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  • 1.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Lie, Irene
    Oslo Univ Hosp, Norway; Norwegian Univ Sci & Technol, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania; Vilnius Univ, Lithuania.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Informal Caregivers Experiences with Performing Telemonitoring in Heart Failure Care at Home-A Qualitative Study2022In: Healthcare, E-ISSN 2227-9032, Vol. 10, no 7, article id 1237Article in journal (Refereed)
    Abstract [en]

    Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.

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  • 2.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp Ulleval, Norway; Univ Oslo, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    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.
    Atar, Dan
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Falk, Ragnhild Sorum
    Oslo Univ Hosp, Norway.
    von Lueder, Thomas
    Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lie, Irene
    Oslo Univ Hosp Ulleval, Norway.
    Health Care Professionals Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey2019In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 2, article id e10362Article in journal (Refereed)
    Abstract [en]

    Background: Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim of this study was to describe health care professionals (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. Results: This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

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  • 3.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    von Lueder, Thomas
    Oslo Univ Hosp, Norway.
    Atar, Dan
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Falk, Ragnhild Sorum
    Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 1, article id e15445Article in journal (Refereed)
    Abstract [en]

    Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the Cardio Set Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

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  • 4.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 23, article id 8916Article in journal (Refereed)
    Abstract [en]

    Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

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  • 5.
    Adamo, Marianna
    et al.
    Univ Brescia, Italy.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    Pagnesi, Matteo
    Univ Brescia, Italy.
    Bayes-Genis, Antoni
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Abdelhamid, Magdy
    Cairo Univ, Egypt.
    Anker, Stefan D.
    German Ctr Cardiovasc Res DZHK, Germany; Charite Univ Med Berlin, Germany.
    Antohi, Elena-Laura
    Univ Med & Pharm Carol Davila, Romania.
    Badano, Luigi
    Ist Auxol Italiano, Italy; Univ Milano Bicocca, Italy.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    Boehm, Michael
    Saarland Univ Hosp, Germany.
    Delgado, Victoria
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Dreyfus, Julien
    Ctr Cardiol Nord, France.
    Faletra, Francesco F.
    ISMETT Ist Mediterraneo Trapianti & Terapie Alta S, Italy; Fdn Cardioctr Ticino, Switzerland.
    Farmakis, Dimitrios
    Athens Univ Hosp Attikon, Greece.
    Filippatos, Gerasimos
    Athens Univ Hosp Attikon, Greece.
    Grapsa, Julia
    Kings Coll London, England.
    Gustafsson, Finn
    Copenhagen Univ Hosp, Denmark.
    Hausleiter, Joerg
    Div Cardiol, Germany.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Karam, Nicole
    Univ Paris Cite, France.
    Lund, Lars
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Lurz, Philipp
    Univ Med Ctr Mainz, Germany.
    Maisano, Francesco
    Univ Vita Salute, Italy.
    Moura, Brenda
    Univ Porto, Portugal; Porto Armed Forces Hosp, Portugal.
    Mullens, Wilfred
    Hosp Oost Limburg, Belgium.
    Praz, Fabien
    Univ Bern, Switzerland.
    Sannino, Anna
    Univ Naples Federico II, Italy.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Tocchetti, Carlo Gabriele
    Univ Naples Federico II, Italy.
    van Empel, Vanessa P. M.
    Maastricht Univ Med Ctr MUMC, Netherlands.
    von Bardeleben, Ralph Stephan
    Univ Med Ctr Mainz, Germany.
    Yilmaz, Mehmet Birhan
    Dokuz Eylul Univ, Turkiye.
    Zamorano, Jose Luis
    Hosp Univ Ramon y Cajal, Spain.
    Ponikowski, Piotr
    Wroclaw Med Univ, Poland.
    Barbato, Emanuele
    Sapienza Univ Rome, Italy.
    Rosano, Giuseppe M. C.
    Dept Med Sci, Italy.
    Metra, Marco
    Univ Brescia, Italy; Univ Brescia, Italy.
    Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC2024In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed)
    Abstract [en]

    Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.

