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Li L, Liu R, Jiang C, Du X, Huffman MD, Lam CSP, Patel A, Hillis GS, Anderson CS, Ma C, Zhao X, Wang X, Li L, Dong J. Assessing the evidence-practice gap for heart failure in China: the Heart Failure Registry of Patient Outcomes (HERO) study design and baseline characteristics. Eur J Heart Fail 2019; 22:646-660. [PMID: 31820513 DOI: 10.1002/ejhf.1630] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/11/2019] [Accepted: 09/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Registry studies in high-income countries have defined contemporary management of heart failure (HF), but few such data exist in the large aging population of China. We report the study design and baseline characteristics of the Heart Failure Registry of Patient Outcomes (HERO) study, undertaken to determine evidence-practice gaps in the management of HF in a broad and representative population of China. METHODS AND RESULTS The HERO study is a prospective, longitudinal, seasonally-rotating, multicentre registry study of patients hospitalized with acute HF who are followed up over 12 months. Patients were recruited on the basis of primary admission clinical diagnosis of acute HF at 73 hospitals in Henan, the largest and most socio-economically diverse province in China, from November 2017 to November 2018; follow-up is ongoing. For each patient, data obtained through interview and medial record review by independent clinical research staff include: socio-demographics, clinical features, diagnostic investigations, and treatment, with a subset of patients providing blood samples for future biomarker investigation. Surviving patients are scheduled to be followed up by telephone at 2 weeks, and 3, 6 and 12 months post-admission, or until death or study withdrawal. A total of 5620 patients (mean age 72 ± 12 years; 50% female) with acute HF were recruited from 8 provincial-, 22 municipal-, and 43 county-level hospitals. Patients had co-morbid hypertensive (48%), coronary (29%), or metabolic (20%) diseases. Among 3147 patients who had echocardiography, 54%, 20% and 25% of patients had ejection fraction of ≥50%, 40-50%, and < 40%, respectively. In-hospital or 3-day post-discharge mortality was 3.2% (182/5620). Death or readmission rate from the 4th day post-discharge to first follow-up (median 32 days) was 22.4% (977/4368). CONCLUSIONS The HERO study provides a unique opportunity to profile evidence-practice gaps across a broad spectrum of patients with acute HF in China.
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Affiliation(s)
- Li Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Rong Liu
- Heart Health Research Center (HHRC), Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Heart Health Research Center (HHRC), Beijing, China.,Department of Cardiology, Anzhen Hospital, Beijing, China.,The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carolyn S P Lam
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,National Heart Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore
| | - Anushka Patel
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital and Medical School, University of Western Australia, Perth, Western Australia
| | - Craig S Anderson
- Heart Health Research Center (HHRC), Beijing, China.,Department of Cardiology, Royal Perth Hospital and Medical School, University of Western Australia, Perth, Western Australia.,The George Institute for Global Health, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xiaoyan Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiaofang Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ling Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,Department of Cardiology, Anzhen Hospital, Beijing, China
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202
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Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients. J Cardiovasc Nurs 2019; 33:281-288. [PMID: 28858887 DOI: 10.1097/jcn.0000000000000444] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). OBJECTIVE The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. METHODS Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). RESULTS The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). CONCLUSIONS Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.
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204
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Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure. J Cardiovasc Nurs 2019; 33:217-224. [PMID: 28930784 DOI: 10.1097/jcn.0000000000000447] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL. OBJECTIVE The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL. METHODS In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire). RESULTS The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL. CONCLUSION In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.
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205
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Heart Failure Self-care Within the Context of Patient and Informal Caregiver Dyadic Engagement: A Mixed Methods Study. J Cardiovasc Nurs 2019; 33:384-391. [PMID: 29601368 DOI: 10.1097/jcn.0000000000000465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent heart failure (HF) patient and informal caregiver (eg, dyadic) studies have either examined self-care from a qualitative or quantitative perspective. To date, the 2 types of data have not been integrated. OBJECTIVE The aim of this study was to understand HF self-care within the context of dyadic engagement. METHODS This was a cross-sectional, mixed methods (quantitative/qualitative) study. Heart failure self-care was measured with the Self-care of Heart Failure Index (v.6) dichotomized to adequate (≥70) or inadequate (<69). Dyadic symptom management type was assessed with the Dyadic Symptom Management Type scale. Interviews regarding self-care were conducted with both dyad members present. Content analytic techniques were used. Data were integrated using an information matrix and triangulated using Creswell and Plano Clark's methods. RESULTS Of the 27 dyads, HF participants were 56% men, with a mean age of 77 years. Caregivers were 74% women, with a mean age of 66 years, representing spouses (n = 14) and adult children (n = 7). Quantitatively, few dyads scored as adequate (≥70) in self-care; the qualitative data described the impact of adequacy on the dyads' behavior. Dyads who scored higher, individually or both, on self-care self-efficacy and self-care management were less likely to change from their life course pattern. Either the patient or dyad continued to handle all self-care as they always had, rather than trying new strategies or reaching out for help as the patient's condition deteriorated. CONCLUSIONS Our data suggest links that should be explored between dyadic adequacy and response to patients' symptoms. Future studies should assess dyadic adequacy longitudinally and examine its relationship to event-free survival and health services cost.
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206
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Self-care in Chinese heart failure patients: Gender-specific correlates. Heart Lung 2019; 48:496-501. [DOI: 10.1016/j.hrtlng.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/27/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022]
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Sohn A, Speier W, Lan E, Aoki K, Fonarow G, Ong M, Arnold C. Assessment of Heart Failure Patients' Interest in Mobile Health Apps for Self-Care: Survey Study. JMIR Cardio 2019; 3:e14332. [PMID: 31758788 PMCID: PMC6851712 DOI: 10.2196/14332] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Heart failure is a serious public health concern that afflicts millions of individuals in the United States. Development of behaviors that promote heart failure self-care may be imperative to reduce complications and avoid hospital re-admissions. Mobile health solutions, such as activity trackers and smartphone apps, could potentially help to promote self-care through remote tracking and issuing reminders. OBJECTIVE The objective of this study was to ascertain heart failure patients' interest in a smartphone app to assist them in managing their treatment and symptoms and to determine factors that influence their interest in such an app. METHODS In the clinic waiting room on the day of their outpatient clinic appointments, 50 heart failure patients participated in a self-administered survey. The survey comprised 139 questions from previously published, institutional review board-approved questionnaires. The survey measured patients' interest in and experience using technology as well as their function, heart failure symptoms, and heart failure self-care behaviors. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was among the 11 questionnaires and was used to measure the heart failure patients' health-related quality of life through patient-reported outcomes. RESULTS Participants were aged 64.5 years on average, 32% (16/50) of the participants were women, and 91% (41/45) of the participants were determined to be New York Heart Association Class II or higher. More than 60% (30/50) of the survey participants expressed interest in several potential features of a smartphone app designed for heart failure patients. Participant age correlated negatively with interest in tracking, tips, and reminders in multivariate regression analysis (P<.05). In contrast, MLHFQ scores (worse health status) produced positive correlations with these interests (P<.05). CONCLUSIONS The majority of heart failure patients showed interest in activity tracking, heart failure symptom management tips, and reminder features of a smartphone app. Desirable features and an understanding of factors that influence patient interest in a smartphone app for heart failure self-care may allow researchers to address common concerns and to develop apps that demonstrate the potential benefits of mobile technology.
