It is not clear what role the level of social support by partners plays in HF self-care; therefore, this study sets out to determine the types of social support provided to HF patients and the impact of differing levels of social support on HF patients' self-care. SUBJECTS AND METHOD:: This is secondary analysis of a subgroup of patients experiencing their second hospital admission for HF at baseline in the COACH study, a multisite trial conducted in the Netherlands. Measures included the European Heart Failure Self-care Behaviour Scale and a multiple component assessment of social support, which categorized patients into low, moderate, and high levels of social support according to the presence of a partner and their perception of support they received from their partner. RESULTS AND CONCLUSIONS:: Patients (n = 333) had an average age of 72 (SD, 11) years, and 92% belonged to New York Heart Association class III or greater. Of the patients with partners (56%), only 49% had a high level of support from their partner. No demographic or clinical characteristic was associated with self-care behavior. Patients with a high level of support reported significantly better self-care (P = .002) than patients with low or moderate levels of social support. Patients with a high level of social support reported being significantly more likely to consult with a health professional for weight gain (P = .011), to limit the amount of fluids they have (P = .02), take their medication (P = .017), to get a flu shot (P = .001), and to exercise on a regular basis (P < .001) than those with medium or low levels of social support. The presence of social support by a partner is not sufficient to influence HF patients' self-care. Social support provided by partners needs to be of a quality and content that matches HF patients' perception of need to influence self-care. Caregivers, especially partners, should be considered as integral in the treatment and care of HF patients.
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| 5. |
- Hagedoorn, Ellen I, et al.
(författare)
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Psychometric evaluation of a revised Family Collaboration Scale
- 2019
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Ingår i: Geriatric Nursing. - : MOSBY-ELSEVIER. - 0197-4572 .- 1528-3984. ; 40:5, s. 463-472
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Tidskriftsartikel (refereegranskat)abstract
- Measuring family caregivers experiences of collaboration with nurses is important in the context of health care reforms that advocate an increased role of families in care. The Family Collaboration Scale (FCS) measures collaboration between nurses and family caregivers, however, the scale has a broad scope. Thus, the aim of this study was to construct a measure that is focused on collaboration only. After revision, a 25-item version of the FCS was sent to 777 family caregivers of hospitalized patients (amp;gt;= 70 years). Psychometric evaluation was employed by the Non-Parametric Item Response Theory to evaluate how items of the revised FCS behave. In total, 302 (39%) family caregivers were found eligible, mean (SD) age 65 (13) and 71% female. A 20-item FCS is proposed showing good psychometric properties. This study contributes to the limited knowledge of measuring collaboration between family caregivers and nurses. (C) 2019 Elsevier Inc. All rights reserved.
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| 6. |
- Hagedoorn, Ellen I, et al.
(författare)
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The association of collaboration between family caregivers and nurses in the hospital and their preparedness for caregiving at home
- 2020
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Ingår i: Geriatric Nursing. - : MOSBY-ELSEVIER. - 0197-4572 .- 1528-3984. ; 41:4, s. 373-380
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Tidskriftsartikel (refereegranskat)abstract
- Family caregivers of an older person who was recently hospitalized often feel unprepared for their new or expanded tasks. Quality and continuity of care for older people is expected to improve when nurses collaborate with family caregivers as partners in care. The aim of this study was to explore the unique contribution of collaboration between family caregivers of older patients and hospital nurses as a possible predictor for preparedness of caregiving after hospital discharge. With a cross sectional design, a postal survey was sent to 777 family caregivers of home-dwelling hospitalized patients (>= 70 years). Regression analyses were used to test the association between collaboration and preparedness for caregiving. In total, 506 (68%) family caregivers responded of whom 281 (38%) were eligible. Their mean (SD) age was 65 (13) and 71% were female. Family caregivers level of collaboration with nurses was significantly associated with their preparedness for caregiving. (C) 2019 Elsevier Inc. All rights reserved.
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| 7. |
- Hagedoorn, Ellen I, et al.
