Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period

Trajectories and Predictors of the Care Needs of Patients With Chronic Heart Failure: Growth Mixture Modeling

BACKGROUND

Research on the care needs of patients with heart failure (HF) has predominantly relied on cross-sectional studies. Consequently, there is limited understanding of how care needs evolve over time within this population.

OBJECTIVES

The aims of this study were to explore the trajectories of care needs in patients with HF 1 year after discharge and analyze the potential factors that can predict these trajectories.

METHODS

A total of 197 patients with HF were recruited and followed at 1, 3, 6, and 12 months postdischarge. Care needs were assessed using the care needs survey questionnaire, and potential factors were selected based on the Andersen Behavioral Model. A growth mixture model was used to identify the trajectories of care needs, whereas logistic regression analyses were used for statistical comparisons.

RESULTS

Three trajectories in the care needs of patients with HF were identified: (1) a mild increase trajectory, (2) a decline trajectory, and (3) a persistently high trajectory. Need factors were the most significant determinants of care needs trajectories, with higher New York Heart Association functional classification, left ventricular ejection fraction less than 40%, and lower self-reported health serving as key predictors of persistently high trajectory. In contrast, only lower self-efficacy and the absence of a spouse as predisposing factors were associated with an increased risk of maintaining persistently high levels of care needs.

CONCLUSION

Care needs after discharge in patients with HF can be characterized by 3 trajectories. Need factors will help clinicians with early identification of patients with persistently high level of care needs.

Self-care in patients with a Left Ventricular Assist Device (LVAD): A systematic review

BACKGROUND

Self-care is essential for patient with chronic conditions such as heart failure. Self-care facilitates adaptation in patients with a Left Ventricular Assist Device (LVAD), improving their outcomes and preventing complications. Currently, no studies provide an overview of self-care in people with LVADs.

OBJECTIVE

The present literature review aims to summarize the current scientific evidence relating to self-care behaviors in this population.

METHODS

A systematic review with narrative synthesis was conducted. The databases consulted were Medline, Scopus, and CHINAL, and free research was performed on Google Scholar. The review included all the articles whose titles, abstracts, and text were considered relevant to the research purpose. The PRISMA flowchart was used to choose all the appropriate studies, and the final sample was deemed pertinent to the SPIDER methodology. Finally, the studies were subjected to a critical assessment of the methodological quality.

RESULTS

Of the 487 studies initially identified, 15 met the inclusion criteria. This review provides a comprehensive overview of self-care behaviors in LVAD patients across all dimensions of self-care: self-care maintenance, self-care monitoring, self-care management, and self-care Confidence. Findings indicate that self-care positively influences LVAD patients by facilitating adaptation to the device and enhancing quality of life.

CONCLUSIONS

Self-care is crucial in LVAD patients, facilitating their adaptation and improving their outcomes. Health education focused on self-care appears particularly relevant in this population, but a more in-depth investigation is needed.

Usefulness of the LAVITA Telemonitoring System in Patients With Heart Failure - A Feasibility Study

Background

Heart failure (HF) hospitalization is increasing in Japan's aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices.

Methods and Results

This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO2), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9-12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3-97.8%); blood pressure 95.6% (IQR 84.8-98.5%); pulse rate 96.5% (IQR 86.5-98.8%); SpO2 93.1% (IQR 76.6-97.9%); AT 88.4% (IQR 31.3-98.5%); and ePRO 76.9% (IQR 26.4-95.9%). The subgroup analysis did not significantly differ.

Conclusions

The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.

Communication needs regarding heart failure trajectory and palliative care between patients and healthcare providers: A cross-sectional study

INTRODUCTION

Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF.

METHODS

A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman's rank correlation, Pearson's correlation, and multiple regression analyses.

RESULTS

Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011).

CONCLUSIONS

Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients' communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management.

Strategies for enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease: a qualitative study

BACKGROUND

Self-management is regarded as a crucial factor influencing the effectiveness of home-based cardiac rehabilitation for patients with coronary heart disease. In nursing practice, nurses employ a variety of strategies to enhance self-management of patients. However, there exists a disparity in nurses' perceptions and practical experiences with these strategies. This study aimed to explore the experiences and strategies of clinical nurses in enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease.