  • 6.
    Adamopoulos, Stamatis
    et al.
    Onassis Cardiac Surg Ctr, Greece.
    Corra, Ugo
    Ctr Med Riabilitaz Veruno, Italy.
    Laoutaris, Ioannis D.
    Onassis Cardiac Surg Ctr, Greece.
    Pistono, Massimo
    Ctr Med Riabilitaz Veruno, Italy.
    Agostoni, Pier Giuseppe
    IRCCS, Italy; Univ Milan, Italy.
    Coats, Andrew J. S.
    IRCCS San Raffaele Pisana, Italy.
    Leiro, Maria G. Crespo
    UDC, Spain.
    Cornelis, Justien
    Univ Antwerp, Belgium.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Filippatos, Gerasimos
    Attikon Univ Hosp, Greece.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ruschitzka, Frank
    Univ Heart Ctr, Switzerland.
    Seferovic, Petar M.
    Univ Belgrade, Serbia.
    Schmid, Jean-Paul
    Klin Barmelweid AG, Switzerland.
    Volterrani, Maurizio
    IRCCS San Raffaele Pisana, Italy.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology2019In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, no 1Article, review/survey (Refereed)
    Abstract [en]

    Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patients functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patients needs. Finally, gaps in our knowledge are discussed.

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  • 7.
    Agren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Luttik, ML
    Caregiving tasks and caregiver burden over time: effects of an intervention for patients with post-operative heart failure and their partners.2014Conference paper (Refereed)
  • 8.
    Aimo, Alberto
    et al.
    Scuola Super Sant Anna, Italy; Fdn Toscana Gabriele Monasterio, Italy.
    Vergaro, Giuseppe
    Scuola Super Sant Anna, Italy; Fdn Toscana Gabriele Monasterio, Italy.
    Gonzalez, Arantxa
    Univ Navarra, Spain; Navarra Inst Hlth Res, Spain; Carlos III Inst Hlth, Spain.
    Barison, Andrea
    Scuola Super Sant Anna, Italy; Fdn Toscana Gabriele Monasterio, Italy.
    Lupon, Josep
    Hosp Badalona Germans Trias & Pujol, Spain.
    Delgado, Victoria
    Hosp Badalona Germans Trias & Pujol, Spain.
    Richards, A. Mark
    Univ Otago, New Zealand.
    de Boer, Rudolf A.
    Univ Med Ctr Groningen, Netherlands.
    Thum, Thomas
    Med Univ Vienna, Austria; German Ctr Cardiovasc Res DZHK, Germany.
    Arfsten, Henrike
    Med Univ Vienna, Austria; German Ctr Cardiovasc Res DZHK, Germany.
    Hulsmann, Martin
    Med Univ Vienna, Austria.
    Falcao-Pires, Ines
    Univ Porto, Portugal.
    Diez, Javier
    Ctr Appl Med Res, Spain.
    Foo, Roger S. Y.
    Natl Univ Singapore Hosp, Singapore.
    Chan, Mark Yan Yee
    Natl Univ Singapore Hosp, Singapore.
    Anene-Nzelu, Chukwuemeka G.
    Natl Univ Singapore Hosp, Singapore.
    Abdelhamid, Magdy
    Cairo Univ, Egypt.
    Adamopoulos, Stamatis
    Onassis Cardiac Surg Ctr, Greece.
    Anker, Stefan D.
    Charite, Germany; Charite, Germany.
    Belenkov, Yuri
    Lomonosv Moscow State Univ, Russia.
    Gal, Tuvia B.
    Rabin Med Ctr, Israel.
    Cohen-Solal, Alain
    Hosp Lariboisiere, France.
    Bohm, Michael
    Univ Saarland, Germany.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    Jankowska, Ewa A.
    Wroclaw Med Univ, Poland.
    Gustafsson, Finn
    Copenhagen Univ Hosp, Denmark.
    Hill, Loreena
    Queens Univ Belfast, North Ireland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Januzzi, James L.
    Massachusetts Gen Hosp, MA 02114 USA; Baim Inst Clin Res, MA USA.
    Jhund, Pardeep
    Univ Glasgow, Scotland.
    Lopatin, Yuri
    Volgograd State Med Univ, Russia.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Metra, Marco
    Univ Brescia, Italy.
    Milicic, Davor
    Univ Zagreb, Croatia.
    Moura, Brenda
    Univ Porto, Portugal; Porto Armed Forces Hosp, Portugal.
    Mueller, Christian
    Univ Hosp, Switzerland.
    Mullens, Wilfried
    Hosp Oost Limburg, Belgium.
    Nunez, Julio
    Univ Valencia, Spain.
    Piepoli, Massimo F.
    Castelsangiovanni Hosp, Italy.
    Rakisheva, Amina
    Sci Res Inst Cardiol & Internal Med, Kazakhstan.
    Ristic, Arsen D.
    Univ Clin Ctr Serbia, Serbia; Univ Belgrade, Serbia.
    Rossignol, Patrick
    Univ Lorraine, France; CHRU Nancy, France.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Tocchetti, Carlo G.
    Univ Naples Federico II, Italy.
    van Linthout, Sophie
    Charite Univ Med Berlin, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Volterrani, Maurizio
    IRCCS San Raffaele, Italy.
    Seferovic, Petar
    Univ Belgrade, Serbia; Serbian Acad Arts & Sci, Serbia.
    Rosano, Giuseppe
    Univ London, England.
    Coats, Andrew J. S.
    Univ Warwick, England.
    Emdin, Michele
    Scuola Super Sant Anna, Italy; Fdn Toscana Gabriele Monasterio, Italy.
    Bayes-Genis, Antoni
    Carlos III Inst Hlth, Spain; Hosp Badalona Germans Trias & Pujol, Spain; Univ Autonoma Barcelona, Spain.
    Cardiac remodelling - Part 2: Clinical, imaging and laboratory findings. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology2022In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 24, no 6, p. 944-958Article, review/survey (Refereed)
    Abstract [en]