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Affiliation(s)
- Albert Sohn
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - William Speier
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Esther Lan
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kymberly Aoki
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gregg Fonarow
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Ong
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Corey Arnold
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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208
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Development and Validation of the Self-care in Motor Neuron Disease Index. J Neurosci Nurs 2019; 51:325-330. [PMID: 31626077 DOI: 10.1097/jnn.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to develop and psychometrically test the properties of the Self-care in Motor Neuron Disease (SCMND) Index. METHODS This instrument development and validation study was conducted in 3 phases. The first is to identify self-care behaviors in people with motor neuron disease (MND), and the second is to evaluate the content validity of the SCMND Index. Then, between March 2017 and March 2018, the tool was administered to 107 people with MND for psychometric tests. RESULTS The SCMND Index was developed based on the middle-range theory of self-care of chronic illness, including 15 self-care behaviors related to respiration, nutrition, mobility, medication, medical visits, and complication management. Content validity was excellent. Data analysis suggests that the instrument has a good internal consistency in all 3 domains and excellent reproducibility. Increased self-care behaviors' median values were associated with mechanical ventilation, cough assistance, and dysphagia. Domains differed significantly based on access (maintenance), hospital admissions (monitoring and management), and respiratory infection (management). CONCLUSIONS Self-care is a patient-centered outcome, and it is a key point of healthcare. Results suggest that the SCMND Index is useful for both clinicians and researchers to evaluate self-care in MND.
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209
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Effect of health literacy on quality of life among patients with chronic heart failure in China. Qual Life Res 2019; 29:453-461. [DOI: 10.1007/s11136-019-02332-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
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210
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Impact of pharmacist-led heart failure tool kits on patient-reported self-care behaviors in a primary care-based accountable care organization. J Am Pharm Assoc (2003) 2019; 59:891-895.e3. [PMID: 31582225 DOI: 10.1016/j.japh.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The goal of this project is to evaluate the impact of a pharmacist-led heart failure (HF) intervention, using an educational toolkit, on patient-reported self-care maintenance, management, and confidence at 30 days. SETTING Three Accountable Care Organization (ACO) primary care provider offices in South Florida from January to March 2018. PRACTICE DESCRIPTION Each primary care clinic was staffed with at least 1 physician, nurse practitioners, a clinical pharmacy faculty member, pharmacy residents and students, and ancillary staff. Pharmacists spent approximately 2 days per week in clinic. PRACTICE INNOVATION At the time of this project, no formalized management program for HF patients existed within the clinics. An educational toolkit was designed, reviewed, and approved by the team of pharmacists and ACO providers before use within the clinics, and included educational material outlining common causes of HF exacerbation, symptoms of HF, symptom management strategies, medication action plan, self-management instructions, medication adherence tips, and a weight-management log sheet. EVALUATION A prospective, pretest and posttest observational project was conducted at the 3 clinical sites for eligible patients. The Self-Care for Heart Failure Index (SCHFI, v.6.2) tool was used to evaluate self-care practices and adequacy of maintenance, management, and confidence at baseline as compared with 30 days. RESULTS Twelve participants completed the initial interview and 30-day follow-up. SCHFI scores for self-maintenance (63-68, P = 0.04) and self-management (38-58, P = 0.01) significantly improved from baseline, whereas self-confidence scores showed an increase, but was not statistically significant (80-82, P = 0.58). All self-care behaviors saw a nonstatistically significant improvement in percentage of patients achieving adequacy. CONCLUSION Pharmacists and educational toolkits in the ACO primary care setting may improve self-maintenance, self-management, and self-confidence behaviors in patients with HF.
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211
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Juárez-Vela R, Sarabia-Cobo C, Antón-Solanas I, Vellone E, Durante A, Gea-Caballero V, Pérez-Calvo J. Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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212
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Cross-cultural assessment of the Self-Care of Chronic Illness Inventory: A psychometric evaluation. Int J Nurs Stud 2019; 116:103422. [PMID: 31791631 DOI: 10.1016/j.ijnurstu.2019.103422] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Self-care refers to behaviors that individuals adopt to prevent or maintain the stability of an illness (self-care maintenance), to monitor signs and symptoms (self-care monitoring), and to respond to signs and symptoms of an illness exacerbation (self-care management). A generic measure of self-care, the Self-Care of Chronic Illness Inventory, based on the Theory of Self-Care of Chronic Illness, was developed for use in individuals with any number and type of chronic conditions. OBJECTIVE The current study investigated the measurement equivalence of the Self-Care of Chronic Illness Inventory in individuals from three different cultural groups. We were interested in determining if Italians, Swedes, and Americans interpret the measure in a conceptually similar way. METHODS This cross-sectional study enrolled 1629 patients, 784 recruited in Italy, 438 in Sweden and 407 in the United States. Self-care (self-care maintenance, self-care monitoring and self-care management) was measured with the Self-Care of Chronic Illness Inventory. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measures across the three countries. Configural, metric, scalar and strict invariance were tested through a series of nested models where increasingly stringent equality constraints were posited. RESULTS Participants were mostly males (56.3%), older adults (69.8%) and had at least two chronic conditions. Results indicated that three out of four measurement equivalence levels were partially or totally supported in all three of the Self-Care of Chronic Illness Inventory scales. The partial scalar invariance level was reached for self-care maintenance [χ2(50) = 63.495, p = 0.095; RMSEA = 0.022, p = 0.999, 90% CI = 0.000 0.038; CFI = 0.981; TLI = 0.977; SRMR = 0.036], self-care monitoring [χ2(22) = 28.770, p = 0.095; RMSEA = 0.024, p = 0.978, 90% CI = 0.000 0.046; CFI = 0.996; TLI = 0.995; SRMR = 0.054], and self-care management [χ2(51) = 91.334, p = 0.001; RMSEA = 0.048, p = 0.576, 90% CI = 0.031 0.063; CFI = 0.949; TLI = 0.937; SRMR = 0.047] scales. CONCLUSIONS These findings suggest that patients in the three countries used an identical cognitive framework or mental model when responding and used the 1-5 Likert response scale in an almost identical way, almost without bias. In spite of sociocultural differences, patients in these countries seem to share the same fundamental view of self-care. The results of the Self-Care of Chronic Illness Inventory will be comparable in these countries.
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213
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Jiang Y, Shorey S, Nguyen HD, Wu VX, Lee CY, Yang LF, Koh KWL, Wang W. The development and pilot study of a nurse-led HOMe-based HEart failure self-Management Programme (the HOM-HEMP) for patients with chronic heart failure, following Medical Research Council guidelines. Eur J Cardiovasc Nurs 2019; 19:212-222. [PMID: 31486332 DOI: 10.1177/1474515119872853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is one of the most common causes of hospital admissions and readmissions. Managing CHF requires a comprehensive treatment plan that consists of medication treatment and behavioural change. However, patients often feel unprepared for their self-management role in the community, especially during the period of transition after discharge from hospital. Therefore, an effective intervention to promote CHF self-management is needed. AIMS This paper describes the development and pilot testing of a multicomponent nursing intervention (i.e. the HOM-HEMP) for a randomised controlled trial to assess its effectiveness in improving self-care behaviour among CHF patients in Singapore. A description of the study intervention is also delineated in detail. METHODS The HOM-HEMP was developed based on the UK Medical Research Council framework for developing and evaluating complex interventions. After the development of the study intervention, a single group pre- and post-repeated measure pilot test was conducted to evaluate the study intervention package for its acceptability and the feasibility of the data collection procedure. Ten participants were recruited through consecutive sampling. All of the participants received the full intervention package with the supplementary mobile application. The data were collected at baseline and immediately after the study intervention (i.e. 6 weeks from baseline). The outcome measures included the Self-Care Heart Failure Index, Cardiac Self-Efficacy Scale, Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale and Short Form of the Social Support Questionnaire. RESULTS The results from the pilot testing showed that the programme was feasible and potentially effective in improving patient's self-care management, psychological outcomes and health-related quality of life. CONCLUSION A self-management psychosocial education approach is the preferred choice for many patients with chronic diseases. The effectiveness of the HOM-HEMP will next be tested in a full scale randomised control trial.
