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Säfström, E., Årestedt, K., Liljeroos, M., Nordgren, L., Jaarsma, T. & Strömberg, A. (2023). Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission: A structural equation model. Journal of Advanced Nursing, 9(6), 2305-2315
Open this publication in new window or tab >>Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission: A structural equation model
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2023 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 9, no 6, p. 2305-2315Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge.

DESIGN: Correlational design based on cross-sectional data from a multicentre survey study.

METHODS: People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling.

RESULTS: In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90.

CONCLUSION: Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care.

IMPACT: This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes.

PATIENT OR PUBLIC CONTRIBUTION: People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Place, publisher, year, edition, pages
WILEY, 2023
Keywords
Adult nursing chronic illness, Conceptual models of nursing, Discharge planning, Older people, Quality of life, Self-care
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-192085 (URN)10.1111/jan.15581 (DOI)000928387700001 ()36744677 (PubMedID)
Note

Funding agencies: The Centre for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden: DLL-939621. DLL-930272, DLL-859581, DLL-742221, DLL-642411 and the Medical Research Council of Southeast Sweden: FORSS-607341, FORSS-749931, FORSS-846301.

Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2024-02-02Bibliographically approved
Verheijden Klompstra, L., Lans, C., Mercke, E., Strömberg, A. & Jaarsma, T. (2023). Comparison of the 6-minute walk distance measured on a 30 m track with guidance of a healthcare professional and those measured with a mobile application outdoors by participants themselves: a validation study. European Journal of Cardiovascular Nursing, 22(5), 544-546
Open this publication in new window or tab >>Comparison of the 6-minute walk distance measured on a 30 m track with guidance of a healthcare professional and those measured with a mobile application outdoors by participants themselves: a validation study
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2023 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 22, no 5, p. 544-546Article in journal (Refereed) Published
Abstract [en]

To improve the practical application of measuring exercise capacity, the purpose of this study was to compare the 6 min walk distance (6MWD) obtained at a 30 m track with the guidance of healthcare professionals vs. the 6MWD obtained by participants themselves using an app. In total, 37 participants performed both tests. The mean of the differences between the 6MWD on the tests was -4 +/- 45 m (95% limits of agreement: 84 to -99 m). The overall agreement between the two 6MWD measures was 97% with an intraclass correlation coefficient of 0.96 (95% confidence interval: 0.91-0.98, P < 0.001). The use of an app is feasible, reliable, and valid to assess the 6MWD.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
Exercise capacity; Mobile applications; App; Cardiac; Validation
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-189796 (URN)10.1093/eurjcn/zvac091 (DOI)000869727400001 ()36131494 (PubMedID)
Note

Funding Agencies|Swedish Research Council for Medicine and Health-VR [2018-02719]; Swedish Research Council for Health, Working Life and Welfare-FORTE [2018-00650]; Swedish Heart-Lung Foundation [20170766]; FORSS [941180]

Available from: 2022-11-08 Created: 2022-11-08 Last updated: 2023-11-23Bibliographically approved
Verheijden Klompstra, L., Mourad, G., Jaarsma, T., Strömberg, A. & Alwin, J. (2023). Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure. Games for Health Journal, 12(3), 242-248
Open this publication in new window or tab >>Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure
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2023 (English)In: Games for Health Journal, ISSN 2161-783X, E-ISSN 2161-7856, Vol. 12, no 3, p. 242-248Article in journal (Refereed) Published
Abstract [en]

Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).

Place, publisher, year, edition, pages
MARY ANN LIEBERT, INC, 2023
Keywords
Exergame; Heart failure; Cost; Serious games; Willingness to pay; Physical activity
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-190944 (URN)10.1089/g4h.2022.0013 (DOI)000893719200001 ()36473172 (PubMedID)
Available from: 2023-01-09 Created: 2023-01-09 Last updated: 2024-02-06Bibliographically approved
Säfström, E., Arestedt, K., Hadjistavropoulos, H. D., Liljeroos, M., Nordgren, L., Jaarsma, T. & Strömberg, A. (2023). Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire. Health Expectations, 26(3), 1137-1148
Open this publication in new window or tab >>Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire
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2023 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 26, no 3, p. 1137-1148Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ.

