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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
Hjelm, C., Andreae, C. & Isaksson, R.-M. (2019). From insecurity to perceived control over the heart failure disease–A qualitative analysis. Nursing & Care Open Access Journal, 6(3), 101-105
Open this publication in new window or tab >>From insecurity to perceived control over the heart failure disease–A qualitative analysis
2019 (English)In: Nursing & Care Open Access Journal, E-ISSN 2572-8474, Vol. 6, no 3, p. 101-105Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: The objective in our study was to explore chronic heart failure patients’ perceived control over their heart disease.

Background: Higher levels of perceived control over one’s chronic heart disease are associated with lower levels of psychological distress and a higher quality of life.

Design: The study has an explorative and descriptive design using a directed manifest qualitative content analysis according to Marring.

Methods: The analysis was based on nine interviews with four men and five women aged between 62-85 years, diagnosed with chronic heart failure. The study followed consolidated criteria for reporting qualitative research (COREQ).

Results: Five categories emerged in the analysis, mirroring a step-by-step process. The first step, insecurity, was followed by evaluation, management and adjustment. The patients finally reached a higher level of perceived control over their lives in relation to their heart disease.

Conclusions: Most of the patients stated that they could assess and manage symptoms and had adapted to their condition, which increased their level of perceived control.

Relevance to clinical practice: These findings suggest that managing symptoms is important for strengthen the patients with chronic heart failure. The findings can help health care professionals in communication with the patient planning for self-care actions.

Place, publisher, year, edition, pages
MedCrave, 2019
Keywords
Control attitude scale, heart disease, heart failure, perceived control, self-care
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:liu:diva-160805 (URN)
Note

DOI does not work: https://doi.org/10.15406/ncoaj.2019.06.00191

Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2019-10-09Bibliographically approved
Andreae, C. (2018). Appetite in patients with heart failure: Assessment, prevalence and related factors. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Appetite in patients with heart failure: Assessment, prevalence and related factors
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Appetite is an important component in nutrition for maintaining the food intake needed by the body. Decreased appetite is a common clinical problem in patients with heart failure. It has a negative impact on food intake and possibly on malnutrition and health outcomes. There is a lack of evidence on how to assess appetite in heart failure. Furthermore, there are knowledge gaps about factors associated with appetite and which role appetite plays for health status in heart failure.  

Aim: The overall aim of the thesis was to investigate appetite in patients with heart failure. Four studies were conducted with the goal to evaluate the psychometric properties of the Council on Nutrition Appetite Questionnaire (CNAQ) (I) and to explore the prevalence of decreased appetite and related factors associated with appetite in patients with heart failure (II-IV).  

Methods: A multicenter study was conducted in three outpatient heart failure clinics in the center of Sweden during 2009-2012. Data were collected through a baseline measurement (I-IV) and an 18-month follow-up (IV). The first study was a psychometric evaluation study (I), while the other studies had an observational cross-sectional design (II-III) and an observational prospective design (IV). One hundred and eighty-six patients diagnosed with heart failure and experiencing heart failure symptoms participated at baseline. At the 18-month follow-up study (IV), one hundred and sixteen participants from the baseline participated. Data were collected from medical records (pharmacological treatment, comorbidity, left ventricle ejection fraction, time of diagnosis), self-reported questionnaires (demographic background data, appetite, symptoms of depression, health status, sleep, self-reported physical activity), objective measurements (anthropometric assessment of body size, blood samples, six minutes’ walk test, and physical activity measured with an actigraph) and clinical assessment (New York Heart Association (NYHA) functional classification, and cognitive assessment). The main outcome variables included appetite (I, II and IV) and health status (III). Descriptive and inferential statistics were used in the studies (I-IV).  

Results: The majority of the participants had moderate heart failure symptoms, i.e., NYHA class II (n=114, 61%). Most of the participants were men (n=130, 70%). Mean age was 70,7 years, (SD=11,0), and mean BMI was 28.7 (SD=5.3). The CNAQ showed acceptable psychometric properties for assessing appetite in patients with heart failure (I). This thesis shows that 38% of the participants experienced an appetite level that put them at risk of weight loss (I). It was shown that factors such as biological, medical, psychological (II) and physical activity/exercise capacity (IV) are associated with appetite. Also, appetite was associated with impaired health status. However, this association was found to be moderated by symptoms of depression (III). Neither appetite nor physical activity changed during the 18-month follow-up (IV).  