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Affiliation(s)
- Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Yu DSF, Li PWC, Yue SCS, Wong J, Yan B, Tsang KK, Choi KC. The effects and cost‐effectiveness of an empowerment‐based self‐care programme in patients with chronic heart failure: A study protocol. J Adv Nurs 2019; 75:3740-3748. [DOI: 10.1111/jan.14162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Doris S. F. Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Polly W. C. Li
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Sunny C. S. Yue
- Department of Medicine and Geriatrics United Christian Hospital Kwun Tong Hong Kong
| | - John Wong
- Division of Cardiology, Department of Medicine and Geriatrics Tseung Kwan O Hospital Tseung Kwan O Hong Kong
| | - Bryan Yan
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin Hong Kong
| | | | - Kai Chow Choi
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
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215
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Massouh A, Abu Saad Huijer H, Meek P, Skouri H. Determinants of Self-Care in Patients With Heart Failure: Observations From a Developing Country in the Middle East. J Transcult Nurs 2019; 31:294-303. [PMID: 31359818 DOI: 10.1177/1043659619865587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Self-care is recognized as a means for improving outcomes of heart failure (HF), yet studies have not addressed what predicts successful self-care in collectivist cultures like Lebanon. Methodology: Self-care was measured, using the Arabic Self-Care of HF index, in 100 participants with HF (76% males; mean age 67.59) recruited from a tertiary medical center. Results: Self-care was suboptimal, with mean scores of 67.26, 66.96, and 69.5 for self-care maintenance, management, and confidence. Better HF knowledge, social support, and self-care confidence and lower New York Heart Association score predicted better self-care maintenance. Better knowledge, social support, and self-care maintenance, no recent hospitalization, and being unemployed predicted better self-care confidence. Better self-care confidence, maintenance, and HF knowledge predicted better self-care management. Discussion: HF self-care in Lebanon is suboptimal. Nurses need to identify facilitators of and barriers to self-care particular to this population. Interventions targeting HF knowledge, confidence, and caregiver support are expected to improve self-care in Lebanese patients.
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Affiliation(s)
| | | | | | - Hadi Skouri
- American University of Beirut, Beirut, Lebanon
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216
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Massouh A, Skouri H, Cook P, Huijer HAS, Khoury M, Meek P. Self-care confidence mediates self-care maintenance and management in patients with heart failure. Heart Lung 2019; 49:30-35. [PMID: 31371031 DOI: 10.1016/j.hrtlng.2019.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care. OBJECTIVES To examine whether confidence explained the associations of social support and HF-knowledge with self-care. METHODS In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care. RESULTS Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144). CONCLUSION Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.
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Affiliation(s)
- Angela Massouh
- American University of Beirut, School of Nursing, Lebanon
| | - Hadi Skouri
- American University of Beirut Medical Center, Department of Cardiology, Lebanon.
| | - Paul Cook
- University of Colorado, Denver; College of Nursing, United States
| | | | - Maurice Khoury
- American University of Beirut Medical Center, Department of Cardiology, Lebanon
| | - Paula Meek
- University of Colorado, Denver; College of Nursing, United States
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217
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Seto E, Morita PP, Tomkun J, Lee TM, Ross H, Reid-Haughian C, Kaboff A, Mulholland D, Cafazzo JA. Implementation of a Heart Failure Telemonitoring System in Home Care Nursing: Feasibility Study. JMIR Med Inform 2019; 7:e11722. [PMID: 31350841 PMCID: PMC6688522 DOI: 10.2196/11722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/29/2018] [Accepted: 06/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Telemonitoring (TM) of heart failure (HF) patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. OBJECTIVE This study aimed to determine the feasibility of implementing a mobile phone-based TM system through a home care nursing agency and to explore the feasibility of conducting a future effectiveness trial. METHODS A feasibility study was conducted by recruiting, through community cardiologists and family physicians, 10 to 15 HF patients who would use the TM system for 4 months by taking daily measurements of weight and blood pressure and recording symptoms. Home care nurses responded to alerts generated by the TM system through either a phone call and/or a home visit. Patients and their clinicians were interviewed poststudy to determine their perceptions and experiences of using the TM system. RESULTS Only one community cardiologist was recruited who was willing to refer patients to this study, even after multiple attempts were made to recruit further physicians, including family physicians. The cardiologist referred only 6 patients over a 6-month period, and half of the patients dropped out of the study. The identified barriers to implementing the TM system in home care nursing were numerous and led to the small recruitment in patients and clinicians and large dropout rate. These barriers included challenges in nurses contacting patients and physicians, issues related to retention, and challenges related to integrating the TM system into a complex home care nursing workflow. However, some potential benefits of TM through a home care nursing agency were indicated, including improved patient education, providing nurses with a better understanding of the patient's health status, and reductions in home visits. CONCLUSIONS Lessons learned included the need to incentivize physicians, to ensure streamlined processes for recruitment and communication, to target appropriate patient populations, and to create a core clinical group. Barriers encountered in this feasibility trial should be considered to determine their applicability when deploying innovations into different service delivery models.
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Affiliation(s)
- Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
- Techna Institute, University Health Network, Toronto, ON, Canada
| | - Plinio Pelegrini Morita
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jonathan Tomkun
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Theresa M Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiology Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl Reid-Haughian
- Professional Practice, Knowledge and Innovation, ParaMed Home Health Care, Toronto, ON, Canada
| | - Andrew Kaboff
- CellTrak Technologies, Inc, Schaumburg, IL, United States
| | - Deb Mulholland
- CellTrak Technologies, Inc, Schaumburg, IL, United States
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
- Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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218
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Motivation, Challenges and Self-Regulation in Heart Failure Self-Care: a Theory-Driven Qualitative Study. Int J Behav Med 2019; 26:474-485. [DOI: 10.1007/s12529-019-09798-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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219
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Carlson B, Austel Nadeau C, Glaser D, Fields W. Evaluation of the effectiveness of the healthy heart tracker on heart failure self-care. PATIENT EDUCATION AND COUNSELING 2019; 102:1324-1330. [PMID: 30777614 DOI: 10.1016/j.pec.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/17/2019] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts. METHODS We conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA. RESULTS Eighty-four 84 patients completed the study. The sample was 72.6 (+ 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks. CONCLUSIONS A focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group. PRACTICE IMPLICATIONS More work is needed to determine optimal written resources for patients with HF.
