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Westas, M., Lundgren, J., Mourad, G., Neher, M. & Johansson, P. (2020). How Healthcare Professionals in Cardiac Care Address Depressive Symptoms: Experiences of Patients With Cardiovascular Disease. Journal of Cardiovascular Nursing
Open this publication in new window or tab >>How Healthcare Professionals in Cardiac Care Address Depressive Symptoms: Experiences of Patients With Cardiovascular Disease
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2020 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

OBJECTIVES: The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters.

METHODS: A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis.

RESULTS: In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34-79] years; 45% women). Three main themes emerged: (1) "not being seen as a whole person," (2) "denying depressive symptoms," and (3) "being provided with help." The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms.

CONCLUSION: Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-164114 (URN)10.1097/JCN.0000000000000669 (DOI)32084077 (PubMedID)
Available from: 2020-03-05 Created: 2020-03-05 Last updated: 2020-04-09Bibliographically approved
Johansson, P., Westas, M., Andersson, G., Alehagen, U., Broström, A., Jaarsma, T., . . . Lundgren, J. (2019). An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial. JMIR mental health, 6(10), Article ID e14648.
Open this publication in new window or tab >>An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial
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2019 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 6, no 10, article id e14648Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression.

OBJECTIVE: The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD.

METHODS: A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire-9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale-self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models.

RESULTS: Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=-2.34 [95% CI -3.58 to -1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression.

CONCLUSIONS: Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc., 2019
Keywords
cardiovascular disease, cognitive behavior therapy, depression, internet, randomized controlled trial
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161243 (URN)10.2196/14648 (DOI)000489649600001 ()31584000 (PubMedID)2-s2.0-85073221407 (Scopus ID)
Note

Funding agencies: Swedish Research CouncilSwedish Research Council [2015-02600]; ALF grant Region Ostergotland [LIO-600321, LIO-687531]; ALF grant Region Ostergotland, Strategic fund [LIO-719561]

Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-12-09Bibliographically approved
Westas, M., Lundgren, J., Mourad, G., Neher, M. & Johansson, P. (2019). Patients with cardiovascular disease and their perceptions on how depression is addressed by health care professionals P98 in cardiac care. In: : . Paper presented at EuroHeartCare 2019 Milan Italy.
Open this publication in new window or tab >>Patients with cardiovascular disease and their perceptions on how depression is addressed by health care professionals P98 in cardiac care
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-160766 (URN)
Conference
EuroHeartCare 2019 Milan Italy
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-07
Lundgren, J., Westas, M., Andersson, G., Mourad, G. & Johansson, P. (2019). The trajectory of depression and physical activity in patients with heart disease during nurse led internet based cognitive behavioural therapy. In: : . Paper presented at EuroHeartCare 2019 Milan Italy.
Open this publication in new window or tab >>The trajectory of depression and physical activity in patients with heart disease during nurse led internet based cognitive behavioural therapy
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background

Few studies have investigated the trajectory of depression and level of physical activity, in patients with heart disease during a psychosocial intervention such as internet based cognitive behavioural therapy (iCBT). For health care professionals in cardiac care it is important to know when an improvement in depression can be expected during iCBT and if this improvement can be associated with physical activity. The aim of this study therefore is, 1) to investigate the trajectory of depression and physical activity during participation in an iCBT program compared to a moderated online discussion forum (ODF). 2) to investigate the association between improvements in depression and physical activity.

Method

A sub-analysis of data collected in a randomised controlled trial (RCT) that evaluated the effect on depression of a nine-week iCBT program guided by nurse. In the RCT, 144 cardiac patients with at least mild depression were randomised to iCBT or ODF. The iCBT program consisted of seven modules where feedback was provided by nurses. The ODF consisted of nine discussion topics moderated by a nurse.

Data for the present analysis was collected at baseline, once weekly during the intervention period, and the follow-up. Depression was measured by Montgomery Åsberg Depression Rating Scale – self rating (MADRS-S). Two modified items from the Physical Activity Questionnaire measured frequency and length of physical activity. Frequency was scored between “none of the days” (0) to “often, 5-7 days” (3). Length was scored from 0 (0 minutes) to 4 (more than 60 minutes). A combined physical activity factor was calculated by multiplying frequency and length scores.