(författare)
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The importance of families in nursing care: attitudes of nurses in the Netherlands
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : WILEY. - 0283-9318 .- 1471-6712. ; 35:4, s. 1207-1215
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Positive attitudes towards family involvement in nursing care are essential for improving the involvement of and collaboration with patients families. The aim of this study is to explore nurses attitudes towards the importance of families in nursing care. Method Using a cross-sectional design, hospital and homecare nurses completed the Families Importance to Nursing Care (FINC-NA) scale, Dutch language version, consisting of four subscales. Data were analysed using descriptive statistics and regression analyses. Results A total of 426 hospital and homecare nurses were eligible for analysis (mean (SD) age 42 years (13), 93% female). The mean (SD) attitude of nurses was 63.8 (12) (100-point scale) on the FINC-NA. Less than half of the nurses (44%) considered family as a collaboration partner, and 37% of nurses stated that families should be invited to actively participate in planning patient care. The nurses attitudes were explained by years of work experience in nursing, work setting and existing policy regarding families in patient care. Conclusion This study identifies areas of improvement regarding to nurses attitudes towards the importance of families in nursing care in order to establish a more family-focused approach in nursing care. Nursing policies should facilitate working with families as part of regular nursing processes. Furthermore, the importance of family involvement in care should be an explicit matter of concern for nursing educational institutions and for policy making within healthcare organisations.
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| 8. |
- 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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| 9. |
- 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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| 10. |
- Hwang, Boyoung, et al.
(författare)
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Family caregiving for patients with heart failure : types of care provided and gender differences.
- 2010
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 16:5, s. 398-403
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge about the potential burden for family caregivers related to the care of patients with heart failure (HF) is limited. The aims of the study were to compare the kind and amount of care provided by partners of HF patients and partners of healthy individuals and to examine the associations between gender and the performance of caregiving tasks. METHODS AND RESULTS: Caregiving tasks performed by 338 partners of HF patients were compared with those performed by 1202 partners of healthy individuals. Partners (age 70 +/- 9, 76% female) of HF patients were more likely to provide personal care compared with partners (age 65 +/- 7, 66% female) of healthy individuals after controlling for their age. However, the magnitude of the odds ratios (OR) differed by gender of partners (OR for male 6.7; 95% confidence interval [CI] 3.9-11.4; OR for female 3.7; 95% CI 2.7-5.1). Partners of HF patients were more likely to provide emotional care than partners of healthy individuals, controlling for age and gender (OR 2.4; 95% CI 1.5-3.6). Male partners of HF patients were more likely to provide personal care compared to female partners of HF patients (OR 1.9; 95% CI 1.1-3.2). CONCLUSIONS: The care performed by partners of HF patients is above and beyond normal spousal assistance. The study underscores the crucial role of family caregivers in the care of HF patients and encourages health care providers to address the needs of both HF patients and their caregivers.
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| 11. |
- Jaarsma, Tiny, et al.
(författare)
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Components of heart failure management in home care : a literature review
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 12:3, s. 230-241
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population.METHODS: The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms.RESULTS: The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components.CONCLUSIONS: There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved.
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| 12. |
- Jaarsma, Tiny, et al.
(författare)
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Design and methodology of the COACH study : a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure
- 2004
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 6:2, s. 227-233
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: While there are data to support the use of comprehensive non-pharmacological intervention programs in patients with heart failure (HF), other studies have not confirmed these positive findings. Substantial differences in the type and intensity of disease management programs make it impossible to draw definitive conclusions about the effectiveness, optimal timing and frequency of interventions. AIMS: 1. To determine the effectiveness of two interventions (basic support vs. intensive support) compared to 'care as usual' in HF patients, on time to first major event (HF readmission or death), quality of life and costs. 2. To investigate the role of underlying mechanisms (knowledge, beliefs, self-care behaviour, compliance) on the effectiveness of the two interventions. METHODS: This is a randomised controlled trial in which 1050 patients with heart failure will be randomised into three treatment arms: care as usual, basic education and support or intensive education and support. Outcomes of this study are; time to first major event (HF hospitalisation or death), quality of life (Minnesota Living with HF Questionnaire, RAND36 and Ladder of Life) and costs. Data will be collected during initial admission and then 1, 6, 12, and 18 months after discharge. In addition, data on knowledge, beliefs, self-care behaviour and compliance will be collected. RESULTS: The study started in January 2002 and results are expected at the end of 2005. CONCLUSIONS: This study will help health care providers in future to make rational and informed choices about which components of a HF management program should be expanded and which components can possibly be deleted.
