| 1. |
- Borland, Maria, 1967, et al.
(författare)
-
Träning vid kronisk hjärtsvikt för att förbättra livskvaliteten
- 2015
-
Ingår i: Läkartidningen. - 0023-7205. ; 112
-
Tidskriftsartikel (refereegranskat)abstract
- Persons with chronic heart failure should be recommended aerobic and resistance exercise to be able to increase maximal oxygen uptake (VO2 max), walking distance, and health related quality of life (moderately strong scientific evidence - quality of evidence +++), and to reduce mortality and hospital admissions and increase muscle strength and endurance (low scientific evidence - quality of evidence ++). Prescription of exercise in chronic heart failure should always be preceded of assessments of aerobic and muscular fitness. The aerobic exercise could be conducted as continuous or interval exercise. In connection with ongoing exercise special attention is needed regarding heart rate, diverging blood pressure reactions, contingent occurrence of arrhythmias and the advent of symptoms such as dizziness and severe dyspnea.
|
|
| 2. |
- Fu, Michael, 1963, et al.
(författare)
-
Optimizing the Management of Heart Failure with Preserved Ejection Fraction in the Elderly by Targeting Comorbidities (OPTIMIZE-HFPEF).
- 2016
-
Ingår i: Journal of cardiac failure. - : Elsevier BV. - 1532-8414 .- 1071-9164. ; 22:7, s. 539-544
-
Tidskriftsartikel (refereegranskat)abstract
- The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is not fully understood. A recently proposed mechanism for HFPEF is that it is a systemic pro-inflammatory state induced by comorbidities, leading to microvascular endothelial dysfunction and subsequent cardiac remodelling and dysfunction. We hypothesize that targeting comorbidities will improve outcomes in elderly patients with HFPEF. Thus, the aim of this study is to determine whether the combination of systematic screening of patients with HFPEF and optimal management of comorbidities associated with HFPEF improves outcomes.
|
|
| 3. |
- Lindgren, Martin, et al.
(författare)
-
Cardiorespiratory fitness and muscle strength in late adolescence and long-term risk of early heart failure in Swedish men.
- 2017
-
Ingår i: European journal of preventive cardiology. - : Oxford University Press (OUP). - 2047-4881 .- 2047-4873. ; 24:8, s. 876-884
-
Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate the association between cardiorespiratory fitness (CRF) and muscle strength in late adolescence and the long-term risk of heart failure (HF). Methods A cohort was created of Swedish men enrolled in compulsory military service between 1968 and 2005 with measurements for CRF and muscle strength ( n=1,226,623; mean age 18.3 years). They were followed until 31 December 2014 for HF hospitalization as recorded in the Swedish national inpatient registry. Results During the follow-up period (median (interquartile range) 28.4 (22.0-37.0) years), 7656 cases of first HF hospitalization were observed (mean±SD age at diagnosis 50.1±7.9 years). CRF and muscle strength were estimated by maximum capacity cycle ergometer testing and strength exercises (knee extension, elbow flexion and hand grip). Inverse dose-response relationships were found between CRF and muscle strength with HF as a primary or contributory diagnosis with an adjusted hazards ratio (95% confidence interval) of 1.60 (1.44-1.77) for low CRF and 1.45 (1.32-1.58) for low muscle strength categories. The associations of incident HF with CRF and muscle strength persisted, regardless of adjustments for the other potential confounders. The highest risk was observed for HF associated with coronary heart disease, diabetes or hypertension. Conclusions In this longitudinal study of young men, we found inverse and mutually independent associations between CRF and muscle strength with risk of hospitalization for HF. If causal, these results may emphasize the importance of the promotion of CRF and muscle strength in younger populations.
|
|
| 4. |
- Lindgren, Martin, et al.
(författare)
-
Cognitive performance in late adolescence and long-term risk of early heart failure in Swedish men.