Results

Figure 1a illustrates the trajectory of depression from baseline assessment until the follow up. There was a significant time and group interaction (F=9.98, p<.001, η2=.106) favouring iCBT. The significant difference in depression between iCBT and ODF started at week six and remained to the follow-up. Figures 1b to 1d illustrates the trajectories of physical activity. We found a significant interaction of time and group favouring iCBT for the combined physical factor (F=2.36, p=0.019, η2=.028). The interaction effects for time and group for frequency (F=1.95, p=0.056) and length in physical activity (F=1.26, p=0.272) was not statistically significant. Pearson correlational analyses showed a positive association between improvement in depression and increase of physical activity (r=.256, p=.004). For the iCBT-group this association was stronger (r= .312, p=.011), whereas there was no significant correlation in the ODF group (r= -.006, p= .965)

 

Conclusion

Both depression and physical activity improved during the course of the nine week iCBT program. However, improvement occur more clearly after half the duration of iCBT program. Early in the program, a temporary worsening of depression was seen. This indicates that patients need support and encouragement to complete the iCBT program, which gives them greater opportunities to improve in depression and physical activity.

National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-160763 (URN)
Conference
EuroHeartCare 2019 Milan Italy
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-07
Alehagen, U., Aaseth, J., Alexander, J., Svensson, E., Johansson, P. & Larsson, A. (2018). Less fibrosis in elderly subjects supplemented with selenium and coenzyme Q10A mechanism behind reduced cardiovascular mortality?. Biofactors, 44(2), 137-147
Open this publication in new window or tab >>Less fibrosis in elderly subjects supplemented with selenium and coenzyme Q10A mechanism behind reduced cardiovascular mortality?
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2018 (English)In: Biofactors, ISSN 0951-6433, E-ISSN 1872-8081, Vol. 44, no 2, p. 137-147Article in journal (Refereed) Published
Abstract [en]

Background: In an intervention study where 221 healthy elderly persons received selenium and coenzyme Q10 as a dietary supplement, and 222 received placebo for 4 years we observed improved cardiac function and reduced cardiovascular mortality. As fibrosis is central in the aging process, we investigated the effect of the intervention on biomarkers of fibrogenic activity in a subanalysis of this intervention study. Material and Methods: In the present subanalysis 122 actively treated individuals and 101 controls, the effect of the treatment on eight biomarkers of fibrogenic activity were assessed. These biomarkers were: Cathepsin S, Endostatin, Galectin 3, Growth Differentiation Factor-15 (GDF-15), Matrix Metalloproteinases 1 and 9, Tissue Inhibitor of Metalloproteinases 1 (TIMP 1) and Suppression of Tumorigenicity 2 (ST-2). Blood concentrations of these biomarkers after 6 and 42 months were analyzed by the use of T-tests, repeated measures of variance, and factor analyses. Results: Compared with placebo, in those receiving supplementation with selenium and coenzyme Q10, all biomarkers except ST2 showed significant decreased concentrations in blood. The changes in concentrations, that is, effects sizes as given by partial eta(2) caused by the intervention were considered small to medium. Conclusion: The significantly decreased biomarker concentrations in those on active treatment with selenium and coenzyme Q10 compared with those on placebo after 36 months of intervention presumably reflect less fibrogenic activity as a result of the intervention. These observations might indicate that reduced fibrosis precedes the reported improvement in cardiac function, thereby explaining some of the positive clinical effects caused by the intervention. (c) 2017 BioFactors, 44(2):137-147, 2018

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
fibrosis; intervention; selenium; coenzyme Q10
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-147583 (URN)10.1002/biof.1404 (DOI)000430002200004 ()29220105 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland; University of Linkoping; Alehagen

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2019-04-12
Lundgren, J., Johansson, P., Jaarsma, T., Andersson, G. & Kärner Köhler, A. (2018). Patient Experiences of Web-Based Cognitive Behavioral Therapy for Heart Failure and Depression: Qualitative Study. Journal of Medical Internet Research, 20(9), Article ID e10302.
Open this publication in new window or tab >>Patient Experiences of Web-Based Cognitive Behavioral Therapy for Heart Failure and Depression: Qualitative Study
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 9, article id e10302Article in journal (Refereed) Published
Abstract [en]