    In patients with heart failure, the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with heart failure with reduced ejection fraction because most studies on cardiac remodelling focused on this setting.

  • 9.
    Allemann, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Andreasson, Frida
    Linnaeus Univ, Sweden.
    Hanson, Elizabeth
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Magnusson, Lennart
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thylén, Ingela
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    The co-design of an online support programme with and for informal carers of people with heart failure: A methodological paper2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 19-20, p. 7589-7604Article in journal (Refereed)
    Abstract [en]

    Aim To describe the co-designing process of an online support programme with and for informal carers of people with heart failure.Design A co-design process built on core concepts and ideas embedded in co-design methodology.Data sources Our co-design process included three phases involving 32 informal caregivers and 25 content creators; (1) Identification of topics and content through literature searches, focus group interviews and user group sessions; (2) Development of the online support programme and; (3) Refinement and finalization which included testing a paper prototype followed by testing the online version and testing and approval of the final version of the support programme.Outcomes The co-design process resulted in a support programme consisting of 15 different modules relevant to informal carers, delivered on a National Health Portal.Conclusion Co-design is an explorative process where researchers need to balance a range of potentially conflicting factors and to ensure that the end users are genuinely included in the process.Relevance to clinical practice Emphasizing equal involvement of end users (e.g. carers or patients) in the design and development of healthcare interventions aligns with contemporary ideas of person-centred care and provides a valuable learning opportunity for those involved. Furthermore, a co-designed online support programme has the capacity to be both accessible and meet end users information and support needs, thereby optimizing their self-care abilities. Additionally, an online support programme provides the opportunity to address current challenges regarding scarce resources and the lack of healthcare personnel.Reporting methods Consolidated criteria for reporting qualitative research (COREQ).Patient or public contribution Both informal carers and content creators were involved in developing the support programme.

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  • 10.
    Andreae, Christina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Tingström, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Operations management PVC.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Med Ctr Utrecht, Netherlands.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM)2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 2, article id e065230Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).Design A prospective, randomised, parallel single centre trial.Settings Primary care settings in Sweden.Participants 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.Intervention Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.Primary and secondary outcomes Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.Results The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.Conclusion One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.