- 2018
-
Ingår i: European journal of heart failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 20:6, s. 989-97
-
Tidskriftsartikel (refereegranskat)abstract
- Heart failure (HF) incidence appears to increase among younger individuals, raising questions of how risk factors affect the younger population. We investigated the association of cognitive performance in late adolescence with long-term risk of early HF.We followed a cohort of Swedish men enrolled in mandatory military conscription in 1968-2005 (n=1 225 300; mean age 18.3years) until 2014 for HF hospitalization, using data from the Swedish National Inpatient Registry. Cognitive performance (IQ) was measured through a combination of tests, separately evaluating logical, verbal, visuospatial, and technical abilities. The results were standardized, weighted, and presented as stanines of IQ. The association between IQ and risk of HF was estimated using Cox proportional hazards models. In follow-up, there were 7633 cases of a first HF hospitalization (mean age at diagnosis 50.1years). We found an inverse relationship between global IQ and risk of HF hospitalization. Using the highest IQ stanine as reference, the adjusted hazard ratio for the lowest IQ with risk of HF was 3.11 (95% confidence interval 2.60-3.71), corresponding to a hazard ratio of 1.32 (95% CI 1.28-1.35) per standard deviation decrease of IQ. This association proved persistent across predefined categories of HF with respect to pre-existing or concomitant co-morbidities; it was less apparent among obese conscripts (P for interaction =0.0004).In this study of young men, IQ was strongly associated with increased risk of early HF. The medical profession needs to be aware of this finding so as to not defer diagnosis.
|
|
| 5. |
- Lindgren, Martin, et al.
(författare)
-
Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men
- 2018
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 259, s. 109-115
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the association of resting heart rate (RHR) measured in late adolescence with the long term risk of myocardial infarction (MI), ischemic stroke (IS), heart failure (HF), atrial fibrillation (AF), cardiovascular- and all-cause death. Methods and results: We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n = 1,008,485; mean age = 18.3 years) until December 2014. Outcomes were collected from the national inpatient - (IPR), outpatient - (OPR) and cause of death registries. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders. While we found no independent association between RHR and risk of IS or MI when comparing the highest with the lowest quintile of the RHR distribution, but a positive association persisted between RHR and incident HF (Hazard ratio (HR) = 1.39 [95% confidence interval (CI) = 1.29–1.49]) after adjustment for body mass index (BMI) and blood pressure (BP). In similarly adjusted models, an inverse association was found for AF while there were weaker associations with death from cardiovascular disease (CVD) and all causes (adjusted HR = 1.12 [CI = 1.04–1.21] and 1.20 [CI = 1.17–1.24]). After further adjustment for cardiorespiratory fitness (CRF), the associations persisted for HF (HR = 1.26 [1.17–1.35] for any diagnostic position and HR = 1.43 [1.28–1.60] for HF as a main diagnosis) and for all-cause death (HR 1.09 [1.05–1.12]) but not for CVD death. Conclusion: Adolescent RHR is associated with future risk of HF and death, independently of BP, BMI and CRF, but not with CVD death, MI or IS, suggesting a causal pathway between elevated heart rate and myocardial dysfunction. © 2018 The Authors
|
|
| 6. |
- Patel, Harshida, 1958, et al.
(författare)
-
Experiences of health care in women with Peripartum Cardiomyopathy in Sweden: a qualitative interview study
- 2016
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Peripartum cardiomyopathy is often associated with severe heart failure occurring towards the end of pregnancy or in the months following birth with debilitating, exhausting and frightening symptoms requiring person-centered care. The aim of this study was to explore women’s experiences of health care while being diagnosed with peripartum cardiomyopathy. Method Qualitative interviews were conducted with 19 women with peripartum cardiomyopathy in Sweden, following consent. Data were analysed using qualitative content analysis. Confirmability was ensured by peer-debriefing, and an audit trail was kept to establish the credibility of the study. Results The main theme in the experience of health care was, ‘Exacerbated Suffering’, expressed in three subthemes; ‘not being cared about’, ‘not being cared for’ and ‘not feeling secure.’ The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. Women felt they were on an assembly line in midwives’ routine work where knowledge about peripartum cardiomyopathy was lacking and they showed distrust and dissatisfaction with care related to negligence and indifference experienced from healthcare professionals. Feelings of being alone and lost were prominent and related to a sense of insecurity, distress and uneasiness. Conclusions This study shows a knowledge gap of peripartum cardiomyopathy in maternity care personnel. This is alarming as the deprecation of symptoms and missed diagnosis of peripartum cardiomyopathy can lead to life-threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms.
|
|
| 7. |
- Patel, Harshida, 1958, et al.