METHODS

A descriptive qualitative study was conducted across two large cardiac rehabilitation centers. Clinical nurses were selected using purposive sampling with maximum variation strategies. Semi-structured interviews were conducted to capture nurses' experiences and strategies for enhancing home-based cardiac rehabilitation self-management. Content analysis was utilized to analyze the textual data.

RESULTS

A total of 18 eligible clinical nurses participated in this study. The interviews resulted in the extraction of seven subthemes, which were consolidated into three main themes: (1) Personalized and Engaging Educational Approaches, including Precision Education-Tailored, Adaptive Approaches and Visual Aided Education-Beyond Simplification to Deep Engagement; (2) Contextual and Psychologically Grounded Nudging Strategies, comprising Information Framing-Psychological Leveraging for Informed Choices, Social Norms-Leveraging Peer Influence for Motivation, and Verbal Reminders-The Power of Consistency and Reinforcement; (3) Continuous and Personalized Support Systems, involving Regular Follow-Up-Dynamic Support for Ongoing Engagement and Collaborative Management-Building a Team for Long-Term Success. These robust strategies can effectively enhance self-management behaviors and quality of life in patients undergoing home-based cardiac rehabilitation.

CONCLUSIONS

From the perspective of clinical nurses, this study explored a variety of strategies for improving home-based cardiac rehabilitation self-management in patients with coronary heart disease. This provides theoretical support for optimizing intervention measures and promotes the effective delivery and application of self-management strategies in practice.

CLINICAL TRIAL NUMBER

Not applicable.

Facilitators and Barriers to Values Discussions Following LVAD Implantation: Perspectives from Diverse Patients and Family Caregivers

BACKGROUND

Delivering care that is responsive to who or what is most important to patients and family caregivers is a key aspect of quality care, yet it remains unclear how clinicians can best support individuals in expressing their personal values. We aimed to describe patient- and family caregiver-identified facilitators and barriers to engaging in values discussions with clinicians following implantation of a left ventricular assist device (LVAD).

METHODS AND RESULTS

Using a qualitative descriptive approach, patients with an LVAD and their caregivers participated in 1-on-1 semistructured interviews and self-reported sociodemographics (January 2023-July 2023). Qualitative data were analyzed using thematic analysis and descriptive statistics were computed for quantitative data.

RESULTS

Patients (n = 27; ages 30-76 years) were predominantly male (59%) and non-Hispanic Black (67%). Caregivers (n = 21; ages 27-76) were female (76%), non-Hispanic Black (67%), and a spouse/partner (62%). Facilitators (5 shared across patient/caregiver groups; 8 unique across patient/caregiver groups) included a perceived close relationship (patient/caregiver), values alignment (patient/caregiver), clinician discussion initiation (patient/caregiver), facing an impending decision (patient/caregiver), 1-on-1 dyadic interactions (patient/caregiver), being assertive (patient), positive dyadic communication (caregiver), and involvement of a third party (caregiver). Barriers (2 shared; 7 unique) included belief that their values are already known (patient/caregiver), sensitivity about values (patient/caregiver), uncertainty about timing (patient), poor clinical communication (patient), patient hopelessness (patient), perceived lack of clinician time (caregiver), and having a reserved personality (caregiver).

CONCLUSION

Findings offer insight into actionable facilitators and barriers to discussions promoting incorporation of patient and family values into LVAD maintenance and chronic disease management.

What do patients want from a digital device that supports heart failure self-management?

OBJECTIVE

To assess patients' needs and the factors determining their acceptance of an e-Health intervention.

METHODS

Purposive sample of patients with heart failure, attending an outpatient consultation were invited to complete a questionnaire designed to assess their needs and acceptance of an e-Health intervention. Data analysis was performed using Chi-square tests with post-hoc corrections.

RESULTS

Response rate was 61 % (n = 101), with most patients (>70 %) indicating they could see themselves using an e-Health intervention to manage their heart failure. Participants with a healthy lifestyle (i.e., non-smoker and consumed alcohol < once/week) were more likely to have a positive attitude towards technology (p adj.=0.013). Those willing to use an e-Health intervention were convinced of its advantages by other patients with heart failure (p adj.=0.013). Advanced age, education level, employment or marital status did not influence patient attitudes toward health technology.

