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Khatib, R., Lee, G. A., Marques-Sule, E., Arnesdatter Hopstock, L., O'Donnell, S., Svavarsdóttir, M. H., . . . Stewart, C. (2019). Evaluating the extent of patient-centred care in a selection of ESC guidelines. European Heart Journal - Quality of Care and Clinical Outcomes, 1-7
Open this publication in new window or tab >>Evaluating the extent of patient-centred care in a selection of ESC guidelines
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2019 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, p. 1-7Article in journal (Refereed) Epub ahead of print
Abstract [en]

Patient-centred care (PCC) is the cornerstone for healthcare professionals to promote high quality care for patients with cardiovascular conditions. It is defined as ‘Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions’. PCC can improve patient outcomes and allow patients and healthcare professionals to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC).Using a narrative literature review and expert consensus, the Science Committee within the Association of Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed, with committee members independently evaluating five PCC aspects: patient voice and involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients’ needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared. The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the ‘multidisciplinary involvement’ category.Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing, or formulating recommendations. Future development of guidelines should ensure better incorporation of patients’ perspective, in particular, and other PCC aspects highlighted in this study.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:liu:diva-160799 (URN)10.1093/ehjqcco/qcz025 (DOI)
Note

qcz025

Available from: 2019-10-08 Created: 2019-10-08 Last updated: 2019-10-08Bibliographically approved
Jaarsma, T. & Strömberg, A. (2019). We told you so: knowledge is not enough to improve heart failure self-care behaviour. ESC Heart Failure
Open this publication in new window or tab >>We told you so: knowledge is not enough to improve heart failure self-care behaviour
2019 (English)In: ESC Heart Failure, E-ISSN 2055-5822Article in journal, Editorial material (Refereed) Epub ahead of print
Abstract [en]

n/a

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-160422 (URN)10.1002/ejhf.1580 (DOI)000483562500001 ()31452305 (PubMedID)2-s2.0-85071650967 (Scopus ID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-10-01Bibliographically approved
Mourad, G., Verheijden Klompstra, L., Jaarsma, T., Strömberg, A. & Alwin, J. (2019). What are patients with heart failure willing to pay for an exergame intervention?. In: : . Paper presented at EuroHeartCare.
Open this publication in new window or tab >>What are patients with heart failure willing to pay for an exergame intervention?
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.

Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.

Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.

Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.

Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.

The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.

Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.

National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-158027 (URN)
Conference
EuroHeartCare
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-09-16
Andreae, C., Strömberg, A., Chung, M. L., Hjelm, C. & Årestedt, K. (2018). Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure. Journal of Cardiovascular Nursing, 33(2), E15-E20
Open this publication in new window or tab >>Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 2, p. E15-E20Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status.

OBJECTIVE: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association.

METHODS: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status.

RESULTS: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001).

CONCLUSIONS: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
appetite, association, depression, health status, heart failure, nutritional status
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-139105 (URN)10.1097/JCN.0000000000000428 (DOI)000440241700003 ()28574973 (PubMedID)2-s2.0-85020167287 (Scopus ID)
Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2018-09-27Bibliographically approved
Riegel, B., Barbaranelli, C., Sethares, K. A., Daus, M., Moser, D. K., Miller, J. L., . . . Jaarsma, T. (2018). Development and initial testing of the self-care of chronic illness inventory. Journal of Advanced Nursing, 74(10), 2465-2476
Open this publication in new window or tab >>Development and initial testing of the self-care of chronic illness inventory
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2018 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 10, p. 2465-2476Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to develop and psychometrically test the self-care of chronic illness Inventory, a generic measure of self-care. Background: Existing measures of self-care are disease-specific or behaviour-specific; no generic measure of self-care exists. Design: Cross-sectional survey. Methods: We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Each of the three scales is scored separately and standardized 0-100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing. Results: The Self-Care Maintenance scale (eight items, two dimensions: illnessrelated and health-promoting behaviour) fit well when tested with a two-factor confirmatory model. The Self-Care Monitoring scale (five items, single factor) fitted well. The Self-Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two-factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. Conclusion: The self-care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
chronic illness; comorbidity; factor analysis; instrument development; multimorbidity; nursing theory; psychometrics; self-care; validity
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-152830 (URN)10.1111/jan.13775 (DOI)000449085600023 ()29943401 (PubMedID)
Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2019-06-27
Hjelmfors, L., Sandgren, A., Strömberg, A., Mårtensson, J., Jaarsma, T. & Friedrichsen, M. (2018). I was told that I would not die from heart failure. Applied Nursing Research, 41, 41-45
Open this publication in new window or tab >>I was told that I would not die from heart failure
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2018 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 41, p. 41-45Article in journal (Refereed) Published
Abstract [en]