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| 13. |
- 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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| 14. |
- Jaarsma, Tiny, et al.
(författare)
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Home care in heart failure: towards an integrated care model
- 2011
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 13:8, s. 823-824
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This editorial refers to The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home-vs. clinic-based management of chronic heart failure patients by S. Stewart et al., published in this issue on pages 909-916.
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| 15. |
- Kraai, Imke H., et al.
(författare)
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Preferences of heart failure patients in daily clinical practice : quality of life or longevity?
- 2013
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 15:10, s. 1113-1121
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Knowledge of patient preferences is vital for delivering optimal healthcare. This study uses utility measurement to assess the preferences of heart failure (HF) patients regarding quality of life or longevity. The utility approach represents the perspective of a patient; facilitates the combination of mortality, morbidity, and treatment regimen into a single score; and makes it possible to compare the effects of different interventions in healthcare.METHODS AND RESULTS: Patient preferences of 100 patients with HF were assessed in interviews using the time trade-off (TTO) approach. Health-related quality of life (HR-QoL) was assessed with the EQ-5D and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients' own estimation of life expectancy was assessed with a visual analogue scale (VAS). Of the 100 patients (mean age 70 ± 9 years; 71% male), 61% attach more weight to quality of life over longevity; while 9% and 14% were willing to trade 6 and 12 months, respectively, for perfect health and attach more weight to quality of life. Patients willing to trade time had a significantly higher level of NT-proBNP and reported significantly more dyspnoea during exertion. Predictors of willingness to trade time were higher NT-proBNP and lower EQ VAS.CONCLUSION: The majority of HF patients attach more weight to quality of life over longevity. There was no difference between both groups with respect to life expectancy described by the patients. These insights enable open and personalized discussions of patients' preferences in treatment and care decisions, and could guide the future development of more patient-centred care.
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| 16. |
- Liljeroos, Maria, et al.
(författare)
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Trajectory of self-care behaviour in patients with heart failure : the impact on clinical outcomes and influencing factors.
- 2020
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 19:5, s. 421-432
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients' self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.AIMS: (1) To describe the trajectory of patients' self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.METHODS: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.RESULTS: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).CONCLUSION: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.
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| 17. |
- Luttik, Marie Louise A., et al.
(författare)
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Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study
- 2014
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Ingår i: European Journal of Heart Failure. - : Oxford University Press (OUP): Policy B / Wiley: 12 months. - 1388-9842 .- 1879-0844. ; 16:11, s. 1241-1248
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Tidskriftsartikel (refereegranskat)abstract
- AimsIt has been suggested that home-based heart failure (HF) management in primary care may be an alternative to clinic-based management in HF patients. However, little is known about adherence to HF guidelines and adherence to the medication regimen in these home-based programmes. The aim of the current study was to determine whether long-term follow-up and treatment in primary care is equally effective as follow-up at a specialized HF clinic in terms of guideline adherence and patient adherence, in HF patients initially managed and up-titrated to optimal treatment at a specialized HF clinic. Methods and resultsWe conducted a multicentre, randomized, controlled study in 189 HF patients (62% male, age 72 11 years), who were assigned to follow-up either in primary care (n = 97) or in a HF clinic (n = 92). After 12 months, no differences between guideline adherence, as estimated by the Guideline Adherence Indicator (GAI-3), and patient adherence, in terms of the medication possession ratio (MPR), were found between treatment groups. There was no difference in the number of deaths (n = 12 in primary care and n = 8 in the HF clinic; P = 0.48), and hospital readmissions for cardiovascular (CV) reasons were also similar. The total number of unplanned non-CV hospital readmissions, however, tended to be higher in the primary care group (n = 22) than in the HF clinic group (n = 10; P = 0.05). Conclusionsless thanp id="ejhf173-para-0003"greater thanPatients discharged after initial management in a specialized HF clinic can be discharged to primary care for long-term follow-up with regard to maintaining guideline adherence and patient adherence. However, the complexity of the HF syndrome and its associated co-morbidities requires continuous monitoring. Close collaboration between healthcare providers will be crucial in order to provide HF patients with optimal, integrated care.