METHODS: This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ.

RESULTS: A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated.

CONCLUSION: The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization.

PATIENT OR PUBLIC CONTRIBUTION: Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.

Place, publisher, year, edition, pages
WILEY, 2023
Keywords
Continuity of care, Patient discharge, Psychometrics, Quality of care, Reproducibility of results, Surveys and questionnaires, Validation studies
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-192084 (URN)10.1111/hex.13728 (DOI)000939223500001 ()36797976 (PubMedID)
Note

Funding agencies: The Center for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden: DLL-939621. DLL-930272, DLL-859581, DLL-742221, DLL-642411, and the Medical Research Council of Southeast Sweden: FORSS-607341, FORSS-749931, FORSS-846301

Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2024-02-02Bibliographically approved
Ericsson, M., Thylén, I., Strömberg, A., Ängerud, K. H., Moser, D. K. & Sederholm Lawesson, S. (2022). Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders—an observational cross-sectional survey study. European Journal of Cardiovascular Nursing, 21(7), 694-701
Open this publication in new window or tab >>Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders—an observational cross-sectional survey study
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2022 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 7, p. 694-701Article in journal (Refereed) Published
Abstract [en]

Aims A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20-90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). Conclusion Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2022
Keywords
Acute coronary syndrome, Decision-making, Care seeking, Pre-hospital delay, Symptom recognition, Symptom response
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-183381 (URN)10.1093/eurjcn/zvab124 (DOI)000764519500001 ()35165735 (PubMedID)
Note

Funding agencies: The Medical Research Council of Southeast Sweden (FORSS), Region Östergötland, Sweden, and Linköping University Hospital Research Fund, Sweden.

Available from: 2022-03-07 Created: 2022-03-07 Last updated: 2023-02-03
Mourad, G., Jaarsma, T., Strömberg, A. & Johansson, P. (2022). Somatization in women and men with non-cardiac chest pain compared to the general Swedish population. Psychiatry Research Communications, 2(2), Article ID 100047.
Open this publication in new window or tab >>Somatization in women and men with non-cardiac chest pain compared to the general Swedish population
2022 (English)In: Psychiatry Research Communications, ISSN 2772-5987, Vol. 2, no 2, article id 100047Article in journal (Refereed) Published
Abstract [en]

We compare the prevalence of somatization in women and men with NCCP in relation to the general Swedish population, analyze the overlap between somatization, cardiac anxiety, and depressive symptoms, and explore variables associated with somatization. A cross sectional design is implemented with data collected between late October 2013 and early January 2014 from 552 patients with NCCP (mean age of 64 ​± ​17 years, 51% women) from four hospitals in southeast Sweden. Somatization was measured with the Patient Health Questionnaire-15, cardiac anxiety with the Cardiac Anxiety Questionnaire, and depressive symptoms with the Patient Health Questionnaire-9. Data were self-reported. The general population consists of 1898 females and 1508 males. Compared to the general population, somatization was significantly (p ​< ​.001) more common in both women and men with NCCP. Women with NCCP had significantly (p ​= ​.003) higher prevalence of somatization than men with NCCP. In patients with NCCP, 12% had only somatization, whereas 39% also reported cardiac anxiety and depressive symptoms. Younger age in women tended to be associated with somatization (OR ​= ​0.98, p ​< ​.073), but also being non-worker (OR ​= ​0.40, p ​= ​.024). In men, somatization tended to be associated with increased healthcare contacts (OR ​= ​1.82, p ​= ​.051). Furthermore, in both women and men, number of co-morbidities (OR ​= ​9.69 p ​< ​.001 and OR ​= ​3.45, p ​= ​.002), cardiac anxiety (OR ​= ​2.93 and OR ​= ​2.09, p ​< ​.001), and depressive symptoms (OR ​= ​8.71 and OR ​= ​4.44, p ​< ​.001) were significantly associated with somatization. Our study demonstrates that somatization is very common among patients with NCCP, especially in women. Patients with NCCP have higher somatization and greater overlap with psychological distress compared to the general population.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Cardiac anxiety, Depressive symptoms, Non-cardiac chest pain, Sex differences, Somatization
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-185757 (URN)10.1016/j.psycom.2022.100047 (DOI)
Note