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Affiliation(s)
- Beverly Carlson
- San Diego State University, School of Nursing, 5500 Campanile Dr., San Diego, CA, 92182, United States.
| | - Colleen Austel Nadeau
- Sharp Grossmont Hospital, 5555 Grossmont Center Drive, La Mesa, CA, 91942, United States.
| | - Dale Glaser
- Glaser Consulting, 3115 4th Avenue San Diego, CA, 92103, United States.
| | - Willa Fields
- San Diego State University, Sharp Grossmont Hospital, 5500 Campanile Dr., San Diego, CA, 92182, United States.
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220
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Knafl GJ, Moser DK, Wu JR, Riegel B. Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers and the impact on heart failure hospitalization rates. Eur J Cardiovasc Nurs 2019; 18:667-678. [PMID: 31244325 DOI: 10.1177/1474515119860321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adherence to evidence-based therapy is essential for optimal management of heart failure. Yet, medication adherence is poor in heart failure patients. The Ascertaining Barriers to Compliance Project decomposed the medication adherence process into initiation, implementation, and discontinuation stages, but electronic monitoring-based adherence analyses usually do not consider this process. AIMS The aim of this study was to describe individual-patient patterns of medication adherence from electronic monitoring data among adults with chronic heart failure, adherence types, and risk factors for increased all-cause hospitalization including measures of poor adherence such as discontinuation. METHODS Data from two prospective studies of adherence measured with electronic monitoring for heart failure patients were combined and restricted to monitoring of angiotensin-converting enzyme inhibitors and beta-blockers over an initial three-month period. Hospitalizations were recorded for this period as well as for a three-month follow-up period. Analyses were conducted using adaptive modeling methods to identify individual-patient adherence patterns, adherence types, and risk factors for an increased hospitalization rate. RESULTS Using electronic monitoring data for 254 heart failure patients, four adherence types were identified: highly consistent, consistent but variable, moderately consistent, and poorly consistent. Sixteen individually significant risk factors for increased hospitalization rates were identified and used to generate a multiple risk factors model. Medication discontinuation was the most important individual risk factor and most important in the multiple risk factors model. CONCLUSION Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers increases hospitalization rates for heart failure patients. Interventions that effectively address this problem are urgently needed.
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Affiliation(s)
- George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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221
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Dinh HTT, Bonner A, Ramsbotham J, Clark R. Cluster randomized controlled trial testing the effectiveness of a self-management intervention using the teach-back method for people with heart failure. Nurs Health Sci 2019; 21:436-444. [PMID: 31190459 DOI: 10.1111/nhs.12616] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/28/2022]
Abstract
In this study, we examined the effectiveness of a self-management intervention delivered to people with heart failure in Vietnam. It used teach-back, a cyclical method of teaching content, checking comprehension, and re-teaching to improve understanding. A single-site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach-back heart failure self-management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self-care, with understanding reinforced using teach-back, a heart failure booklet, weighing scales, diary, and a follow-up phone call 2 weeks post-discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self-care (maintenance, management and confidence), and all-cause hospitalizations assessed at 1 and 3 months (end-point). Upon completion of the study, the intervention group had significantly greater knowledge and self-care maintenance than the control group. Other outcomes did not differ between the two groups. The teach-back self-management intervention demonstrated promising benefits in promoting self-care for heart failure patients.
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Affiliation(s)
- Ha T T Dinh
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne Ramsbotham
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robyn Clark
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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222
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Toledo C, Andrade DC, Díaz HS, Inestrosa NC, Del Rio R. Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment. Mol Neurobiol 2019; 56:8035-8051. [PMID: 31165973 DOI: 10.1007/s12035-019-01655-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.
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Affiliation(s)
- C Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de investigación en fisiología del ejercicio, Universidad Mayor, Santiago, Chile
| | - H S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - N C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - R Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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223
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Reid KRY, Reid K, Esquivel JH, Thomas SC, Rovnyak V, Hinton I, Campbell C. Using video education to improve outcomes in heart failure. Heart Lung 2019; 48:386-394. [PMID: 31174893 DOI: 10.1016/j.hrtlng.2019.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/27/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Heart Failure (HF) guidelines recommend HF self-care education. An optimal method of educating HF patients does not currently exist. OBJECTIVES To evaluate the effectiveness of supplementing usual HF education with video education and evaluate patients' satisfaction with video education. METHODS A mixed methods design was used. A convenience sample of 70 patients was recruited from an academic medical center. Participants completed the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index before and after receiving video education, to measure HF knowledge, self-efficacy, and self-care respectively. Video usage and satisfaction with video education data were collected. All-cause 30-day readmissions data were compared to a historical group. RESULTS HF knowledge and self-care maintenance scores increased significantly. Self-efficacy, self-care management and all-cause 30-day readmissions did not significantly improve. Most HF patients were highly satisfied. CONCLUSION Supplementing usual HF education with VE was associated with improved HF knowledge and self-care maintenance.
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Affiliation(s)
- Kimone R Y Reid
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA 22908-0782, United States.
| | - Kathryn Reid
- University of Virginia School of Nursing, P.O. Box 800826, Charlottesville, VA 22908-0826, United States.
| | - Jill Howie Esquivel
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA 22908-0782, United States.
| | - S Craig Thomas
- University of Virginia Health System, Advanced Heart Failure Center, 500 Ray C Hunt Dr., PO Box 800852, Charlottesville, VA, United States.
| | - Virginia Rovnyak
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA 22908-0782, United States.
| | - Ivora Hinton
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA 22908-0782, United States.
| | - Cathy Campbell
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA 22908-0782, United States.
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225
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Lay S, Moody N, Johnsen S, Petersen D, Radovich P. Home Care Program Increases the Engagement in Patients With Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822318815439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heart failure patients seen in the outpatient home care setting and in cardiology clinics have repeated emergency department visits, hospital admissions, and readmissions despite receiving education about their medications diet and self-care interventions such as daily weights. The objective of this evidence-based practice change was to determine, in home care patients, whether the use of standardized teach-back methodology educational materials would improve their knowledge and confidence in the self-care of their chronic disease. Of the 22 patients enrolled, 15 were not readmitted to the hospital within 9 months of home care admission. The Self-Care of Heart Failure Index revealed an improvement in patient and caregiver contributions to heart failure self-care maintenance (daily adherence and symptom monitoring). The findings suggest that engaging patients by increasing their knowledge of their disease and their self-confidence can reduce hospitalizations and subsequent readmissions.
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Affiliation(s)
| | | | | | | | - Patricia Radovich
- Loma Linda University Health, CA, USA
- Loma Linda University, CA, USA
- Azusa Pacific University, CA, USA
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226
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Psychometric testing of the Multidimensional Scale of Perceived Social Support in patients with comorbid COPD and heart failure. Heart Lung 2019; 48:193-197. [DOI: 10.1016/j.hrtlng.2018.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
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227
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228
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Factors Affecting Self-care Maintenance and Management in Patients With Heart Failure: Testing a Path Model. J Cardiovasc Nurs 2019; 34:297-305. [PMID: 31033857 DOI: 10.1097/jcn.0000000000000575] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Self-care is indispensable for health maintenance and well-being. This naturalistic decision-making process involves behavioral choices to maintain physiological stability (self-care maintenance) and response to occurring symptoms (self-care management). However, several factors affect self-care, but some have contradictory results. OBJECTIVE We aimed to examine how depressive symptoms, social support, eHealth literacy, and heart failure (HF) knowledge directly and indirectly affect self-care maintenance and management and to identify the mediating role of self-care confidence in self-care maintenance and management. METHODS The study included a total of 141 patients with HF (average age, 65.2 years; male, 55.3%). We analyzed their data, including demographic and clinical characteristics, obtained from the Patient Health Questionnaire-9, Multidimensional Scale of Perceived Social Support, eHealth Literacy Scale, Dutch Heart Failure Knowledge Scale, and Self-Care of Heart Failure Index. Furthermore, path analysis was conducted to examine the effects of the study variables on self-care maintenance and management. RESULTS Self-care confidence significantly and directly affected self-care maintenance and management and mediated the relationships between factor variables (depressive symptoms, social support, and HF knowledge) and outcome variables (self-care maintenance and management). Specifically, depressive symptoms had a negative and direct effect on self-care maintenance, whereas eHealth literacy had significant and direct effects on self-care management and HF knowledge. CONCLUSION Self-care confidence decreases the negative effects of depressive symptoms on self-care. This study underscores the need for interventions targeting patients' self-care confidence to maximize self-care among patients with HF.