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| 18. |
- Luttik, Marie Louise, et al.
(författare)
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Caregiver burden in partners of Heart Failure patients; limited influence of disease severity.
- 2007
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 9:6-7, s. 695-701
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In complying with required life style changes Heart Failure (HF) patients often depend on their partners. However providing care may cause burden and affect the health of these partners. The aim of this study was to investigate determinants of caregiver burden in order to identify caregivers who are at risk. METHODS: Using a cross-sectional design, caregiver burden and potential determinants were measured in partners of HF patients. Demographic and clinical data were assessed in HF patients, partners completed questionnaires on caregiver burden (the Caregiver Reaction Assessment, CRA), caregiving tasks performed, physical and mental health status and quality of the marital relationship. RESULTS: In total 357 partners (75% female, mean age 67 years) participated. The physical health status of HF patients was only significantly associated with two domains of caregiver burden, 'disruption of daily schedule' (p<0.01) and 'loss of physical strength' (p<0.01). No associations were found with age, co-morbidity and LVEF. All domains of the CRA were mainly associated with the partner's own mental health (p<0.01) and with providing personal care to HF patients (p<0.01). Gender differences were only found with regard to the domain of 'feeling a lack of family support'. CONCLUSION: The assessment of caregiver burden should focus on the mental strength of partners. Furthermore when assistance in personal care is needed, additional support, either informal or professional, may be indicated.
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| 19. |
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| 20. |
- Luttik, Marie Louise, et al.
(författare)
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For better and for worse : Quality of life impaired in HF patients as well as in their partners
- 2005
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 4:1, s. 11-14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Quality of Life (QOL) is known to be impaired in patients with Heart Failure (HF). The involvement of a key person, most often the spouse, enables the HF patient to manage the medical regimen and therefore to sustain Quality of Life (QOL). Yet little is known on the impact of caring for an HF patient on the QOL of the caregiving partner. This study aims to explore the QOL of partners of HF patients compared to the QOL of the patients. METHODS: The study population consisted of 38 couples of hospitalized HF patients and their partners. The Cantril Ladder of Life was used to rate QOL during hospitalization, with regard to the month prior to hospitalization and as projected 3 years in the future. Demographic and clinical variables were collected by patient interview and chart review. RESULTS: On a scale from 0-10, QOL scores of partners varied from 5.9 to 6.4. At some point the QOL score of partners was even lower than the QOL scores of HF patients. In the month prior to hospital admission the QOL of partners was significantly higher in comparison to the QOL of HF patients (6.1 vs. 4.9, respectively). However, this reversed during hospital admission, with QOL scores of partners being significantly lower compared to QOL scores of HF patients (5.9 vs. 6.8, respectively), even after correcting for age and gender. CONCLUSION: In our study the QOL of partners of HF patients was low. Whether this is explicitly due to having to live with a HF patient is not clear. Further research on what partners actually do and the relationship between being a caregiver and QOL is necessary in order to support these partners in giving optimal care and support.
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| 21. |
- Luttik, Marie Louise, et al.
(författare)
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Living with heart failure : partner perspectives.
- 2007
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Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 22:2, s. 131-7
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Tidskriftsartikel (refereegranskat)abstract
- To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessary to gain insight in the experiences and potential needs of these partners. Thirteen partners of HF patients participated in semistructured interviews specifically focused on their experiences as a partner. Patients had had HF for at least 18 months, and their partners were interviewed at home without the patient being present. Content analysis was used to organize the data and to identify categories and themes. Partners of HF patients experience several changes in life as reflected in the main themes: changes in life, changes in relationship, coping, and support. Partners support patients in their daily activities; they often change their own daily schedule and have to adjust joint activities. Regaining a new balance together is one of the challenges that couples face when confronted with HF. Anxiety is an important theme especially in the acute phase that can interfere with adequate coping strategies. Changes in relationship are related to difficulties in communication and sexuality. Although most partners seem to cope relatively well, the impact of HF on their lives is profound. Partners are vulnerable especially at the onset of the illness, and therefore, it is important to involve partners actively in the early process of rehabilitation and recognize their importance to the patient and their potential problems.
