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  • 1.
    Alehagen, Urban
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Rehfeld, Jens F.
    University of Copenhagen, Denmark .
    Goetze, Jens P.
    University of Copenhagen, Denmark .
    Pro-A-Type Natriuretic Peptide, Proadrenomedullin, and N-Terminal Pro-B-Type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure2013In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 19, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    Objective: Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP), midregional pro A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care. less thanbrgreater than less thanbrgreater thanMethods and Results: The study included 470 elderly patients (mean age 73 years) with symptoms of heart failure in primary health care. All participants underwent clinical examination, 2-dimenstional echocardiography, and plasma measurement of the 3 propeptides and were followed for 13 years. All mortality was registered during the follow-up period. The 4th quartiles of the biomarkers were applied as cutoff values. NT-proBNP exhibited the strongest prognostic information with andgt;4-fold increased risk for cardiovascular mortality within 5 years. For all-cause mortality MR-proADM exhibited almost 2-fold and NT-proBNP 3-fold increased risk within 5 years. In the 5-13-year perspective, NT-proBNP and MR-proANP showed significant and independent cardiovascular prognostic information. NT-proBNP and MR-proADM showed significant prognostic information regarding all-cause mortality during the same time. In those with ejection fraction (EF) andlt;40%, MR-proADM exhibited almost 5-fold increased risk of cardiovascular mortality with 5 years, whereas in those with EF andgt;50% NT-proBNP exhibited andgt;3-fold increased risk if analyzed as the only biomarker in the model. If instead the biomarkers were all below the cutoff value, the patients had a highly reduced mortality risk, which also could influence the handling of patients. less thanbrgreater than less thanbrgreater thanConclusions: The 3 biomarkers could be integrated in a multimarker strategy for use in primary health care. (J Cardiac Fail 2013;19:31-39)

  • 2.
    Alehagen, Urban
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svensson, E.
    Swedish Defence Research Agency, Division of Command and Control Systems, Department of Man-System Interaction, Linköping, Sweden.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Natriuretic Peptide Biomarkers as Information Indicators in Elderly Patients With Possible Heart Failure Followed Over Six Years: A Head-to-Head Comparison of Four Cardiac Natriuretic Peptides2007In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 13, no 6, p. 452-461Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the differences between natriuretic peptides used to evaluate elderly patients with heart failure. The aim of the study was to evaluate the information and the power to predict cardiovascular mortality derived from an analysis of cardiac natriuretic peptides from the same study population and at the same time. Methods and Results: In all, 415 elderly patients (age 65-82 years) in primary health care were evaluated and followed for 6 years. All patients had symptoms of heart failure and were examined by a cardiologist. An electrocardiogram and chest x-rays were taken, and the systolic and diastolic functions were assessed using Doppler echocardiography. Brain natriuretic peptide (BNP), N-terminal proBNP, atrial natriuretic peptide (ANP), and N-terminal proANP were analyzed. All 4 peptides were associated with age, and only 1 of them showed any gender difference. Three of the 4 peptides (not ANP) provided important information for identifying patients with impaired systolic function and diastolic dysfunction (pseudonormal or restrictive filling pattern), and for assessing the risk of cardiovascular death. Conclusions: Cardiac natriuretic peptides are useful tools for evaluating elderly patients with heart failure. Three of the 4 peptides were very similar. ANP exhibits inferior properties and cannot be recommended in clinical practice. © 2007 Elsevier Inc. All rights reserved.

  • 3.
    Andreae, Christina
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Uppsala University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Sawatzky, Richard
    Trinity Western University, Canada; Centre Health Evaluat and Outcome Science, Canada.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015)2016In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 3, p. 245-245Article in journal (Other academic)
    Abstract [en]

    n/a

  • 4.
    Andreae, Christina
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Sawatzky, Richard
    Trinity Western University, Canada; Providence Health Care Research Institute, Canada.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure2015In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 21, no 12, p. 954-958Article in journal (Refereed)
    Abstract [en]

