| 1. |
- Aamodt, Ina Thon, et al.
(författare)
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Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR PUBLICATIONS, INC. - 1438-8871. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the Cardio Set Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
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| 2. |
- Aamodt, Ina Thon, et al.
(författare)
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Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:23
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Tidskriftsartikel (refereegranskat)abstract
- Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.
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| 3. |
- Ben Gal, Tuvia, et al.
(författare)
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Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale
- 2020
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Ingår i: Heart, Lung and Circulation. - : Elsevier. - 1443-9506 .- 1444-2892. ; :7, s. E121-E130
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.
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| 4. |
- Khatib, Rani, et al.
(författare)
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Evaluating the Extent of Patient-Centred Care in a Selection of ESC Guidelines
- 2020
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Ingår i: European Heart Journal - Quality of Care and Clinical Outcomes. - : Oxford University Press. - 2058-5225 .- 2058-1742. ; 6:1, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Patient-centred care (PCC) is the cornerstone for healthcare professionals (HCP) to promote high quality care for patients with cardiovascular conditions. It is defined as 'Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions'. PCC can improve patient outcomes and allow patients and HCP to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively these guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC).METHODS: Using a narrative literature review and expert consensus, the Science Committee within the Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed evaluated with committee members independently evaluating five PCC aspects: patient voice & involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients' needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared.RESULTS: The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the 'multidisciplinary involvement' category.CONCLUSIONS: Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing or formulating recommendations. Future development of guidelines should ensure better incorporation of patients' perspective, in particular, and other PCC aspects highlighted in this study.
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| 5. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Hälsorelaterad livskvalitet och psykisk ohälsa hos patienter med icke-kardiell bröstsmärta
- 2020
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Ingår i: BestPractice Nordic, Primärvård. ; :2
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Återkommande icke-kardiell bröstsmärta har negativ inverkan på psykiskt välmående och hälsorelaterad livskvalitet (HRQoL). Detta gäller i synnerhet patienter med tidigare hjärtsjukdom vilka visar signifikant lägre HRQoL än patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom.Många patienter som söker akut på grund av bröstsmärta blir utskrivna utan någon förklaring, annat än att akut hjärtsjukdom uteslutits, så kallad icke-kardiell bröstsmärta.1,2 Återkommande bröstsmärta kan påverka patienternas psykiska välbefinnande och hälsorelaterade livskvalitet (HRQoL) negativt.3-6 En stor andel av dessa patienter kan ha haft hjärtsjukdom sedan tidigare.7 Det råder i dag brist på studier som undersökt HRQoL bland patienter med icke-kardiell bröstsmärta samt hur tidigare erfarenhet av hjärtsjukdom påverkar sambandet mellan psykiskt välbefinnande och HRQoL hos dessa patienter. Syftet med denna studie var därför att beskriva HRQoL bland patienter med icke-kardiell bröstsmärta, med eller utan tidigare hjärtsjukdom. Vidare var syftet att undersöka sambandet mellan HRQoL och psykisk ohälsa, vilket i denna studie omfattade hjärtrelaterad ångest, depressiva symtom, rädsla för kroppsliga sensationer och somatisering. Metod Sammanlagt 552 patienter som vårdats för bröstsmärta och skrivits ut från fyra sjukhus i sydöstra Sverige med icke-kardiell bröstsmärta som diagnos (ICD 10–diagnoskoder: R07.2, R07.3, R07.4 och Z03.4) deltog i studien. Patienterna var 64 ± 17 år gamla, huvudsakligen gifta/sambo och jämnt fördelade avseende kön. Patienter med tidigare hjärtsjukdom var äldre än de utan (71 år respektive 60 år) och bestod av fler män än kvinnor (60 procent respektive 44 procent). HRQoL undersöktes med frågeformuläret EuroQol-5D-5L (EQ-5D),8 hjärtrelaterad ångest med Cardiac Anxiety Questionnaire (CAQ),9 depressiva symtom med Patient Health Questionnaire-9 (PHQ-9),10 rädsla för kroppsliga sensationer med Body Sensations Questionnaire (BSQ)11 och somatisering med Patient Health Questionnaire-15 (PHQ-15).12 Resultat Omkring hälften av patienterna rapporterade minst måttliga problem avseende smärtor/besvär och en av fyra rapporterade minst måttliga problem i HRQoL–dimensionerna rörlighet, vanliga aktiviteter och oro/nedstämdhet. Avseende personlig vård var det åtta procent som rapporterade problem. EQ-5D VAS och EQ-5D index var 0,7 ± 0,2 respektive 0,7 ± 0,3 för den totala studiepopulationen. Patienter