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| 22. |
- Luttik, Marie Louise, et al.
(författare)
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Marital status, quality of life, and clinical outcome in patients with heart failure
- 2006
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Ingår i: Heart & Lung. - : Elsevier BV. - 0147-9563 .- 1527-3288. ; 35:1, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This study investigated the impact of having a partner on quality of life (QoL), the number of hospital readmissions, and 9-month survival in patients with heart failure (HF). METHODS: The study population consisted of hospitalized patients with HF. QoL was measured by the Cantril Ladder of Life (0-10) during hospital admission. Clinical data, readmission rate, and number of deaths were registered by patient interview and chart review. RESULTS: Of the 179 patients, 96 (54%) were married or were living with a partner. Differences in QoL between married patients and those living alone were most pronounced with regard to future expectations of QoL (6.5 vs 5.0, P=.00). However, in a multivariate model QoL was primarily associated with socioeconomic status, age, and gender. Married patients had 12% less events in the 9-month follow-up period compared with patients living alone (P=not significant). CONCLUSION: This study indicates that most patients with HF who are living alone are mostly elderly women with a low socioeconomic status, who are at risk for recurrent events and a worse QoL.
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| 23. |
- Luttik, Marie Louise, et al.
(författare)
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Quality of life and depressive symptoms in heart failure patients and their partners : the impact of role and gender.
- 2009
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 15:7, s. 580-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Partners of heart failure (HF) patients are important in the course and management of the disease. It is unclear whether HF affects the quality of life (QoL) of partners as much as it affects the QoL of patients. METHODS AND RESULTS: The study aims to determine the influence of role (patient or partner) and gender on quality of life (QoL) and depressive symptoms in HF patients and their partners. Using a cross-sectional design, data on demographics, QoL, and depressive symptoms were collected from 393 HF patients (age, 68+/-11; 76% male) and their partners (age, 67+/-12; 24% male) using questionnaires (Medical Outcome Study 36-item General Health Survey [RAND-36], Cantril Ladder of Life, and Center for Epidemiologic Studies Depression Scale) that were send at home. At a group level HF, patients reported a significantly worse QoL and more depressive symptoms compared with their partners. When examining the influence of role and gender a significant interaction between role and gender was found. QoL in terms of general well-being of female HF partners and female HF patients did not differ (7.0 vs. 6.9), whereas male partners had a significantly higher well-being compared to male HF patients (7.6 vs. 6.8). Most of the RAND-36 domains were explained by role (either being a patient or a partner) with patients having lower scores compared with their partners. However, the RAND-36 domain mental health was mainly explained by gender, with women reporting worse mental health compared with men, independent of their role as a patient or a partner. The same trend was found for the presence of depressive symptoms. CONCLUSIONS: Females, either as patients or as partners are vulnerable in their response to HF in terms of their QoL. The QoL of male partners does not seem to be negatively affected. Supporting couples who are dealing with HF requires different interventions for male and female patients and their partners.
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| 24. |
- Luttik, Marie Louise, et al.
(författare)
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Quality of life in partners of people with congestive heart failure : gender and involvement in care.
- 2009
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 65:7, s. 1442-51
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper is a report of a study conducted to investigate quality of life in partners of people with congestive heart failure in comparison to individuals living with a healthy partner. BACKGROUND: Congestive heart failure is a chronic debilitating disease with severe symptoms and complex treatment. The support of partners is essential in the management of congestive heart failure. Living with a chronic illness generally affects the quality of life of patients and their partners. METHOD: Data were collected using a cross-sectional, comparative design between October 2002 and February 2005 with 303 partners of people with congestive heart failure. Reference data were collected in 304 age- and gender-matched individuals living with a healthy partner, drawn from the general population. All respondents completed questionnaires at home on quality of life and general well-being. Analysis of variance was used to analyse the data. FINDINGS: Overall, differences in quality of life between partners of people with heart failure and matched controls were small. However, substantial variation in the quality of life of partners was found by exploring the role of gender and involvement in care. Quality of life scores varied strongly for male and female partners who had to perform caregiving tasks. The performance of these caregiving tasks was negatively associated with the quality of life of female partners but not with that of male partners. CONCLUSION: Female partners especially should not be overlooked when they become involved in personal care tasks. Nurses should not be reluctant to involve male partners in caring for women with heart failure.