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229
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Kim J, Hwang SY, Heo S, Shin MS, Kim SH. Predicted relationships between cognitive function, depressive symptoms, self-care adequacy, and health-related quality of life and major events among patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:418-426. [PMID: 30919663 DOI: 10.1177/1474515119840877] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive decline, which often occurs in heart failure, is likely to decrease health-related quality of life and increase morbidity and mortality (major events), but it has been scantly addressed. AIMS To examine whether baseline cognitive domains of global cognition, memory and executive function predict baseline health-related quality of life and 15-month major events among patients with heart failure. METHODS This prospective study included 117 patients (mean age 65.5 ± 9.42 years; men 58.1%; New York Heart Association class III/IV 25.6%), who completed questionnaires, including neuropsychological testing for cognitive evaluation, depressive symptoms, self-care and health-related quality of life measures. Their 15-month major events were extracted from medical record reviews. RESULTS Approximately one-third of the sample had cognitive impairment. Forty-one patients (35.0%) experienced major events. Patients with major events had significantly worse memory (immediate recall memory 13.9 vs. 11.5, P=0.030; delayed recall memory 4.3 vs. 3.1, P=0.014) and reduced executive function (trail-making test A 28.1 vs. 38.0 seconds, P=0.031). After controlling for age, sex, heart failure severity and comorbidity, memory loss with depressive symptoms was associated with worse health-related quality of life, and odds ratios of experiencing major events increased only with reduced cognitive function in global cognition and executive function. CONCLUSION Cognitive function is an important factor for health-related quality of life and major events, and memory loss - worsened health-related quality of life and poor executive function was more likely to increase the risk of major events. Future studies should consider both cognitive function and depressive symptoms when designing heart failure interventions to improve patient outcomes.
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Affiliation(s)
- JinShil Kim
- 1 College of Nursing, Gachon University, South Korea
| | | | - Seongkum Heo
- 3 College of Nursing, University of Arkansas for Medical Sciences, USA
| | - Mi-Seung Shin
- 4 Department of Internal Medicine, Gachon University Gil Medical Center, South Korea
| | - Sun Hwa Kim
- 5 Stroke Unit, Hanyang University Medical Center, South Korea
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230
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Juárez-Vela R, Sarabia-Cobo CM, Antón-Solanas I, Vellone E, Durante A, Gea-Caballero V, Pérez-Calvo JI. Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. Rev Clin Esp 2019; 219:351-359. [PMID: 30850119 DOI: 10.1016/j.rce.2018.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. PATIENTS AND METHODS Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83±8 were recruited to participate in this study. RESULTS The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1±1; b) "forget to take one of your medicines", 2±2; c) "ask for low-salt items when eating out or visiting others", 2±1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2±1; b) reduce fluid intake, 1±1; c) take an extra diuretic, 1±1. Over 50% of our sample felt confident or very confident at following professional advice (3±1), keeping themselves free of symptoms (3±1), recognizing changes in their condition (3±1) and evaluating the significance of such changes (3±1). CONCLUSIONS HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.
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Affiliation(s)
- R Juárez-Vela
- Grupo de Investigación en Insuficiencia Cardiaca e Insuficiencia Fisiopatológica de la Interacción Cardiorrenal (IFICaR), Escuela de Enfermería, Instituto de Investigación Sanitaria de Aragón-ISS, Universidad de La Rioja, Logroño, La Rioja, España
| | - C M Sarabia-Cobo
- Facultad de Enfermería, Universidad de Cantabria, Santander, España
| | - I Antón-Solanas
- Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, España
| | - E Vellone
- Departamento de Biomedicina y Prevención, Universidad de Roma Tor Vergata, Roma, Italia
| | - A Durante
- Departamento de Biomedicina y Prevención, Universidad de Roma Tor Vergata, Roma, Italia
| | - V Gea-Caballero
- Grupo de Investigación Emergente Acreditado en Arte y Ciencia del Cuidado GREIACC, Escuela de Enfermería La Fe (Valencia), IIS La Fe, Valencia, España.
| | - J I Pérez-Calvo
- Grupo de Investigación en Insuficiencia Cardiaca e Insuficiencia Fisiopatológica de la Interacción Cardiorrenal (IFICaR), Servicio de Medicina Interna, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón-ISS, Zaragoza, España
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231
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Ruppar TM, Cooper PS, Johnson ED, Riegel B. Self-care interventions for adults with heart failure: A systematic review and meta-analysis protocol. J Adv Nurs 2019; 75:676-682. [PMID: 30397943 PMCID: PMC6392180 DOI: 10.1111/jan.13903] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022]
Abstract
AIM To synthesize and compare outcomes from controlled trials of interventions to improve heart failure self-care among adults. BACKGROUND Heart failure self-care interventions are recommended for preventing and detecting exacerbations, improving symptom management and preventing hospitalizations. Little is known about the overall effectiveness of heart failure self-care programmes and which types of interventions show the greatest improvement in outcomes. DESIGN Systematic review and meta-analysis, including moderator analyses. METHODS Multiple databases (including MEDLINE/PubMed, CINAHL, PsycINFO, Scopus and Cochrane Central Register of Controlled Trials) will be searched from inception through 2018 along with grey literature searches to identify trials testing interventions to improve self-care outcomes of adults with heart failure. Data will be extracted from eligible studies on sample, methodological and intervention characteristics and data to calculate effect sizes. Data will be analysed using random-effects models. Moderator variables will be analysed with meta-regression and sub-group analyses. Risk for bias will be assessed using the Cochrane Risk for Bias tool and by examining potential sources of bias as moderator variables. Funding for this project began in July 2017. DISCUSSION We will analyse self-care behaviour outcomes and clinical outcomes including hospitalizations, mortality, disease severity and quality of life. This will be the most extensive meta-analysis of heart failure self-care interventions to date. IMPACT Comparative effectiveness of existing self-care interventions is not yet known. This research will identify the most promising self-care intervention components for designing better interventions and guide targeting of interventions to specific sub-populations. PROSPERO Registration Number: CRD42017075831.
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Affiliation(s)
| | | | - E. Diane Johnson
- J. Otto Lottes Health Sciences LibraryUniversity of MissouriColumbiaMissouri
| | - Barbara Riegel
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvania
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232
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Pancani L, Ausili D, Greco A, Vellone E, Riegel B. Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis. Int J Behav Med 2019; 25:399-409. [PMID: 29856009 DOI: 10.1007/s12529-018-9731-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients' characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories. METHOD We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association. RESULTS Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated. CONCLUSION Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.