med icke-kardiell bröstsmärta och tidigare hjärtsjukdom rapporterade signifikant lägre HRQoL (p ≤0,05) jämfört med patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom. Hjärtrelaterad ångest, depressiva symtom och somatisering hade i den totala studiepopulationen svaga signifikanta negativa samband (beta = 0,187–0,284, p <0,001) med HRQoL. Hos patienter med tidigare hjärtsjukdom var sambandet mellan depressiva symtom och HRQoL måttligt (beta = -0,339, p <0,001), jämfört med svagt samband hos patienter utan tidigare hjärtsjukdom (beta = -0,193, p <0,001). Å andra sidan var sambandet mellan hjärtrelaterad ångest och HRQoL svagt hos både patienter med tidigare hjärtsjukdom (beta = -0,156, p = 0,05) och patienter utan tidigare hjärtsjukdom (beta = -0,229, p <0,001). Slutsatser Patienter med icke-kardiell bröstsmärta, särskilt de med tidigare hjärtsjukdom, rapporterade låga nivåer av HRQoL och en stor andel uppvisade problem med smärtor/besvär och oro/nedstämdhet. Hjärtrelaterad ångest, depressiva symtom och somatisering hade negativ inverkan på HRQoL, men skiljde sig en del mellan dem som haft eller inte haft hjärtsjukdom sedan tidigare. Detta bör beaktas vid utveckling av psykologiska interventioner som syftar till att förbättra HRQoL hos patienter med icke-kardiell bröstsmärta.Referenser 1. spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. Journal of the Royal Society of Medicine. 2003;96(3):122-125. 2. Leise MD, Locke GR, 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clinic proceedings. Mayo Clinic. 2010;85(4): 323-330. 3. Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Disease-a-month : DM. 2008;54(9): 604-612. 4. Mol KA, Smoczynska A, Rahel BM, et al. Non-cardiac chest pain: prognosis and secondary healthcare utilisation. Open Heart. 2018;5(2): e000859. 5. Mourad G, Stromberg A, Johansson P, et al. Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. The Patient. 2016;9(1): 69-77.6. Fagring AJ, Gaston-Johansson F, Kjellgren KI, et al. Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women. European journal of cardiovascular nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2007;6(4): 329-336. 7. Mourad G, Jaarsma T, Stromberg A, et al. The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter? BMC Psychiatry. 2018;18(1): 172. 8. EuroQolGroup. EQ-5D 2017. Available from: www.euroqolgroup.org, accessed 2017-11-06. 9. Eifert GH, Thompson RN, Zvolensky MJ, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Research and Therapy. 2000;38(10): 1039-1053. 10. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9): 606-613.11. Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology. 1984;52(6): 1090-1097. 12. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine. 2002;64(2): 258-266.
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| 7. |
- van der Wal, Martje H. L., et al.
(författare)
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Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan
- 2020
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Ingår i: Journal of Cardiovascular Nursing. - : Wolters Kluwer. - 0889-4655 .- 1550-5049. ; 35:1, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Thirst is a distressing symptom and influences quality of life of patients with heart failure (HF). Knowledge about thirst in HF is insufficient; therefore, the aim of this study was to describe factors related to thirst, self-reported reasons for thirst, and interventions to relieve thirst in 3 different countries.METHODS: A cross-sectional study was conducted in Sweden, the Netherlands, and Japan. Patients were recruited at the HF clinic or during HF hospitalization. Thirst was assessed by a visual analog scale (0-100); reasons for thirst and interventions to relieve thirst were assessed by an open-ended questionnaire. Patients were divided into low and high thirst based on the first and third tertiles of the visual analog scale.RESULTS: Two hundred sixty-nine patients participated in the study (age, 72 ± 12 years). Mean thirst intensity was 24 ± 24, with a mean thirst of 53 ± 15 in the highest tertile. No significant differences in thirst among the 3 countries were found. Multivariable logistic regression analysis showed that a higher dose of loop diuretics (odds ratio, 3.47; 95% confidence interval, 1.49-8.06) and fluid restriction (odds ratio, 2.21; 95% confidence interval, 1.08-4.32) were related to thirst. The most reported reasons for thirst were salty/spicy food (20%) and low fluid intake (18%). Most of the patients (56%) drank more in case of thirst; 20% only drank a little bit, probably related to a fluid restriction.CONCLUSIONS: Thirst in patients with HF was related to a higher dose of loop diuretics and fluid restriction. Healthcare providers should realize that it is important to assess thirst regularly and reconsider the need of a fluid restriction and the amount of loop diuretics in case of thirst.
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| 8. |
- Vellone, Ercole, et al.
(författare)
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Cognitive impairment in patients with heart failure : an international study
- 2020
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 7:1, s. 47-54
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.Methods and results: A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.Conclusions: CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.
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