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| 25. |
- Luttik, Marie Louise, et al.
(författare)
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The importance and impact of social support on outcomes in patients with heart failure : an overview of the literature
- 2005
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Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 20:3, s. 162-169
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Tidskriftsartikel (refereegranskat)abstract
- As advances in medical treatment of heart failure (HF) become limited, other factors are being studied to improve outcomes. There is much evidence that supportive social relations have a major impact on health outcomes and that social support is essential for adjustment to illness. This article describes current research on the influence of social support on outcomes in patients with HF. A computerized literature search in Medline, CINAHL, and PsychLit was performed on each of the different outcomes in relation to social support, covering the period 1993 to 2003. Seventeen studies were found that investigated the relationship between social support and different outcome measures in HF. Four studies found clear relationships between social support and rehospitalizations and mortality; the relationship between quality of life and depression was less clear. Up to now, limited research has been done on the impact of social support on outcomes in patients with HF. The available studies suggest that social support has an impact on HF outcomes but further research is necessary before firm conclusions about the nature of these relationships can be reached.
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| 26. |
- Luttik, Marie Louise, et al.
(författare)
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The objective burden in partners of heart failure patients; development and initial validation of the Dutch Objective Burden Inventory.
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:1, s. 3-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Measures on objective caregiver burden in partners of Heart Failure patients are hardly available and never include HF specific aspects. AIM: The main objective of our study was to develop an inventory that assesses the objective caregiver burden of partners of HF patients, including the full range of potential care giving demands. METHODS: To develop the inventory, six domains of caregiving demands were identified. Items for the domains were generated from the literature, expert opinion and existing scales. The original 50-items self-report inventory was administered to 321 partners of HF patients. Demographic data of HF partners were collected by questionnaire. Clinical data of the HF patients were collected by chart review. RESULTS: Component analysis led to exclusion of 12 original items and to a meaningful four-factor solution with a total explained variance of 43%. The components reflected four different kinds of care giving tasks; personal care, emotional, motivational and practical (treatment related) support. They demonstrated good internal consistency and initial validity was supported by a pattern of meaningful associations with external variables. CONCLUSION: The Objective Burden Inventory is a promising inventory to assess objective care giving tasks performed by HF partners, including emotional and motivational support. It provides information on the caregiver situation that may help to develop effective interventions.
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| 27. |
- Näsström, Lena, 1967-, et al.
(författare)
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Exploring partners' perspectives on participation in heart failure home care : a mixed-method design
- 2017
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Ingår i: Journal of Advanced Nursing. - : Blackwell Munksgaard. - 0309-2402 .- 1365-2648. ; 73:5, s. 1208-1219
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To describe the partners' perspectives on participation in the care for patients with heart failure receiving home care. Background. Partners are often involved in care of patients with heart failure and have an important role in improving patients' well-being and self-care. Partners have described both negative and positive experiences of involvement, but knowledge of how partners of patients with heart failure view participation in care when the patient receives home care is lacking. Design. A convergent parallel mixed-method design was used, including data from interviews and questionnaires. Methods. A purposeful sample of 15 partners was used. Data collection lasted between February 2010 - December 2011. Interviews were analysed with content analysis and data from questionnaires (participation, caregiving, health-related quality of life, depressive symptoms) were analysed statistically. Finally, results were merged, interpreted and labelled as comparable and convergent or as being inconsistent. Results. Partners were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation: adapting to the caring needs and illness trajectory, coping with caregiving demands, interacting with healthcare providers and need for knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context. Conclusion. The results revealed different levels of partner participation. Heart failure home care included good opportunities for both participation and contact during home visits, necessary to meet partners' ongoing need for information to comprehend the situation.