    Background: Decreased appetite in heart failure (HF) may lead to undemutrition which could negatively influence prognosis. Appetite is a complex clinical issue that is often best measured with the use of self-report instruments. However, there is a lack of self-rated appetite instruments. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are validated instruments developed primarily for elderly people. Yet, the psychometric properties have not been evaluated in HF populations. The aim of the present study was to evaluate the psychometric properties of CNAQ and SNAQ in patients with HE Methods and Results: A total of 186 outpatients with reduced ejection fraction and New York Heart Association (NYHA) functional classifications II-IV were included (median age 72 y; 70% men). Data were collected with the use of a questionnaire that included the CNAQ and SNAQ. The psychometric evaluation included data quality, factor structure, construct validity, known-group validity, and internal consistency. Unidimensionality was supported by means of parallel analysis and confirmatory factor analyses (CFAs). The CFA results indicated sufficient model fit. Both construct validity and known-group validity were supported. Internal consistency reliability was acceptable, with ordinal coefficient alpha estimates of 0.82 for CNAQ and 0.77 for SNAQ. Conclusions: CNAQ and SNAQ demonstrated sound psychometric properties and can be used to measure appetite in patients with HF.

  • 5.
    Barbareschi, Giorgio
    et al.
    University of Groningen.
    Sanderman, Robbert
    University of Groningen.
    Lesman Leegte, Ivonne
    University of Groningen.
    J. Van Veldhuisen, Dirk
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Educational Level and the Quality of Life of Heart Failure Patients: A Longitudinal Study2011In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 17, no 1, p. 47-53Article in journal (Refereed)
    Abstract [en]

    Background: Lower education in heart failure (HF) patients is associated with high levels of anxiety, limited physical functioning, and an increased risk of hospitalization. We examined whether educational level is related to longitudinal differences in quality of life (QoL) in HF patients. Methods and Results: This research is a substudy of the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH). QoL of 553 HF patients (mean age 69, 38% female, mean left ventricular ejection fraction 33%) was assessed during their hospitalization and at 4 follow-up measurements after discharge. In total 32% of the patients had very low, 24% low, 32% medium, and 12% high education. Patients with low educational levels reported the worst QoL. Significant differences between educational groups (P less than .05) were only reported in physical functioning, social functioning, energy/fatigue, pain, and limitations in role functioning related to emotional problems. Longitudinal results show that a significantly higher proportion of high-educated patients improved in functional limitations related to emotional problems over time compared with lower-educated patients (P less than .05). Conclusions: Patients with low educational levels reported the worst physical and functional condition. High-educated patients improved more than the other patients in functional limitations related to emotional problems over time. Low-educated patients may require different levels of intervention to improve their physical and functional condition.

  • 6. De Smedt, Ruth H E
    et al.
    Jaarsma, Tiny
    Haaijer-Ruskamp, Flora M
    Denig, Petra
    The impact of perceived adverse effects on medication changes in heart failure patients.2010In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 16, no 2, p. 135-41.e2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Given the importance of patient safety and well-being, we quantified the likelihood and type of medication changes observed after 5 possible adverse effects (AE) perceived by heart failure (HF) patients. METHODS AND RESULTS: We conducted a retrospective cohort study using 18 months follow-up data from the Coordinating study evaluating Outcomes of Advising and Counseling in HF study on 754 patients previously hospitalized for HF (NYHA II-IV, mean age 70 years). Data used for this secondary analysis included problem checklists that patients had completed at 3 points in time, and medication data collected from chart review. Changes in potential causal cardiovascular medication and relevant alleviating medication were classified. Within group and relative risks (RR) for medication changes were calculated. Of the 754 patients, 50% reported dizziness, 44% dry cough, 19% nausea, 19% diarrhea, and 12% gout on the first checklist. Overall, the likelihood of a medication change was increased by 38% after a perceived AE. Dry cough had the highest increased likelihood of an associated cardiovascular medication change (RR 1.83, CI 1.35-2.49). Patients reporting gout had a four fold higher likelihood of alleviating medication started or intensified. CONCLUSIONS: A considerable number of HF patients perceived possible AE. However, the likelihood of medication being changed after a possible AE was rather low. There seems to be room for improving the management of AE.