Background: Web-based cognitive behavioral therapy (wCBT) has been proposed as a possible treatment for patients with heart failure and depressive symptoms. Depressive symptoms are common in patients with heart failure and such symptoms are known to significantly worsen their health. Although there are promising results on the effect of wCBT, there is a knowledge gap regarding how persons with chronic heart failure and depressive symptoms experience wCBT. Objective: The aim of this study was to explore and describe the experiences of participating and receiving health care through a wCBT intervention among persons with heart failure and depressive symptoms. Methods: In this qualitative, inductive, exploratory, and descriptive study, participants with experiences of a wCBT program were interviewed. The participants were included through purposeful sampling among participants previously included in a quantitative study on wCBT. Overall, 13 participants consented to take part in this study and were interviewed via telephone using an interview guide. Verbatim transcripts from the interviews were qualitatively analyzed following the recommendations discussed by Patton in Qualitative Research amp; Evaluation Methods: Integrating Theory and Practice. After coding each interview, codes were formed into categories. Results: Overall, six categories were identified during the analysis process. They were as follows: "Something other than usual health care," "Relevance and recognition," "Flexible, understandable, and safe," "Technical problems," "Improvements by real-time contact," and "Managing my life better." One central and common pattern in the findings was that participants experienced the wCBT program as something they did themselves and many participants described the program as a form of self-care. Conclusions: Persons with heart failure and depressive symptoms described wCBT as challenging. This was due to participants balancing the urge for real-time contact with perceived anonymity and not postponing the work with the program. wCBT appears to be a valuable tool for managing depressive symptoms.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC, 2018
Keywords
cognitive therapy; content analysis; depression; heart failure; internet; patient experience; telehealth
National Category
Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-151795 (URN)10.2196/10302 (DOI)000444499200001 ()30185405 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2015-02600]; Region Ostergotland, Sweden [LIO-531701, LIO-629211]; Medical Research Council of Southeast Sweden [FORSS-470121]; Swedish Heart and Lung Association [E082/14, E 087/13]; A-L and A Andersson Foundation for psychiatric research [LIO 5611101]

Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2019-06-27
Broström, A., Wahlin, A., Alehagen, U., Ulander, M. & Johansson, P. (2018). Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.. Journal of Cardiovascular Nursing, 33(5), 422-428
Open this publication in new window or tab >>Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 5, p. 422-428Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154038 (URN)10.1097/JCN.0000000000000393 (DOI)000457865500009 ()28060086 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-02
Mourad, G., Jaarsma, T., Strömberg, A., Svensson, E. & Johansson, P. (2018). The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?. BMC Psychiatry, 18(1), Article ID 172.
Open this publication in new window or tab >>The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?
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2018 (English)In: BMC Psychiatry, ISSN ISSN 1471-244X, Vol. 18, no 1, article id 172Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.

METHODS: In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.

RESULTS: A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.

CONCLUSIONS: In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.

Keywords
Cardiac anxiety, Cardiac disease, Depressive symptoms, Fear of body sensations, Healthcare visits, Non-cardiac chest pain, Somatization
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-148445 (URN)10.1186/s12888-018-1689-8 (DOI)000434313300001 ()29866125 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden [LIO-439131]; Medical Research of Southeast Sweden [FORSS-475291]

Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2019-06-27
Mourad, G., Jaarsma, T., Strömberg, A., Svensson, E. & Johansson, P. (2017). Psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?. In: Abstract book: . Paper presented at EuroHeartCare, Jönköping, Sweden, 18-20 May 2017 (pp. S3-S3). Sage Publications, 16 (S1), Article ID 24.
Open this publication in new window or tab >>Psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?
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2017 (English)In: Abstract book, Sage Publications, 2017, Vol. 16 (S1), p. S3-S3, article id 24Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Patients with non-cardiac chest pain (NCCP) suffer psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms, which can increase healthcare use. It is unknown how these variables are related and whether the relationships differ between patients with or without history of cardiac disease.

Objective: To explore and model the associations between somatization, fear of body sensations, cardiac anxiety, depressive symptoms, and healthcare use in patients with NCCP with or without history of cardiac disease.