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Affiliation(s)
- Luca Pancani
- Department of Psychology, Università degli Studi di Milano - Bicocca, Milan, Italy.
| | - Davide Ausili
- Department of Medicine and Surgery, Università degli Studi di Milano - Bicocca, Monza, Italy
| | - Andrea Greco
- Department of Psychology, Università degli Studi di Milano - Bicocca, Milan, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, Università di Roma "Tor Vergata", Rome, Italy
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Lovén Wickman U, Yngman-Uhlin P, Hjortswang H, Wenemark M, Stjernman H, Riegel B, Hollman Frisman G. Development of a self-care questionnaire for clinical assessment of self-care in patients with inflammatory bowel disease: A psychometric evaluation. Int J Nurs Stud 2019; 89:1-7. [DOI: 10.1016/j.ijnurstu.2018.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 01/03/2023]
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234
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Lyons KS, Gelow JM, Hiatt SO, Mudd JO, Auld J, Chien CV, Lee CS. The Role of Dyadic Confidence on Engagement in Heart Failure Care Behaviors. THE GERONTOLOGIST 2018; 58:635-643. [PMID: 28449107 DOI: 10.1093/geront/gnx030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Increasingly, older adults and their families are expected to manage complex conditions with little support. In the case of heart failure (HF), symptom monitoring and management are critical in preventing acute exacerbations and poor clinical outcomes. The current study examined the role of dyadic confidence on engagement in HF care behaviors by patients and their spouses. Research Design and Methods A cross-sectional design was used to examine 60 couples living with HF. Three dyadic confidence variables were created to represent average level of confidence, gap in confidence, and direction of gap within each couple. A series of multilevel models were used to examine dyadic engagement in HF maintenance, management, and consulting behaviors and the role of dyadic confidence. Results Patients were significantly more engaged in HF maintenance behaviors than spouses; couples were more collaborative in their engagement in HF management and consulting behaviors. Average level of confidence in the dyad was significantly associated with patient engagement in all three HF behaviors. Spouse engagement was associated with more congruence in confidence and having higher levels of confidence than their partners with HF. Women were significantly more engaged in HF behaviors than men, regardless of role. Discussion and Implications The study employed a dyadic approach to HF care and a novel approach to confidence. Findings confirm the social nature of confidence and its important role in HF. Clinicians have opportunities to optimize patient outcomes by fostering greater collaboration within couples.
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Affiliation(s)
- Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland
| | - Jill M Gelow
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Shirin O Hiatt
- School of Nursing, Oregon Health and Science University, Portland
| | - James O Mudd
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Jonathan Auld
- School of Nursing, Oregon Health and Science University, Portland
| | | | - Christopher S Lee
- School of Nursing, Oregon Health and Science University, Portland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland
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235
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Lyons KS, Hiatt SO, Gelow JM, Auld J, Mudd JO, Chien CV, Lee CS. Depressive symptoms in couples living with heart failure: the role of congruent engagement in heart failure management. Aging Ment Health 2018; 22:1585-1591. [PMID: 28959891 DOI: 10.1080/13607863.2017.1381945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF. METHOD A cross-sectional design was used to examine 60 couples living with HF. Multilevel modeling was used to examine partner and within-dyad effects of engagement in HF behaviors on depressive symptoms. RESULTS Just over one quarter (27%) of couples had both members experiencing at least mild depressive symptoms. Controlling for stage of HF and one's own level of engagement, one's partner's level of engagement was significantly associated with one's level of depressive symptoms; higher levels of engagement by one's partner were associated with lower levels of depressive symptoms. Additionally, spouses had lower levels of depressive symptoms when they had similar levels of engagement to their partner with HF; spouses had higher levels of depressive symptoms when they had higher levels of engagement than their partner with HF. CONCLUSION Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple.
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Affiliation(s)
- Karen S Lyons
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Shirin O Hiatt
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Jill M Gelow
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Jonathan Auld
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - James O Mudd
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher V Chien
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher S Lee
- c School of Nursing/Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
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236
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Gender differences in self-care maintenance and its associations among patients with chronic heart failure. Int J Nurs Sci 2018; 6:58-64. [PMID: 31406870 PMCID: PMC6608650 DOI: 10.1016/j.ijnss.2018.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/28/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
Objectives To identify the gender differences in self-care maintenance and its associations among chronic heart failure patients using the Information-Motivation-Behavioral Skills model. Methods Two hundred and ten patients (54.0% female) with chronic heart failure participated in this cross-sectional study. Self-care, knowledge of heart failure, social support and illness perception were measured using the Self-Care of Heart Failure Index, the questionnaire of heart failure knowledge, the Perceived Social Support Scale, and the Revised Illness Perception Questionnaire, respectively. Results Mean scores for self-care maintenance were 51.4 ± 14.8 in men and 55.6 ± 14.1 in women (t = -2.066, P < 0.05). Associated factors of self-care maintenance were social support and self-care confidence in men and the knowledge of heart failure, self-care management and self-care confidence in women. The relationship between social support and self-care maintenance was meditated by self-care confidence in men, whereas the relationship between knowledge of heart failure and self-care maintenance was meditated by self-care management and self-care confidence in women. Conclusions Self-care maintenance were inadequate in both genders with chronic heart failure. Interventions for enhancing social support and self-care confidence in men patients, and strengthening knowledge of heart failure, self-care management and self-care confidence in women patients, may facilitate self-care maintenance.
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237
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A Mobile Application for Patients With Heart Failure: Theory- and Evidence-Based Design and Testing. Comput Inform Nurs 2018; 36:540-549. [PMID: 30045131 DOI: 10.1097/cin.0000000000000465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-care is vital for the successful management of heart failure. Mobile health can enable patients with heart failure to perform effective self-care. This article describes the theory-guided development and beta testing of a mobile application intervention to support self-care and increase symptom awareness in community-dwelling patients with heart failure. Ten participants entered physiologic data, answered qualitative questions about symptoms, and reviewed heart failure education within the HF App daily. Two validated instruments, the Self-care of Heart Failure Index and Heart Failure Somatic Awareness Scale, were administered both before and after the intervention, and results were compared using t tests. Results indicated that there were clinically significant changes from preintervention to postintervention in self-care scores in each subscale, with a statistically significant difference in the confidence subscale scores (P = .037). However, there were no statistically significant differences between preintervention and postintervention symptom awareness scores. These results indicate that incorporating mobile applications that comprise symptom monitoring, reminders, education, and the ability to track trends in physiologic data is most useful to assist individuals with heart failure to perform effective self-care.