  • 7.
    Gustafsson, Mikael
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Alehagen, Urban
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Imaging congestion with a pocket ultrasound device - prognostic implications in patients with chronic heart failure.2015In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 21, no 7, p. 548-554Article in journal (Refereed)
    Abstract [en]

    AIMS: Venous congestion is common in patients with chronic heart failure (HF). We used a pocket-sized ultrasound imaging device (PID) to assess the patient's congestive status and related our findings to prognosis.

    METHODS AND RESULTS: 104 consecutive outpatients from an HF outpatient clinic were studied. Interstitial lung water (ILW), pleural effusion (PE) and the diameter of the vena cava inferior (VCI) were assessed using a PID. ILW was assessed by demonstration of B-lines (comet tail artefact (CTA). Out of the 104 patients, 28 had CTA, and eight had PE. Median VCI diameter was 18 mm, ±14/22 mm (quartiles). Each of these parameters correlated weakly (r= 0.26-0.37, p< 0.05) with the HF biomarker NT-proBNP. During the median follow-up time of 530 days, 14 hospitalizations deaths and 7 deaths were registered. Findings of CTA, PE or a composite of both, increased the risk of death or hospitalization (hazard ratio 3-4, p< 0.05). After adjustment for age, cardiac systolic function and NT-proBNP, this difference remained significant for CTA alone and CTA + PE combined, but not for PE alone.

    CONCLUSION: By using a handheld ultrasound device, signs of pulmonary congestion could be demonstrated. When found, these had a significant prognostic impact in clinically stable HF.

  • 8. Hwang, Boyoung
    et al.
    Luttik, Marie Louise
    Dracup, Kathleen
    Jaarsma, Tiny
    Family caregiving for patients with heart failure: types of care provided and gender differences.2010In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 16, no 5, p. 398-403Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge about the potential burden for family caregivers related to the care of patients with heart failure (HF) is limited. The aims of the study were to compare the kind and amount of care provided by partners of HF patients and partners of healthy individuals and to examine the associations between gender and the performance of caregiving tasks. METHODS AND RESULTS: Caregiving tasks performed by 338 partners of HF patients were compared with those performed by 1202 partners of healthy individuals. Partners (age 70 +/- 9, 76% female) of HF patients were more likely to provide personal care compared with partners (age 65 +/- 7, 66% female) of healthy individuals after controlling for their age. However, the magnitude of the odds ratios (OR) differed by gender of partners (OR for male 6.7; 95% confidence interval [CI] 3.9-11.4; OR for female 3.7; 95% CI 2.7-5.1). Partners of HF patients were more likely to provide emotional care than partners of healthy individuals, controlling for age and gender (OR 2.4; 95% CI 1.5-3.6). Male partners of HF patients were more likely to provide personal care compared to female partners of HF patients (OR 1.9; 95% CI 1.1-3.2). CONCLUSIONS: The care performed by partners of HF patients is above and beyond normal spousal assistance. The study underscores the crucial role of family caregivers in the care of HF patients and encourages health care providers to address the needs of both HF patients and their caregivers.

  • 9.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    van der Wal, M H L
    van Veldhuisen, D J
    Diversity in management of heart failure patients.2006In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 12, no 7, p. 584-5Article in journal (Refereed)
  • 10.
    Johansson, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    van der Wal, Martje
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Association Between Prehospital Delay and Subsequent Clinical Course in Patients With/Hospitalized for Heart Failure2012In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 3, p. 202-207Article in journal (Refereed)
    Abstract [en]