CONCLUSIONS & PRACTICE IMPLICATIONS

Results indicate patients have a positive attitude towards the use of e-Health interventions to enable their self-management of heart failure. These findings will inform further development and delivery strategies of e-Health interventions.

A WeChat platform program (WCPP) for full-process management of patients with cardiac valve interventional surgery based on psycho-cardiology: protocol of a mixed-method study

BACKGROUND

Valvular heart disease is the third most common cardiovascular disease; it significantly diminishes patients' quality of life and imposes burdens on individuals, families, and healthcare systems. In recent years, psycho-cardiology has emerged as a prominent field in which to explore the link between mental illness and heart disease. This mixed-method study aims to assess the effectiveness of the WCPP, which includes hospital-to-home transitional care, remote intelligent monitoring, and decision aids, in improving the physical and mental health of patients.

METHODS

A mixed-method study was conducted at a cardiac valve interventional surgery (CVIS) center in Southwest China. A total of 154 CVIS patients participated, with the intervention group receiving the WCPP and the control group following the traditional CVIS management program. Both groups were followed up at 1, 3, 6, and 12 months. The primary outcome is measured via the Chinese version of the 36-item Short Form Health Survey (SF-36). The Secondary outcomes included the 6-min walk test (6MWT), modified Barthel index (MBI), major adverse cardiovascular events (MACE), patient satisfaction, and length of hospital stay (LOS). Additionally, qualitative research will assess the psychological state and experiences of the patients.

DISCUSSION

Our study is one of the few involving patients with CVIS and the first to apply psycho-cardiology through a full-process management platform. The study population is predominantly from Southwest China and includes a diverse range of demographic and socioeconomic backgrounds. Upon completion, this study will provide valuable insights into the use of a remote, full-process management platform for CVIS patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400081052. Registered on 21 February 2024. The trial complies with the SPIRIT and CONSORT guidelines.

Patient perspectives on liver transplant evaluation: A qualitative study

OBJECTIVE

Liver transplant (LT) evaluation is a complex process for patients involving multi-step and parallel medical, surgical, and psychosocial assessments of a patient's appropriateness for transplant. Patients may experience difficulties in navigating the evaluation process, potentially leading to disengagement and resulting in further health decline or death prior to completing evaluation. We aimed to identify and characterize patients' perceptions of undergoing LT evaluation.

METHODS

We performed fourteen 30-45 min, semi-structured interviews between 3/2021-5/2021 with patients at a large LT center. Using the constant comparison method, we individually noted themes within and across interviews and codes.

RESULTS

Our analysis generated 5 thematic dimensions related to patient engagement (i.e., patient involvement/activation): (1) psychological impact of evaluation on patients' lives; (2) information received during evaluation; (3) prior medical experience of the patient; 4) communication between patients and transplant providers; and (5) support system of the patients. Among these dimensions, we identified 8 themes.

CONCLUSION

LT patient engagement is a multi-dimensional component of LT evaluation that incorporates the psychological impact, information received, prior medical experience, communication, and support systems of patients.

PRACTICAL IMPLICATIONS

This work can inform targeted interventions for increasing patient engagement during the LT evaluation process.

Towards halal pharmaceutical: Exploring alternatives to animal-based ingredients

Halal is a crucial concept for Muslim consumers regarding consumed products, including pharmaceutical ingredients, which are essential in modern medicine. To address the issue of using porcine-sourced ingredients in pharmaceuticals, it is essential to search for halal alternatives derived from poultry, animal by-products from meat processing, marine sources, and plants. However, the complexity of this problem is further compounded by the rapid advances in innovation and technology, which can lead to adulteration of ingredients derived from pigs. Other challenges include the sustainability of alternative materials, management of waste or by-products practice, halal awareness, certification, government policies, religious adherence of consumers, food suppliers, marketers, and purchasing of products. The importance of halal and non-halal problems, specifically in the context of pharmaceutical materials, is still rarely discussed, including alternatives derived from poultry, animal by-products, marine sources, and plants. Due to the increasing global population, there is a growing need to increase awareness and concern among Muslim consumers for halal products, including pharmaceuticals. Therefore, this research aimed to investigate the importance of halal and non-halal issues in pharmaceutical ingredients, the potential impact on the Muslim community, as well as opportunities and challenges in the search for alternative ingredients.