(författare)
-
Fathers’ experiences of care when their partners suffer from peripartum cardiomyopathy: a qualitative interview study
- 2018
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Peripartum cardiomyopathy (PPCM), a potentially life-threatening condition in women, can have a profound impact on thefamily. Although structured support systems are developed, these systems tend to be based on the healthcare providers’ perceptions and focus mainly on mothers’ care. Fathers’ vital role in supporting their partners has been advocated in previous research. However, the impact of PPCM on the male partners of women is less understood. The aim of this study was to explore the experiences of healthcare in fathers whose partner was suffering from peripartum cardiomyopathy. Methods: The data from interviews with fourteen fathers were analysed using inductive content analysis. Results: An overarching category “The professionals could have made a difference” was identified from the data, characterised by the sub-categories: ‘To be informed/not informed,’ ‘To feel secure/insecure,’ ‘To feel visible/invisible’ and ‘Wish that it had been different’. Lack of timely information did not allow fathers to understand their partner´s distress, and plan for the future. The birth of the child was an exciting experience, but a feeling of helplessness was central, related to seeing their partner suffering. A desire for follow-up regarding the effect of PPCM on themselves was expressed. Conclusions: When men, as partners of women with PPCM, get adequate information of their partner´s condition, they gain a sense of security and control that gives them strength to handle their personal and emotional life-situation during the transition of becoming a father, along with taking care of an ill partner with PPCM. Hence, maternity professionals should also focus on fathers’ particular needs to help them fulfil their roles. Further research is urgently required in this area.
|
|
| 8. |
- Patel, Harshida, 1958, et al.
(författare)
-
Fathers’ reactions over their partner's diagnosis of peripartum cardiomyopathy: A qualitative interview study
- 2019
-
Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 71, s. 42-48
-
Tidskriftsartikel (refereegranskat)abstract
- Background Fathers' experience of childbirth has been described as both distressing and wonderful, but little has been described in the literature about fathers´ reactions when their partners get life threatening diagnoses such as peripartum cardiomyopathy (PPCM) during the peripartum period. Aim To learn more about fathers' reactions over their partner's diagnosis of peripartum cardiomyopathy. Methods Fourteen fathers, whose partner was diagnosed with PPCM before or after giving birth, were interviewed. Data were analysed using inductive content analysis technique. Results The first reaction in fathers was shock when they heard their partner had PPCM, which was sudden, terrible and overwhelming news. Their reactions to trauma are described in the main category: The appalling diagnosis gave a new perspective on life with emotional sub-categories: overwhelmed by fear, distressing uncertainty in the situation and for the future, feeling helpless but have to be strong, disappointment and frustration, and relief and acceptance. Although terrified, fathers expressed gratitude towards health care professionals for the diagnosis that made it possible to initiate adequate treatment. Conclusion Exploring father's reactions will help peripartum and cardiology healthcare professionals to understand that emotional support for fathers is equally important as the support required for mothers during the peripartum period. Specifically they will help professionals to focus on future efforts in understanding and meeting the supportive care needs of fathers when their partner suffers from a life-threatening diagnosis like PPCM.
|
|
| 9. |
- Patel, Harshida, 1958, et al.
(författare)
-
Symptoms in women with Peripartum Cardiomyopathy: a mixed method study
- 2016
-
Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 32, s. 14-20
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women´s experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women’s experiences of symptoms in Peripartum Cardiomyopathy. Design: A triangulation of methods with individual interviews and data from medical records. Setting: Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. Participants: 19 women were interviewed and medical records were reviewed by authors. Data analysis: All interview transcripts were analyzed using qualitative inductive content analysis to identify key themes. Results: The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum and time from symptoms to diagnosis varied between 3–190 days (median 40). The physical symptoms were: shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. Conclusions and implications for practice: Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives’ knowledge of Peripartum Cardiomyopathy
|
|
| 10. |
- Patel, Harshida, 1958, et al.
(författare)
-
What do we know about women with Peripartum Cardiomyopathy?
- 2017
-
Ingår i: Virginia Henderson Global Nursing e-Repository. - USA : Sigma Theta Tau.
-
Konferensbidrag (refereegranskat)abstract
- Peripartum Cardiomyopathy (PPCM) is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth (Sliwa et al., 2010). The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with PPCM, leading to missed or delayed diagnosis (Germain and Nelson-Piercy, 2011). The aim of the study was to describe women’s experiences of symptoms of PPCM and received care, and identify the areas for improvement. Nineteen women were interviewed. The key themes were identified using content analysis. The main theme emerged is, The eternal suffering. The meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness (Patel et al., 2016). The care experiences are captured in exacerbated suffering, comprising subthemes, not being cared about, not being cared for and not feeling secure (Patel et al., 2016). Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum, and time from symptoms to diagnosis varied between 3–190 days (median 40). Although women expressed miscellaneous experiences of care, majority of them described being not cared in adequate manner. The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. The deprecation of symptoms and missed diagnosis of PPCM can lead to a life threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms. The analyses shows the importance of respecting women’s narratives and positive interactions with midwives and obstetricians as well as the knowledge gap is highlighted in the maternity care personnel.
|
|