    Background: The clinical consequences of prehospital delay in heart failure (HF) patients are unknown. This study explores the relationship between prehospital delay of HF patients and length of hospital stay, plasma values of brain natriuretic peptides (BNP) as well as the association of delay with all-cause mortality, readmission for HF, or all-cause readmissions during short-(60 days) and long-term (18 months) follow-up. less thanbrgreater than less thanbrgreater thanMethods: Data from 1023 hospitalized HF patients mean aged 71 years from the Coordinating study evaluating Outcomes of Advising and Counselling in HF study were analyzed. less thanbrgreater than less thanbrgreater thanResults: Patients who delayed less than 1 day had significantly shorter stay in hospital (10 days vs. 11 days, P = 0.033). They also had significantly (P = 0.004) lower median plasma values of BNP (377 pg/mL) at discharge compared to patients who delayed andgt;24 hours (492 pg/mL). Delay was not related to all-cause mortality and/or readmissions for HF. less thanbrgreater than less thanbrgreater thanConclusion: Although patients with a prehospital delay less than 1 day were more symptomatic on admission, they had a shorter hospital stay as well as lower plasma values of BNP at discharge. Delay was not associated hospital readmissions or mortality after discharge.

  • 11.
    Jonkman, Nini H.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Westland, Heleen
    University of Medical Centre Utrecht, Netherlands.
    Groenwold, Rolf H. H.
    University of Medical Centre Utrecht, Netherlands.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Anguita, Manuel
    Hospital Reina Sofia, Spain.
    Blue, Lynda
    British Heart Fdn, Scotland.
    Bruggink-Andre de la Porte, Pieta W. F.
    Deventer Hospital, Netherlands.
    Dewalt, Darren A.
    University of N Carolina, NC USA.
    Hebert, Paul L.
    University of Washington, WA 98195 USA.
    Heisler, Michele
    University of Michigan, MI 48109 USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kempen, Gertrudis I. J. M.
    Maastricht University, Netherlands.
    Leventhal, Marcia E.
    University of Basel, Switzerland.
    Lok, Dirk J. A.
    Deventer Hospital, Netherlands.
    Martensson, Jan
    Jönköping University, Sweden.
    Muniz, Javier
    University of A Coruna, Spain; INIBIC, Spain; Institute Salud Carlos III, Spain.
    Otsu, Haruka
    Hirosaki University, Japan.
    Peters-Klimm, Frank
    University of Heidelberg Hospital, Germany.
    Rich, Michael W.
    Washington University, MO 63110 USA.
    Riegel, Barbara
    University of Penn, PA 19104 USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Tsuyuki, Ross T.
    University of Alberta, Canada.
    Trappenburg, Jaap C. A.
    University of Medical Centre Utrecht, Netherlands.
    Schuurmans, Marieke J.
    University of Medical Centre Utrecht, Netherlands.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis2016In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 11, p. 861-871Article in journal (Refereed)
    Abstract [en]

    Background: To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results: Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97-0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96-0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92-0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion: No specific program characteristics were consistently associated with better effects of self management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

  • 12.
    Kato, Naoko
    et al.
    University of Tokyo, Japan; The Japan Society for the Promotion of Science, Tokyo, Japan.
    Kinugawa, K.
    University of Tokyo, Japan.
    Yao, A.
    University of Tokyo, Japan.
    Hatano, M.
    University of Tokyo, Japan.
    Shiga, T.
    University of Tokyo, Japan.
    Kazuma, K.
    University of Tokyo, Japan.
    Relationship of depressive symptoms with hospitalization and death in Japanese patients with heart failure2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 10, p. 912-919Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Depressive symptoms are risk factors for poor outcomes and are positively associated with disease severity in patients with heart failure (HF). However, little is known about this association in the Japanese population. Therefore, we evaluated the prevalence of depressive symptoms and whether depressive symptoms predicted hospitalization for HF and death independent of disease severity and other factors in HF patients.

    METHODS AND RESULTS:

    A 2-year prospective cohort study was conducted on 115 outpatients with HF (73.9% males; mean age 64.7 years) in Tokyo. Of these, 27 patients (23.5%) were classified as having depressive symptoms (Center for Epidemiologic Studies Depression Scale score >or=16). Patients with depressive symptoms had higher rates of 2-year cardiac death or HF hospitalization (34.0% vs. 10.3%; P < .01), HF hospitalization (27.4% vs. 9.2%; P = .01), and all-cause death (27.4% vs. 7.2%; P < .01). Multivariate Cox regression analyses indicated that depressive symptoms were predictors of cardiac death or HF hospitalization (hazard ratio [HR], 3.29; P = .02), HF hospitalization (HR, 3.36; P = .04), and all-cause death (HR, 5.52; P = .01), independent of age and brain natriuretic peptide.