Conclusion: Decreased appetite is a serious phenomenon that needs attention in the care of patients with heart failure. Health care professionals can now use a validated and simple appetite instrument to assess appetite in heart failure. In addition, attention should be paid to elderly patients and those who have symptoms of depression, sleep problems, impaired cognitive function and impaired physical activity, as well as to patients on suboptimal medical treatment. Higher appetite was shown to contribute to a better health status, but this was only evident in patients without symptoms of depression. Therefore, special attention should be paid to symptoms of depression, as this risk factor affected the association between appetite and health status. This thesis enhances the understanding of the magnitude of the problem with decreased appetite in heart failure both in numbers and factors. New priorities in nutrition care and new ideas can be established, both in practice and in research, in order to improve a nutrition care that is vital for patients with heart failure.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 87
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1606
Keywords
Appetite, Age, Cognitive function, Depression, Health status, Heart failure, Malnutrition, Physical activity, Psychometrics, Pharmacotherapy, Sleep
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-145533 (URN)10.3384/diss.diva-145533 (DOI)9789176853733 (ISBN)
Public defence
2018-04-20, Berzeliussalen, Ingång 65, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2018-03-14 Created: 2018-03-05 Last updated: 2019-09-30Bibliographically approved
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
Lennie, T. A., Andreae, C., Rayens, M. K., Song, E. K., Dunbar, S. B., Pressler, S. J., . . . Moser, D. K. (2018). Micronutrient Deficiency Independently Predicts Time to Event in Patients with Heart Failure. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(17), 1-10, Article ID e007251.
Open this publication in new window or tab >>Micronutrient Deficiency Independently Predicts Time to Event in Patients with Heart Failure
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 17, p. 1-10, article id e007251Article in journal (Refereed) Published
Abstract [en]

Dietary micronutrient deficiencies have been shown to predict event‐free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event‐free survival, defined as a combined end point of all‐cause hospitalization and death.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151417 (URN)10.1161/JAHA.117.007251 (DOI)000452804600001 ()
Note

Funding agencies: National Institute of Nursing Research [NIH P20NR0106791, NIH RO1NR009280]; American Heart Association; Great Rivers Affiliate Postdoctoral Fellowship; National Center for Research Resources; National Center for Advancing Translational Sciences; General C

Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2019-01-07Bibliographically approved
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
Andreae, C., Årestedt, K., Evangelista, L. L. & Strömberg, A. (2017). Physical activity and appetite in patients with stable heart failure – A cross sectional study. In: : . Paper presented at American Heart Association, Anaheim CA 11-15 November.
Open this publication in new window or tab >>Physical activity and appetite in patients with stable heart failure – A cross sectional study
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151418 (URN)
Conference
American Heart Association, Anaheim CA 11-15 November
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-19
Andreae, C., Årestedt, K., Evangelista, L. & Strömberg, A. (2017). Sedentary lifestyle is associated with poor appetite in patients with heart failure.. In: : . Paper presented at EuroHeartCare Jönköping Sweden 18-20 May.
Open this publication in new window or tab >>Sedentary lifestyle is associated with poor appetite in patients with heart failure.
2017 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151410 (URN)
Conference
EuroHeartCare Jönköping Sweden 18-20 May
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-19
Wleklik, M., Uchmanowicz, I., Jankovska-Polanska, B. & Andreae, C. (2017). The role of nutritional status in elderly patients with heart failure. The Journal of Nutrition, Health & Aging, 22(5), 581-588
Open this publication in new window or tab >>The role of nutritional status in elderly patients with heart failure
2017 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 22, no 5, p. 581-588Article in journal (Refereed) Published
Abstract [en]

Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.

Place, publisher, year, edition, pages
Springer, 2017
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151414 (URN)10.1007/s12603-017-0985-1 (DOI)000432630800005 ()
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-28Bibliographically approved
Andreae, C., Strömberg, A., Sawatzky, R. & Årestedt, K. (2016). Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015). Journal of Cardiac Failure, 22(3), 245-245
Open this publication in new window or tab >>Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015)
2016 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 3, p. 245-245Article in journal (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127054 (URN)10.1016/j.cardfail.2015.11.011 (DOI)000372211300015 ()
Available from: 2016-04-19 Created: 2016-04-13 Last updated: 2017-05-05
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1482-767X

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