Aim and objectives: To describe patients experiences of communication about their heart failure prognosis and explore how these experiences affected their preferences for future communication about the prognosis. Background: Professionals need to discuss about the heart failure prognosis with patients in order to improve their understanding of their illness and address palliative care needs. Methods: An inductive and exploratory design was used. A total of 24 patients (75% men, 52-87 years of age) in New York Heart Association class I-III from primary outpatient care participated in focus group-, or individual semi-structured interviews. Thematic analysis was used to identify and interpret patterns in the data. Findings: Two overarching themes, "The message sent" and "Hoping for the best or preparing for the worst", each with three sub-themes, were discovered during the thematic analysis. Many patients described that professionals had not provided them with any prognosis information at all. Other patients described professional information about prognosis that was given in an either very optimistic or very negative way. However, patients also described situations where professionals had given information in a way that they thought was perfect for them to handle, and in accordance with their preferences. Conclusion: This study shows that patients have different experiences and preferences for communication about prognosis and uses different approaches in order to cope living with a chronic illness such as heart failure.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC, 2018
Keywords
Heart failure; Palliative care; Prognosis; Communication; Coping
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-149476 (URN)10.1016/j.apnr.2018.03.007 (DOI)000435427100008 ()29853212 (PubMedID)
Note

Funding Agencies|Swedish Heart-Lung Foundation [20110417]; King Gustaf Vs and Queen Victorias Foundation

Available from: 2018-07-05 Created: 2018-07-05 Last updated: 2019-06-27
Thrysoee, L., Strömberg, A., Brandes, A. & Hendriks, J. (2018). Management of newly diagnosed atrial fibrillation in an outpatient clinic settingpatients perspectives and experiences. Journal of Clinical Nursing, 27(3-4), 601-611
Open this publication in new window or tab >>Management of newly diagnosed atrial fibrillation in an outpatient clinic settingpatients perspectives and experiences
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 3-4, p. 601-611Article in journal (Refereed) Published
Abstract [en]

Aims and objectivesTo gain in-depth knowledge of patients experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. BackgroundAtrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision-making on medical therapy. DesignThis is a qualitative study of 14 patients newly diagnosed with atrial fibrillation, ranging from asymptomatic patients, to those with mild to severe symptoms; they were all referred from general practitioners. MethodsData were generated in 2013-2015 using participant observation during each consultation, followed by individual interviews postconsultation. ResultsPatients were referred with limited information on AF and knowledge about the management consultation procedures. The consultations were performed in a professional way by the cardiologist as well as by the nurses with an emphasis on the medical aspects of atrial fibrillation. The understanding that atrial fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. ConclusionsThis study indicates that patients were uncertain on what AF was before as well as after their consultation. The communication was concentrated on the medical aspects of atrial fibrillation and visiting the clinic was an overwhelming experience for the patients. They had difficulty understanding what atrial fibrillation was, why they were treated with anticoagulation, and that anticoagulating was a lifelong treatment. Relevance for clinical practiceThis study demonstrates some lack of patient-centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
atrial fibrillation; clinical management; multidisciplinary care; outpatient clinic; patient experiences
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-145787 (URN)10.1111/jocn.13951 (DOI)000425733600031 ()28677250 (PubMedID)
Note

Funding Agencies|Novo Nordisk Foundation

Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-05-09
Allemann, H., Strömberg, A. & Thylén, I. (2018). Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study. Journal of Cardiovascular Nursing, 33(6), E1-E8
Open this publication in new window or tab >>Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study
2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 6, p. E1-E8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The links between chronic illness, psychological well-being, and social support have previously been established. Social isolation and loneliness have shown an increased mortality risk for those with heart failure (HF). Increasingly more people with HF are living with an implantable cardioverter defibrillator (ICD), but only a few small-scale studies have focused on social support in this population.