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| 28. |
- Näsström, Lena, et al.
(författare)
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Exploring partners' perspectives on participation in heart failure home-care - a mixed method design
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 15:1 Suppl, s. S70-S70
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Previous research has shown that partners and other family members are involved in the care for patients with heart failure, and have an important role regarding outcomes in chronic illness. This involvement included support, both emotionally and practically, and partners often contributed to self-care activities. Partners quality of life may be negatively affected when caring for a person with heart failure, and worse mental health have also been reported. Partners have described both positive and negative experiences of involvement in care, but there is a lack of knowledge of how partners of patients with heart failure view participation in care when the patients receive home-care.Purpose: The aim of this study was to gain a broader understanding of the partners’ perspectives on participation in the care for patients with heart failure receiving structured home-care.Methods: A convergent parallel mixed method design was applied with data from interviews analysed with qualitative content analysis, and questionnaires statistically analysed (n=15). Initially results were analysed separately and thereafter merged in a final interpretation with regard to whether they were comparable and convergent, expanded the understanding, or were inconsistent.Results: Partners scored that they were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation; adapting to the caring needs and illness trajectory, coping with caregiving demands, interacting with health care providers, and need for knowledge to comprehend the situation. Combining the two datasets showed both confirmatory results that were convergent and also gave expanded knowledge that broaden the understanding of partner participation in this context.Conclusions: The results revealed different levels of partner participation, with most partners being satisfied with their participation in care, but some partners expressed a fear of demands to come in the future. Heart failure home-care included good opportunities for both participation and contact during home visits, necessary to meet partners’ ongoing need for information to comprehend the situation.
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| 29. |
- Postmus, Douwe, et al.
(författare)
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A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure
- 2011
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Ingår i: American Heart Journal. - : Elsevier. - 0002-8703 .- 1097-6744. ; 162:6, s. 1096-1104
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Tidskriftsartikel (refereegranskat)abstract
- Background Although previously conducted meta-analyses suggest that nurse-led disease management programs in heart failure (HF) can improve patient outcomes, uncertainty regarding the cost-effectiveness of such programs remains. Methods To compare the relative merits of 2 variants of a nurse-led disease management program (basic or intensive support by a nurse specialized in the management of patients with HF) against care as usual (routine follow-up by a cardiologist), a trial-based economic evaluation was conducted alongside the COACH study. Results In terms of costs per life-year, basic support was found to dominate care as usual, whereas the incremental cost-effectiveness ratio between intensive support and basic support was found to be equal to (sic)532,762 per life-year; in terms of costs per quality-adjusted life-year (QALY), basic support was found to dominate both care as usual and intensive support. An assessment of the uncertainty surrounding these findings showed that, at a threshold value of (sic)20,000 per life-year/(sic)20,000 per QALY, basic support was found to have a probability of 69/62% of being optimal against 17/30% and 14/8% for care as usual and intensive support, respectively. The results of our subgroup analysis suggest that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF would be optimal if the willingness-to-pay threshold exceeds (sic)45,345 per life-year/(sic)59,289 per QALY. Conclusions Although the differences in costs and effects among the 3 study groups were not statistically significant, from a decision-making perspective, basic support still had a relatively large probability of generating the highest health outcomes at the lowest costs. Our results also substantiated that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF could further improve health outcomes at slightly higher costs.
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| 30. |
- Postmus, Douwe, et al.