    CONCLUSIONS:

    Depressive symptoms were common and independent predictors of poor outcomes in Japanese patients with HF.

  • 13.
    Kraai, IH
    et al.
    University Medical Centre Groningen.
    Luttik, M L A
    University Medical Centre Groningen.
    de Jong, R M
    University Medical Centre Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hillege, H L
    University Medical Centre Groningen.
    Heart Failure Patients Monitored With Telemedicine: Patient Satisfaction, a Review of the Literature2011In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 17, no 8, p. 684-690Article, review/survey (Refereed)
    Abstract [en]

    Background: Remote monitoring of the clinical status of heart failure patients has developed rapidly and is the subject of several trials. Patient satisfaction is an important outcome, as recommended by the U.S. Food and Drug Administration to use in clinical research, and should be included in studies concerning remote monitoring. The objective of this review is to describe the current state of the literature on patient satisfaction with noninvasive telemedicine, regarding definition, measurement, and overall level of patient satisfaction with telemedicine. less thanbrgreater than less thanbrgreater thanMethods and Results: The Pubmed, Embase, Cochrane, and Cinahl databases were searched using heart failure, satisfaction-, and telemedicine-related search terms. The literature search identified 193 publications, which were reviewed by 2 independent reviewers. Fourteen articles were included. None of the articles described a clear definition or concept of patient satisfaction with telemedicine. Patient satisfaction with telemedicine was measured with self-developed questionnaires or face-to-face or telephonic interviews. None of the articles used the same questionnaire or telephonic survey to measure patient satisfaction. Only one questionnaire was assessed for validity and reliability. In general, patients seemed to be satisfied or very satisfied with the use of telemedicine. less thanbrgreater than less thanbrgreater thanConclusions: Measurement of patient satisfaction is still underexposed in telemedicine research and the measurement of patient satisfaction with telemedicine underappreciated with poorly constructed questionnaires.

  • 14. Lesman-Leegte, Ivonne
    et al.
    Jaarsma, Tiny
    Coyne, James C
    Hillege, Hans L
    Van Veldhuisen, Dirk J
    Sanderman, Robbert
    Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 1, p. 17-23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Comparisons of heart failure (HF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly. METHODS AND RESULTS: Data were collected from 781 HF patients (36% female; age 72 +/- 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D >or=16: 39% vs. 21%, P < .001). HF patients had more chronic conditions-specifically diabetes and asthma/chronic obstructive pulmonary disease. Impaired QoL and depressive symptoms were most prevalent among HF patients with comorbidities. Prevalence was also higher in HF patients in the absence of these conditions. CONCLUSIONS: HF has a large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls.

  • 15. Luttik, Marie Louise
    et al.
    Lesman-Leegte, I
    Jaarsma, Tiny
    Quality of life and depressive symptoms in heart failure patients and their partners: the impact of role and gender.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 7, p. 580-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partners of heart failure (HF) patients are important in the course and management of the disease. It is unclear whether HF affects the quality of life (QoL) of partners as much as it affects the QoL of patients. METHODS AND RESULTS: The study aims to determine the influence of role (patient or partner) and gender on quality of life (QoL) and depressive symptoms in HF patients and their partners. Using a cross-sectional design, data on demographics, QoL, and depressive symptoms were collected from 393 HF patients (age, 68+/-11; 76% male) and their partners (age, 67+/-12; 24% male) using questionnaires (Medical Outcome Study 36-item General Health Survey [RAND-36], Cantril Ladder of Life, and Center for Epidemiologic Studies Depression Scale) that were send at home. At a group level HF, patients reported a significantly worse QoL and more depressive symptoms compared with their partners. When examining the influence of role and gender a significant interaction between role and gender was found. QoL in terms of general well-being of female HF partners and female HF patients did not differ (7.0 vs. 6.9), whereas male partners had a significantly higher well-being compared to male HF patients (7.6 vs. 6.8). Most of the RAND-36 domains were explained by role (either being a patient or a partner) with patients having lower scores compared with their partners. However, the RAND-36 domain mental health was mainly explained by gender, with women reporting worse mental health compared with men, independent of their role as a patient or a partner. The same trend was found for the presence of depressive symptoms. CONCLUSIONS: Females, either as patients or as partners are vulnerable in their response to HF in terms of their QoL. The QoL of male partners does not seem to be negatively affected. Supporting couples who are dealing with HF requires different interventions for male and female patients and their partners.