OBJECTIVE: The aim of this study was to explore factors related to perceived social support in a large cohort of individuals with HF living with an ICD.

METHODS: All eligible adult ICD recipients in the Swedish ICD registry were invited to participate in this cross-sectional study. For this analysis, those with HF and complete data on perceived social support were included (N = 1550; age, 67.3 (SD, 9.8) years; 19.5% female).

RESULTS: Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity were not related to the outcome.

CONCLUSION: One in five participants reported low/medium social support. Our study underlines the complex relationships between perceived social support, psychological well-being and perceived control over the heart condition. Multiple aspects need to be taken into account when developing interventions to provide psychosocial support and optimize outcomes in this patient group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-154035 (URN)10.1097/JCN.0000000000000523 (DOI)000457866800001 ()30063538 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-18
Lin, C.-Y., Pakpour, A. H., Brostrom, A., Fridlund, B., Franzén Årestedt, K., Strömberg, A., . . . Martensson, J. (2018). Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients. Journal of Cardiovascular Nursing, 33(3), 281-288
Open this publication in new window or tab >>Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed) Published
Abstract [en]

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-9s 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 legstfeet 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.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2018
Keywords
confirmatory factor analysis; heart failure; Rasch; self-care behavior scale
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-150299 (URN)10.1097/JCN.0000000000000444 (DOI)000440243400021 ()28858887 (PubMedID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2019-06-27
Andreae, C., Franzén Årestedt, K., Evangelista, L. & Strömberg, A. (2018). The associations between physical activity and appetite in patients with heart failure – a prospective observational study. In: : . Paper presented at American Heart Association. 10-12 November. Chicago, Illinois.. American Heart Association, Inc., 138, Article ID A14932.
Open this publication in new window or tab >>The associations between physical activity and appetite in patients with heart failure – a prospective observational study
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: Physical activity and appetite both play a crucial role for health outcomes and quality of life in patients with heart failure. Nevertheless, both of these key functions are frequently decreased in patients with heart failure. Whilst most attention focuses independently on the physical activity levels, the associations with appetite has been insufficiently investigated. The aim was therefore to explore the associations between physical activity and appetite in community dwelling heart failure patients.

Methods: This prospective observational study consisted of 186 patients with symptomatic heart failure of whom 56 (30%) were women and 130 (70%) were men. Mean age was 70.7 (SD=11 years), the majority had NYHA-class II, 114 (63%). Objective and subjective methods were used to measure physical activity include a wearable actigraph (SenceWear) for 4 days and six minutes’ walk test. The actigraph calculate total energy expenditure, active energy expenditure, number of steps and METs daily average index. Patients also stated their physical activity level on a numeric rating scale. A self-reported questionnaire, the Council on Nutrition Appetite Questionnaire was used to assess appetite. Simple linear regression was conducted to explore the associations between physical activity and appetite at baseline and at 18-month follow-up.

Results: In general, the levels of physical activity in this sample was low and appetite was poor. There was a significant association between objective physical activity measures and appetite at baseline ranging between (p=<0.001-0.041). The number of steps and walking distance had the strongest association, each explaining 6% and 7% of the total variance in appetite. At the 18-month follow-up, all objective and subjective physical activity measures were associated with appetite (p=0.001-0.035) with the number of steps being most strongly associated (p=<0.001) explaining 14% of the total variation in appetite.

Conclusions: Patients with heart failure who are more physically active experiences better appetite. These findings underscore the importance of placing greater attention on both physical activity and appetite in clinical practice as these factors has implications for patient’s health outcomes. Further longitudinally oriented studies are needed to determine whether there is a causal relationship between physical activity and appetite in heart failure populations.

Keywords: Appetite, Heart Failure, Physical activity

Place, publisher, year, edition, pages
American Heart Association, Inc., 2018
Series
Circulation, ISSN 0569-6704 ; 138
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-153900 (URN)
Conference
American Heart Association. 10-12 November. Chicago, Illinois.
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-01-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4259-3671

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