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238
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Nomali M, Mohammadrezaei R, Keshtkar AA, Roshandel G, Ghiyasvandian S, Alipasandi K, Zakerimoghadam M. Self-Monitoring by Traffic Light Color Coding Versus Usual Care on Outcomes of Patients With Heart Failure Reduced Ejection Fraction: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e184. [PMID: 30429118 PMCID: PMC6262204 DOI: 10.2196/resprot.9209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022] Open
Abstract
Background Patients with heart failure (HF) reduced ejection fraction (HFrEF) have symptoms that are more severe and experience a higher rate of hospitalization compared with HF preserved ejection fraction (HFpEF) patients. However, symptom recognition cannot be made by patients based on current approaches. This problem is a barrier to effective self-care that needs to be improved by new self-monitoring instruments and strategies. Objective This study describes a protocol for the self-monitoring daily diaries of weight and shortness of breath (SOB) based on the traffic light system (TLS). The primary objective is to compare the self-care between the intervention and control group. Comparison of HF knowledge, HF quality of life (HFQOL), and all-cause hospitalization between the 2 groups are the secondary objectives. Methods A single-blind randomized controlled trial is being conducted at the HF clinic at Tehran Heart Center (Tehran, Iran). Sixty-eight adult patients of both genders will be enrolled during admission to HF clinic. Eligible subjects will be assigned to either the intervention or control group by a block balanced randomization method. Baseline surveys will be conducted before random allocation. Participants in the intervention group will receive an integrated package consisting of (1) HF self-care education by an Australian Heart Foundation booklet on HF, (2) regular home self-monitoring of weight and SOB, and (3) scheduled call follow-ups for 3 months. Patients in the control group will receive no intervention and they only complete monthly surveys. Results This study is ongoing and is expected to be completed by the end of 2018. Conclusions This is the first trial with new self-monitoring instruments in Iran as a low and middle-income country. If the findings show a positive effect, the package will be applied in different regions with the same health care status. Trial Registration Iranian Registry of Clinical Trials IRCT2017021032476N1; https://en.irct.ir/trial/25296?revision=25296 (Archived by WebCite at http://www.webcitation.org/73DLICQL8) International Registered Report Identifier (IRRID) PRR1-10.2196/9209
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Affiliation(s)
- Mahin Nomali
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Ramin Mohammadrezaei
- Heart Failure Clinic, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Abbas Ali Keshtkar
- Department of Health Science Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Islamic Republic Of Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Kian Alipasandi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Masoumeh Zakerimoghadam
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
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Chew HSJ, Cheng HY, Chair SY. The suitability of motivational interviewing versus cognitive behavioural interventions on improving self-care in patients with heart failure: A literature review and discussion paper. Appl Nurs Res 2018; 45:17-22. [PMID: 30683246 DOI: 10.1016/j.apnr.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Chronic heart failure remains a major public health concern due to its high prevalence and disease burden. Although self-care has been advocated as the sustainable solution, it remains inadequate. Recent studies have shown the potential of integrating structured counselling elements into traditional educational programs to enhance self-care but the optimal counselling method remains unclear. AIM To compare the applicability of cognitive behavioural interventions and motivational interviewing on improving self-care behaviours in patients with chronic heart failure. METHOD A systematic three-step search strategy was used to identify studies that incorporated cognitive behavioural interventions and/or motivational interviewing to improve heart failure self-care. Quantitative and qualitative trial studies that met the inclusion criteria were appraised using the Joanna Brigg's Institute criteria. RESULTS Motivational interviewing showed higher potential in improving HF self-care behaviours, but sustainability remains unclear. Cognitive behavioural interventions only showed effectiveness when applied to patients with comorbid depressive symptoms. Statistically significant results were only elucidated upon statistical adjustments and examination of behaviours individually. Potential effective components of CBI include setting up environmental reminders, addressing misconceptions and skills-training while that of MI was the communication style. CONCLUSION MI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours. MI could be used to enhance the intention to change by evoking ambivalence and change talk. CBI could be used to enhance problem-solving skills and set environmental reminders to strengthen the translation of intention to behaviour.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Ho Yu Cheng
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sek Ying Chair
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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240
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Dellafiore F, Buck HG, Pucciarelli G, Barbaranelli C, Paturzo M, Alvaro R, Vellone E. Psychometric characteristics of the mutuality scale in heart failure patients and caregivers. Heart Lung 2018; 47:553-561. [DOI: 10.1016/j.hrtlng.2018.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/23/2018] [Indexed: 12/28/2022]
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241
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Dalal HM, Taylor RS, Jolly K, Davis RC, Doherty P, Miles J, van Lingen R, Warren FC, Green C, Wingham J, Greaves C, Sadler S, Hillsdon M, Abraham C, Britten N, Frost J, Singh S, Hayward C, Eyre V, Paul K, Lang CC, Smith K. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. Eur J Prev Cardiol 2018; 26:262-272. [PMID: 30304644 PMCID: PMC6376602 DOI: 10.1177/2047487318806358] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low. Design and methods The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone. Results The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of –5.7 points (95% confidence interval –10.6 to –0.7) in favour of the REACH-HF intervention group (p = 0.025). With the exception of patient self-care (p < 0.001) there was no significant difference in other secondary outcomes, including clinical events (p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant. Conclusions The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.
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Affiliation(s)
- Hasnain M Dalal
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK.,2 Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Rod S Taylor
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Kate Jolly
- 3 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Russell C Davis
- 4 Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Patrick Doherty
- 5 Department of Health Sciences, University of York, York, UK
| | - Jackie Miles
- 6 Research and Development, Aneurin Bevan University Health Board, St Woolos Hospital, Newport, UK
| | | | - Fiona C Warren
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Colin Green
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jennifer Wingham
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Colin Greaves
- 8 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Susannah Sadler
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Melvyn Hillsdon
- 9 Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Charles Abraham
- 10 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Julia Frost
- 1 Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Sally Singh
- 11 Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | | | | | - Kevin Paul
- 14 REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Chim C Lang
- 15 School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Karen Smith
- 16 School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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242
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Yang IS, Kang Y. Self-care model based on the theory of unpleasant symptoms in patients with heart failure. Appl Nurs Res 2018; 43:10-17. [DOI: 10.1016/j.apnr.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
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Dellafiore F, Arrigoni C, Pittella F, Conte G, Magon A, Caruso R. Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study. BMJ Open 2018; 8:e021966. [PMID: 30269065 PMCID: PMC6169756 DOI: 10.1136/bmjopen-2018-021966] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF). METHODS AND RESULTS A monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort's demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients' discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient-caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%-18.0%. CONCLUSION This study sets the stage for future research where elements of the patient-caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients' self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.
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Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Pavia, Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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244
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Dinh H, Bonner A, Ramsbotham J, Clark R. Self-management intervention using teach-back for people with heart failure in Vietnam: A cluster randomized controlled trial protocol. Nurs Health Sci 2018; 20:458-463. [PMID: 30238650 DOI: 10.1111/nhs.12534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 12/29/2022]
Abstract
Globally, the increasing prevalence of heart failure is a burden on health-care systems, especially in under-resourced countries, such as Vietnam. We describe a prospective single-site, cluster randomized controlled trial of an intervention designed to teach adult patients about heart failure and how to undertake self-care activities. The intervention, delivered by a nurse, comprises of an individual teaching session using teach-back, a heart failure booklet, weighing scales, a diary to document daily weight, and a follow-up phone call 2 weeks after hospital discharge. Teach-back is a process of asking patients to repeat information and for the nurse to fill any gaps or misunderstanding until adequate understanding is demonstrated. The control group will receive usual education plus the heart failure (HF) booklet. A total of 140 participants will be allocated into two study groups. The level of randomization is at the ward level. The primary outcome (HF knowledge) and secondary outcomes (self-care behaviors and all-cause hospitalizations) will be measured at 1 and 3 months. This study will make an important contribution regarding a protocol of teach-back and chronic disease self-management.