  • 16.
    Nieuwenhuis, Maurice M W
    et al.
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Van Veldhuisen, Dirk J
    University of Groningen.
    Van Der Wal, Martje H L
    University of Groningen.
    Factors Associated With Patient Delay in Seeking Care After Worsening Symptoms in Heart Failure Patients2011In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 17, no 8, p. 657-663Article in journal (Refereed)
    Abstract [en]

    Background: To receive optimal treatment and care, it is essential that heart failure (HF) patients react adequately to worsening symptoms and contact a health care provider early. This specific "patient delay" is an important part of the total delay time. The purpose of this study was to assess patient delay and its associated variables in HF patients. less thanbrgreater than less thanbrgreater thanMethods and Results: In this cross-sectional study, data of 911 hospitalized HF patients from 17 Dutch hospitals (mean age 71 +/- 12 years; 62% male; left ventricular ejection fraction 34 +/- 15%) were analyzed. During the index hospitalization, patient delay and HF symptoms were assessed by interview. Patients completed questionnaires on depressive symptoms, knowledge and compliance. Clinical and demographic data were collected from medical charts and interviews by an independent data collector. Logistic regression analysis was performed to examine independent associations with patient delay. Median patient delay was 48 hours; 296 patients reported short delay (andlt;12 h) and 341 long delay (andgt;= 168 h). A history of myocardial infarction (MI) (odds ratio [OR] 0.49, 95% confidence interval [Cl] 0.34-0.71) or stroke (OR 0.43, 95% CI 0.24-0.76) was independently associated with short patient delay. Male gender, more HF knowledge, and more HF symptoms were associated with long patient delay. No differences were found between patients with and without a history of HF. less thanbrgreater than less thanbrgreater thanConclusions: Patients with a history of a life-threatening event (MI or stroke) had a shorter delay than patients without such an event. Patients without a life-threatening event might need to be educated on the recognition and need for appropriate action in a different way then those with an acute threatening previous experience.

  • 17.
    Savarese, Gianluigi
    et al.
    Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Orsini, Nicola
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hage, Camilla
    Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Vedin, Ola
    Uppsala University and Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
    Rosano, Giuseppe M C
    St George's University, London, UK, St George's University, IRCCS San Raffaele Pisana, Rome, Italy.
    Lund, Lars H
    Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Karolinska University Hospital, Stockholm, Sweden..
    Associations With and Prognostic and Discriminatory Role of N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure With Preserved Versus Mid-range Versus Reduced Ejection Fraction.2018In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 24, no 6, p. 365-374Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to characterize N-terminal pro-B-type natriuretic peptide (NT-proBNP) in terms of determinants of levels and of its prognostic and discriminatory role in heart failure with mid-range (HFmrEF) versus preserved (HFpEF) and reduced (HFrEF) ejection fraction.

    METHODS AND RESULTS: In 9847 outpatients with HFpEF (n = 1811; 18%), HFmrEF (n = 2122; 22%) and HFrEF (n = 5914; 60%) enrolled in the Swedish Heart Failure Registry, median NT-proBNP levels were 1428, 1540, and 2288 pg/mL, respectively. Many determinants of NT-proBNP differed by ejection fraction, with atrial fibrillation (AF) more important in HFmrEF and HFpEF, diabetes and hypertension in HFmrEF, and age and body mass index in HFrEF and HFmrEF, whereas renal function, New York Heart Association functional class, heart rate, and anemia were similar. Hazard ratios for death and death/HF hospitalization for NT-proBNP above the median ranged from 1.48 to 2.00 and were greatest for HFmrEF and HFpEF. Areas under the receiver operating characteristic curve for death and death/HF hospitalization were greater in HFmrEF than in HFpEF and HFrEF and were reduced by AF in HFpEF and HFmrEF but not in HFrEF.