(författare)
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The COACH risk engine : a multistate model for predicting survival and hospitalization in patients with heart failure
- 2012
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Ingår i: European Journal of Heart Failure. - : Oxford University Press (OUP): Policy B. - 1388-9842 .- 1879-0844. ; 14:2, s. 168-175
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Tidskriftsartikel (refereegranskat)abstract
- Aims Several models for predicting the prognosis of heart failure (HF) patients have been developed, but all of them focus on a single outcome variable, such as all-cause mortality. The purpose of this study was to develop a multistate model for simultaneously predicting survival and HF-related hospitalization in patients discharged alive from hospital after recovery from acute HF. less thanbrgreater than less thanbrgreater thanMethods and results The model was derived in the COACH (Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) cohort, a multicentre, randomized controlled trial in which 1023 patients were enrolled after hospitalization because of HF. External validation was attained with the FINN-AKVA (Finish Acute Heart Failure Study) cohort, a prospective, multicentre study with 620 patients hospitalized due to acute HF. The observed vs. predicted 18-month survival was 72.1% vs. 72.3% in the derivation cohort and 71.4% vs. 71.2% in the validation cohort. The corresponding values of the c statistic were 0.733 [95% confidence interval (CI) 0.705-0.761] and 0.702 (95% CI 0.663-0.744), respectively. The models accuracy in predicting HF hospitalization was excellent, with predicted values that closely resembled the values observed in the derivation cohort. less thanbrgreater than less thanbrgreater thanConclusion The COACH risk engine accurately predicted survival and various measures of recurrent hospitalization in (acute) HF patients. It may therefore become a valuable tool in improving and personalizing patient care and optimizing the use of scarce healthcare resources.
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| 31. |
- Strömberg, Anna, 1967-, et al.
(författare)
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Psychometric Validation of the Heart Failure Caregiver Questionnaire (HF-CQ (R))
- 2017
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Ingår i: Patient. - : ADIS INT LTD. - 1178-1653 .- 1178-1661. ; 10:5, s. 579-592
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Tidskriftsartikel (refereegranskat)abstract
- Background The Heart Failure Caregiver Questionnaire (HF-CQ (R)) was developed to assess subjective outcomes of heart failure caregivers. The HF-CQ (R) comprises 21 questions on three domains, namely physical, emotional/psychological and lifestyle. The objective of this study was to evaluate the psychometric properties of the HF-CQ (R). Methods Patients (n = 150) with heart failure and their primary caregivers (n = 150) were recruited from 11 sites in USA. Caregivers completed the HF-CQ (R) and additional questionnaires, namely Caregiver Reaction Assessment, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain, and the Hospital Anxiety and Depression Scale. Patient-completed Global Impression of Severity, construct validity, concurrent validity, reliability and responsiveness of the HF-CQ (R) were also assessed. Results In the physical and lifestyle domains, all items showed acceptable validity. No high correlations between HF-CQ (R) scores and other caregiver-completed instruments, including the Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain or Caregiver Reaction Assessment, were reported. The intra-class correlation coefficient exceeded the threshold for reliability (amp;gt;0.7) across the physical well-being (0.785), emotional/psychological (0.797), lifestyle (0.787) and total scores (0.850), indicating acceptable reliability. Internal consistency results using Cronbachs alpha showed the total aggregate score of 0.942 to be reliable. In the responsiveness analyses, each of the three scales and the total score showed responsiveness to changes defined by the Caregiver Global Impression of Severity. The overall caregiver burden score increased with increased severity of illness in the cared-for patients. Conclusions The study provides initial evidence for the acceptable validity of the HF-CQ (R) as an instrument to measure heart failure caregiver burden.
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| 32. |
- Ågren, Susanna, et al.
(författare)
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Caregiving tasks and caregiver burden; effects of an psycho-educational intervention in partners of patients with post-operative heart failure
- 2015
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Ingår i: Heart & Lung. - : Elsevier. - 0147-9563 .- 1527-3288. ; 44:4, s. 270-275
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effects of a psycho-educational intervention on caregiver burden in partners of patients with postoperative heart failure. Background: Since partners of cardiac surgery patients play a significant role in the patients recovery, it is important to address their needs during hospitalization and after discharge. Methods: Forty-two patients with postoperative heart failure and their partners participated in a randomized controlled pilot study. Dyads in the intervention group received psycho-educational support from a multidisciplinary team. Dyads in the control group received usual care. Results: No significant differences were found in the performance of caregiving tasks and perceived caregiver burden in the control versus the intervention group. Conclusion: A pilot study exploring the effects of a psycho-educational intervention in patients and their partners did not reveal significant effects with regard to reduced feelings of burden in partners. Alleviating caregiver burden in partners may need a more intense or specific approach. (C) 2015 Elsevier Inc. All rights reserved.
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