Funding: The study was funded by the County Council of Östergötland, Sweden (LIO-439131), and the Medical Research of Southeast Sweden (FORSS-475291), but they were not involved in any part of the study.

Available from: 2022-06-10 Created: 2022-06-10 Last updated: 2022-08-03Bibliographically approved
Strömberg, A., Liljeroos, M., Ågren, S., Årestedt, K. & Chung, M. L. (2021). Associations Among Perceived Control, Depressive Symptoms, and Well-being in Patients With Heart Failure and Their Spouses: A Dyadic Approach. Journal of Cardiovascular Nursing, 36(3), 198-205
Open this publication in new window or tab >>Associations Among Perceived Control, Depressive Symptoms, and Well-being in Patients With Heart Failure and Their Spouses: A Dyadic Approach
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2021 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 36, no 3, p. 198-205Article in journal (Refereed) Published
Abstract [en]

Background 

High levels of perceived control and lower levels of depressive symptoms are associated with better well-being in both patients with heart failure and their spouses at an individual level. However, there is a knowledge gap about how these individual factors have reciprocal influences on partners' well-being within the patient-spouse dyads.

Objective 

The aims of this study were to examine dyads of patients with heart failure and their spouses on whether the patients' perceived control over the management of heart failure and depressive symptoms predicts their own and their spouses' physical and emotional well-being and to examine whether patients' perceived control predicts their own and their spouses' depressive symptoms.

Methods 

A total 155 patient-spouse dyads (patients: 75% male, mean age of 71 years, 53% classified as New York Heart Association III; spouses: 75% female, mean age of 69 years) were recruited from 2 hospital-based outpatient heart failure clinics. Participants completed the Control Attitude Scale, the Beck Depression Inventory, and the Short-Form 36. Dyadic data were analyzed using multilevel regression of the actor-partner interdependence model.

Results 

Perceived control had an actor effect on emotional well-being only for patients, and there were partner effects of perceived control on emotional well-being for both patients and their spouses. Depressive symptoms exhibited an actor effect on physical and emotional well-being for patients and spouses, but there were no partner effects of depressive symptoms on emotional well-being. Perceived control had partner effects on depressive symptoms for patients and spouses, but an actor effect of depressive symptoms was only found for patients.

Conclusion 

In an interdependent relationship within the patient-spouse dyads, each dyad member's perceived control influenced their partner's emotional well-being as well as depressive symptoms. The findings suggest development of dyadic interventions that can increase perceived control over the heart condition.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2021
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-174682 (URN)10.1097/JCN.0000000000000682 (DOI)000642400000003 ()32398503 (PubMedID)2-s2.0-85101239131 (Scopus ID)
Note

Funding: Linkoping University; Swedish Science Council; Centre for Clinical Research Sormland

Available from: 2021-03-29 Created: 2021-03-29 Last updated: 2021-05-26Bibliographically approved
Andreae, C., van der Wal, M. H. L., van Veldhuisen, D. J., Yang, B., Strömberg, A. & Jaarsma, T. (2021). Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life. Journal of Cardiovascular Nursing, 36(6), 539-545
Open this publication in new window or tab >>Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life
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2021 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 36, no 6, p. 539-545Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.

OBJECTIVE: The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.

METHODS: Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.

RESULTS: A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates.