Methods: Data were collected in Sweden in 670 patients (mean age 65±16 years, 51% women) within one month from discharge using the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, and Patient Health Questionnaire-9. Structural Equation Modelling analyses were used to explore the relationships between somatization, fear of body sensations, cardiac anxiety, depressive symptoms and healthcare use in NCCP patients with or without history of cardiac disease.

Results: About 40% of the NCCP patients had previous diagnosis of cardiac disease. Patients with NCCP and a history of cardiac disease were older (71 vs. 60 years), had more comorbidities (4.7 vs. 2.8), and reported significantly higher scores in somatization (p=0.02), cardiac anxiety (p<0.001), and depressive symptoms (p=0.02), and greater healthcare use (p<0.001). Depressive symptoms were not directly associated with healthcare use (Chi-Square=68.28, df=10, P-value=0.000, RMSEA=0.099, CFI=0.96). In patients with history of cardiac disease, the impact of depressive symptoms on healthcare use was mediated by somatization, fear of body sensations, and cardiac anxiety (Chi-Square=7.61, df=8, P-value=0.48, RMSEA=0.000, CFI=0.99). In patients with no history of cardiac disease, the impact of depressive symptoms on healthcare use was directly mediated by cardiac anxiety (Chi-Square=4.17, df=7, P-value=0.76, RMSEA=0.000, CFI=0.99).

Conclusions: The associations between psychological distress and healthcare use were different for patients with or without cardiac disease. In both groups depressive symptoms had no direct association with healthcare use.

Place, publisher, year, edition, pages
Sage Publications, 2017
Series
European Journal Of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:liu:diva-142715 (URN)
Conference
EuroHeartCare, Jönköping, Sweden, 18-20 May 2017
Funder
Region ÖstergötlandMedical Research Council of Southeast Sweden (FORSS)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2019-06-27Bibliographically approved
Karlström, P., Johansson, P., Dahlström, U., Boman, K. & Alehagen, U. (2017). The impact of time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. Results from the UPSTEP study. International Journal of Cardiology, 236, 315-320
Open this publication in new window or tab >>The impact of time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. Results from the UPSTEP study
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, p. 315-320Article in journal (Refereed) Published
Abstract [en]

Background: Heart failure (HF) is a life-threatening condition and optimal handling is necessary to reduce risk of therapy failure. The impact of the duration of HF diagnosis on HF outcome has not previously been examined. The objectives of this study were (I) to evaluate the impact of patient age on clinical outcomes, (II) to evaluate the impact of duration of the HF disease on outcomes, and (III) to evaluate the impact of age and HF duration on B-type Natriuretic Peptide (BNP) concentration in a population of HF patients. Methods and results: In the UPSTEP (Use of PeptideS in Tailoring hEart failure Project) study we retrospectively evaluated how age and HF duration affected HF outcome. HF duration was divided into amp;lt; 1 year, 1-5 years and amp;gt; 5 years. A multivariate Cox proportional hazard regression analysis showed that HF duration influenced outcome more than age, even when adjusted for comorbidities(amp;lt; 1 year versus amp;gt; 5 years: HR 1.65; 95% CI 1.28-2.14; P amp;lt; 0.0002) on HF mortality and hospitalisations. The influence of age on BNP showed increased BNP as age increased. However, there was a significant effect on BNP concentration when comparing HF duration of less than one year to HF duration to more than five years, even when adjusted for age. Conclusions: Patients with longer HF duration had significantly worse outcome compared to those with short HF duration, even when adjusted for patient age and comorbidities. Age did not influence outcome but had an impact on BNP concentration; however, BNP concentration increased as HF duration increased. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Heart failure; B-type Natriuretic Peptides; Age; Heart failure duration; Heart failure outcome
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-138904 (URN)10.1016/j.ijcard.2017.02.054 (DOI)000402476500055 ()28268084 (PubMedID)
Note

Funding Agencies|Regional Research Foundation in south-eastern Sweden [FORSS-3963, FORSS-5677, FORSS-F2004-223]; Regional Research Foundation in northern Sweden [33/2006, 20/2007]; Swedish Heart-Lung Foundation [2000596]; Biosite International and Infiniti Medical AB

Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2018-04-18
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7431-2873

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