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Affiliation(s)
- Ha Dinh
- Hanoi Medical University, Hanoi, Vietnam.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne Ramsbotham
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robyn Clark
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Flinders University, Adelaid, South Australia, Australia
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245
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Lee MJ, Jung D. Development and effects of a self-management efficacy promotion program for adult patients with congenital heart disease. Eur J Cardiovasc Nurs 2018; 18:140-148. [DOI: 10.1177/1474515118800099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mi-Ja Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Dukyoo Jung
- College of Nursing, Ewha Womans University, Seoul, Korea
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246
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Xu J, Arruda S, Gallo JJ, Wenzel J, Nolan MT, Flowers D, Szanton SL, Dennison Himmelfarb C, Han HR. Using vignettes to understand heart failure self-care. J Clin Nurs 2018; 27:3554-3560. [PMID: 29943481 DOI: 10.1111/jocn.14581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore hospitalised heart failure (HF) patients' self-care decisions. BACKGROUND Heart failure self-care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self-care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self-care decision-making. DESIGN This qualitative descriptive analysis was conducted as part of a mixed methods study. METHODS We conducted semi-structured interviews (N = 20) to elicit patient decisions about self-care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses. RESULTS Participants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling. CONCLUSIONS Symptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult. RELEVANCE TO CLINICAL PRACTICE Vignettes may be a helpful tool to prompt patient-healthcare provider communication about self-care management and prompt discussions about appropriate self-care decisions in response to varying levels of symptom severity.
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Affiliation(s)
- Jiayun Xu
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Joseph J Gallo
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland
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Auld JP, Mudd JO, Gelow JM, Lyons KS, Hiatt SO, Lee CS. Patterns of heart failure symptoms are associated with self-care behaviors over 6 months. Eur J Cardiovasc Nurs 2018; 17:543-551. [PMID: 29442523 PMCID: PMC6067986 DOI: 10.1177/1474515118759074] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time. AIMS To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time. METHOD Latent mixture analysis was used to identify subgroups based on physical symptoms of dyspnea, sleepiness and edema (using the heart failure somatic perception and Epworth sleepiness scales). Growth modeling was used to determine if symptom subgroups were associated with self-care behaviors (using the self-care in heart failure index) over 6 months. Sociodemographic and clinical variables predicting the likelihood of subgroup membership were identified using logistic regression. RESULTS The sample ( n=146) was on average 57 years old, 70% were men and 59% had class III/IV heart failure. Two symptom subgroups were identified (entropy 0.91): a high symptom group ( n=24; 16%) with no significant change in symptoms over time (high sustained), and a low symptom group ( n=122; 84%) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (odds ratio (OR) 3.67, P=0.023) and patients with more depressive symptoms (OR 1.16, P=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin-angiotensin-aldosterone system agent were less likely to be in the high symptom group (OR 0.17, P=0.015). CONCLUSION Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. The results of this study support symptoms as an important driver of self-care behaviors.
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Affiliation(s)
- Jonathan P. Auld
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - James O. Mudd
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Jill M. Gelow
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Karen S. Lyons
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Shirin O. Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Christopher S. Lee
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
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248
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Wu WC, Parent M, Dev S, Hearns R, Taveira TH, Cohen L, Shell-Boyd J, Jewett-Tennant J, Marshall V, Gee J, Schaub K, LaForest S, Ball S. Group medical visits after heart failure hospitalization: Study protocol for a randomized-controlled trial. Contemp Clin Trials 2018; 71:140-145. [PMID: 29940335 DOI: 10.1016/j.cct.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
A primary goal of this research project is to better understand how shared medical appointments (SMAs) can improve the health status and decrease hospitalization and death for patients recently discharged with heart failure (HF) by providing education, disease state monitoring, medication titration, and social support to patients and their caregivers. We propose a 3-site randomized-controlled efficacy trial with mixed methods to test a SMA intervention, versus usual care. Patients within 12 weeks of a HF hospitalization will be randomized to receive either HF-SMA (intervention arm) with optional co-participation with their caregivers, versus usual care (control arm). The HF-SMA will be provided by a non-physician team composed of a nurse, a nutritionist, a health psychologist, a nurse practitioner and/or a clinical pharmacist and will consist of four sessions of 2-h duration that occur every other week for 8 weeks. Each session will start with an assessment of patient needs followed by theme-based disease self-management education, followed by patient-initiated disease management discussion, and conclude with break-out sessions of individualized disease monitoring and medication case management. The study duration will be 180 days for all patients from the day of randomization. The primary study hypothesis is that, compared with usual care, patients randomized to HF-SMA will experience better cardiac health status at 90 and 180 days follow-up. The secondary hypotheses are that, compared to usual care, patients randomized to HF-SMA will experience better overall health status, a combined endpoint of hospitalization and death, better HF self-care behavior, and lower B-type natriuretic peptide levels.
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Affiliation(s)
- Wen-Chih Wu
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA.
| | - Melanie Parent
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA
| | - Sandesh Dev
- Carl T. Hayden Medical Research Foundation, 650 E. Indian School Road 151A, Phoenix, AZ 85012-1892, USA
| | - Rene Hearns
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Tracey H Taveira
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA
| | - Lisa Cohen
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA
| | - Jeneen Shell-Boyd
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Jeri Jewett-Tennant
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Vanessa Marshall
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Julie Gee
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Kimberley Schaub
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sharon LaForest
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sherry Ball
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
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249
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Wonggom P, Du H, Clark RA. Evaluation of the effectiveness of an interactive avatar-based education application for improving heart failure patients' knowledge and self-care behaviours: A pragmatic randomized controlled trial protocol. J Adv Nurs 2018; 74:2667-2676. [PMID: 29920745 DOI: 10.1111/jan.13768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness of an avatar-based education application for improving knowledge and self-care behaviour in patients with heart failure (HF). BACKGROUND Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technologies for patient education has shown benefits in improving knowledge, self-care behaviours and quality of life in chronic diseases such as cancer, diabetes and depression. Research has demonstrated positive outcomes in clinical practice. However, the effectiveness of this technology has not been evaluated among patients with HF. DESIGN A multi-centred, non-blinded randomized, two-armed parallel pragmatic, controlled trial. METHOD Eighty-eight participants will be recruited from the HF clinics at three public hospitals and randomized into either control or intervention groups. The intervention group will receive the avatar-based education plus usual care. The control group will receive usual care. The primary outcome is HF knowledge, secondary outcomes include; improved self-care behaviours, readmission and satisfaction. Data will be collected at the baseline and at 1- and 3-month follow-ups. DISCUSSION This study will measure the effectiveness of avatar-based education on patients' knowledge and self-care behaviours following HF. The evidence will be evaluated in terms of the reduction in patients' readmission.
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Affiliation(s)
- Parichat Wonggom
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Huiyun Du
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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250
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Riegel B, Barbaranelli C, Sethares KA, Daus M, Moser DK, Miller JL, Haedtke CA, Feinberg JL, Lee S, Stromberg A, Jaarsma T. Development and initial testing of the self‐care of chronic illness inventory. J Adv Nurs 2018; 74:2465-2476. [DOI: 10.1111/jan.13775] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/21/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Riegel
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | | | | | - Marguerite Daus
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | - Debra K. Moser
- College of Nursing University of Kentucky Lexington Kentucky
| | | | | | | | - Solim Lee
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | - Anna Stromberg
- Division of Nursing and Department of Cardiology Department of Medical and Health Sciences Linkoping University Linkoping Sweden
| | - Tiny Jaarsma
- Faculty of Medicine and Health Linkoping University Linkoping Sweden
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