CONCLUSIONS: Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2021
Keywords
appetite, depressive symptoms, fatigue, heart failure, quality of life
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-171162 (URN)10.1097/JCN.0000000000000756 (DOI)000756652700005 ()33136703 (PubMedID)
Note

Funding: Netherlands Heart FoundationNetherlands Heart Foundation [2000Z003]; Biosite France SAS; Jouy-en-Josas, France (brain natriuretic peptide); Roche Diagnostics Nederland BV, Venlo, the Netherlands; Novartis Pharma BV, Arnhem, the NetherlandsNetherlands Government

Available from: 2020-11-06 Created: 2020-11-06 Last updated: 2022-03-08Bibliographically approved
van der Wal, M. H. L., Hjelmfors, L., Strömberg, A. & Jaarsma, T. (2020). Cardiologists attitudes on communication about prognosis with heart failure patients. ESC Heart Failure, 7(3), 878-882
Open this publication in new window or tab >>Cardiologists attitudes on communication about prognosis with heart failure patients
2020 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 7, no 3, p. 878-882Article in journal (Refereed) Published
Abstract [en]

Aim According to guidelines, a prognosis should be discussed with all heart failure (HF) patients. However, many patients do not have these conversations with a healthcare provider. The aim of this study was to describe attitudes of cardiologists in Sweden and the Netherlands regarding this topic. Methods and results A survey was sent to 250 cardiologists in Sweden and the Netherlands with questions whether should the prognosis be discussed, what time should the prognosis be discussed, whom should discuss, what barriers were experienced and how difficult it is to discuss the prognosis (scale from 1-10). A total of 88 cardiologists participated in the study. Most cardiologists (82%) reported to discussing the prognosis with all HF patients; 47% at the time of diagnoses. The patients own cardiologist, another cardiologist, the HF nurse, or the general practitioner could discuss this with the patient. Important barriers were cognitive problems (69%) and a lack of time (64%). Cardiologists found it not very difficult to discuss the topic (mean score 4.2) with a significant difference between Swedish and Dutch cardiologist (4.7 vs. 3.7; P &lt; 0.05). Conclusion Most cardiologists found it important to discuss the prognosis with HF patients although there are several barriers. Swedish cardiologists found it more difficult compared with their Dutch colleagues. A multidisciplinary approach seems important for improvement of discussing prognosis with HF patients.

Place, publisher, year, edition, pages
WILEY PERIODICALS, INC, 2020
Keywords
Communication; Heart failure; Palliative care; Prognosis
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-166469 (URN)10.1002/ehf2.12672 (DOI)000536512400012 ()32159281 (PubMedID)
Note

Funding Agencies|FORTE [201702227]

Available from: 2020-06-20 Created: 2020-06-20 Last updated: 2021-05-01
Vellone, E., Chiala, O., Boyne, J., Verheijden Klompstra, L., Evangelista, L. S., Bäck, M., . . . Jaarsma, T. (2020). Cognitive impairment in patients with heart failure: an international study. ESC Heart Failure, 41(1), 47-54
Open this publication in new window or tab >>Cognitive impairment in patients with heart failure: an international study
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2020 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 41, no 1, p. 47-54Article in journal (Refereed) Published
Abstract [en]

Aims Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients. Methods and results A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients older age, lower education, and lower 6MWT scores (R-2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores. Conclusions CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

Place, publisher, year, edition, pages
WILEY PERIODICALS, INC, 2020
Keywords
Heart failure; Cognitive impairment; Exercise capacity
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-162918 (URN)10.1002/ehf2.12542 (DOI)000503196400001 ()31854133 (PubMedID)
Note

Funding Agencies|Swedish National Science Council [K2013-69X-22302-01-3, 2016-01390]; Swedish National Science Council/Swedish Research Council for Health, Working Life and Welfare (VR-FORTE) [2014-4100]; Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation [E085/12]; Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation [20130340, 20160439]; Vardal Foundation [2014-0018]; Medical Research Council of Southeast Sweden [FORSS 474681]

Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2021-12-28
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4259-3671

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