    CONCLUSIONS: In HFpEF and especially HFmrEF, NT-proBNP was more prognostic and discriminatory, but also more affected by confounders such as AF. These data support the use of NT-proBNP for eligibility, enrichment, and surrogate end points in HFpEF and HFmrEF trials, and suggest that cutoff levels for eligibility should be carefully tailored to comorbidity.

  • 18.
    Wagenaar, Kim P.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Hakim, Niaz
    University of Medical Centre Utrecht, Netherlands.
    Broekhuizen, Berna D. L.
    University of Medical Centre Utrecht, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Rutten, Frans H.
    University of Medical Centre Utrecht, Netherlands.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    Representativeness of Participants in Heart Failure E-Health Trials: A Report From the E-Vita HF Study2017In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 23, no 1, p. 88-89Article in journal (Other academic)
    Abstract [en]

    n/a

  • 19.
    Waldréus, Nana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences. Sodertalje Sjukhus, Sweden.
    van der Wal, Martje H. L.
    University of Groningen, Netherlands.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Sodertalje Sjukhus, Sweden.
    van Veldhuisen, Dirk J.
    University of Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure2014In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 20, no 9, p. 689-695Article in journal (Refereed)
    Abstract [en]

    Background: Thirst is often increased in patients with heart failure (HF) and can cause distress during the course of the condition. The aim of the present study was to describe the trajectory of thirst during an 18-month period and to identify variables associated with persistent thirst in patients with HF. Methods and Results: Data were collected from 649 patients with HF with the use of the Revised Heart Failure Compliance Scale at 1, 6, 12, and 18 months after a period of hospital treatment for worsening HF. Thirst trajectory was described for the 4 follow-up visits and logistic regression analysis was used to identify factors independently associated with persistent thirst. In total, 33% (n = 212) of the patients reported thirst on greater than= 1 occasions and 34% (n = 46) continued to have thirst at every follow-up visit. Nineteen percent (n = 121) of the patients had persistent thirst. Patients with persistent thirst were more often younger and male and had more HF symptoms. Higher body mass index and serum urea also increased the risk of persistent thirst. Conclusions: Patients with HF who were thirsty at the 1-month follow-up were more often also thirsty at subsequent visits. Assessment of thirst is warranted in clinical practice because one-fifth of patients suffer from persistent thirst.

  • 20.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners2012In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 5, p. 359-366Article in journal (Refereed)
    Abstract [en]

    Background: Chronic heart failure (HF) may cause great suffering for both patients and their partners. High marital quality with sufficient emotional support has been found to influence long-term survival in patients with chronic HF. However, emotional reactions of burden, stress and depression have been found to be associated with the partner’s new role. Psychosocial support, and patients-partner education is usually not included in standard chronic HF care despite recommendations in international guidelines.

    Aim: To evaluate the effects of an integrated dyad care programme with education and psychosocial support to patients with chronic HF and their partners during a post-discharge period of 3 months after acute deterioration of chronic HF.

    Methods: A randomised, controlled design with a follow up assessment after 3 months was used. The dyads in the control group received care as usual. The experimental group participated in an integrated care intervention, delivered in three modules through nurse-led face-to-face counselling, a computer-based CD-ROM program and other written teaching materials.

    Results: The intervention improved perceived control (P<0.05) in patients, but not in the partners. There were no other significant differences between the groups with regard to the dyads’ health related quality of life and depressive symptoms, patients’ self-care behaviour and partners’ experiences of caregiver burden.

    Conclusion: This is the first major randomised study evaluating a programme focusing on the development of problem solving skills to assist the dyads in managing heart failure. The intervention significantly improved the level of perceived control in the patient group.

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