| 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. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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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| 9. |
- 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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| 10. |
- 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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| 11. |
- 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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