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  • 11.
    Andreae, Christina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    van der Wal, Martje H. L.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
    van Veldhuisen, Dirk J.
    Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
    Yang, Bei
    entre for Clinical Research Sörmland, Uppsala University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands.
    Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life2021In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 36, no 6, p. 539-545Article in journal (Refereed)
    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.

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  • 12.
    Andreassen, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Danielsson, Henrik
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Hemmingsson, Helena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Univ, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    An interactive digital calendar with mobile phone reminders (RemindMe) for people with cognitive impairment: a pilot randomized controlled trial2022In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 4, p. 270-281Article in journal (Refereed)
    Abstract [en]

    Background People with cognitive impairment often need support to perform everyday-life activities. Interventions are available, but evidence-based interventions are lacking. Aim This pilot RCT aimed to investigate use of an intervention with an interactive digital calendar with mobile phone reminders (RemindMe) in relation to change in outcomes and impact on occupational performance, independence, health-related quality of life, and psychosocial impact of the support for people with cognitive impairment. Method The study design was a multi-centre parallel-group pilot RCT [ClinicalTrails.gov, identifier: NCT04470219]. Fifteen participants from primary rehabilitation centres in Sweden were recruited and randomly assigned to intervention group (n = 8) receiving the intervention with RemindMe, or control group (n = 7) receiving usual treatment by an occupational therapist. Data were collected at baseline, after two- and four months, and analysed using descriptive and non-parametric statistics. Result The Canadian Occupational Performance Measure (COPM), and the Functional Independence Measure (FIM item n-r) showed significant differences. There were no significant differences in health-related quality of life nor in the psychosocial impact of the used support. Conclusion Plausible changes in outcome measures were found in COPM and FIM (items n-r). These instruments indicate change in outcome measures and impact on occupational performance and independence.

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  • 13.
    Andreassen, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hemmingsson, Helena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Univ, Sweden.
    Boman, Inga-Lill
    Danderyd Hosp, Sweden.
    Danielsson, Henrik
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Feasibility of an Intervention for Patients with Cognitive Impairment Using an Interactive Digital Calendar with Mobile Phone Reminders (RemindMe) to Improve the Performance of Activities in Everyday Life2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 7, article id 2222Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients needs and thus being person-centered.

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  • 14.
    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.

  • 15.
    Bayes-Genis, Antoni
    et al.
    Hosp Badalona Germans Trias & Pujol, Spain; Inst Salud Carlos III, Spain.
    Januzzi, James L.
    Massachusetts Gen Hosp, MA 02114 USA; Harvard Med Sch, MA 02115 USA; Baim Inst Clin Res, MA USA.
    Richards, A. Mark
    Natl Univ Hlth Syst, Singapore; Univ Otago, New Zealand.
    Arfsten, Henrike
    Med Univ Vienna, Austria.
    de Boer, Rudolf A.
    Univ Groningen, Netherlands.
    Emdin, Michele
    Scuola Super Sant Anna, Italy; Fdn Toscana Gabriele Monasterio, Italy.
    Gonzalez, Arantxa
    Inst Salud Carlos III, Spain; Univ Navarra, Spain; Navarra Inst Hlth Res IdiSNA, Spain.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Jhund, Pardeep S.
    Univ Glasgow, Scotland.
    Mueller, Christian
    Univ Basel, Switzerland; Univ Basel, Switzerland.
    Nunez, Julio
    Inst Salud Carlos III, Spain; Univ Valencia, Spain.
    Rossignol, Patrick
    Univ Lorraine, France.
    Milinkovic, Ivan
    Univ Belgrade, Serbia.
    Rosano, Giuseppe M. C.
    Univ & IRCCS San Raffaele, Italy.
    Coats, Andrew
    Monash Univ, Australia; Univ Warwick, England.
    Seferovic, Petar
    Univ Belgrade, Serbia; Serbian Acad Arts & Sci, Serbia.
    The Peptide for Life Initiative: a call for action to provide equal access to the use of natriuretic peptides in the diagnosis of acute heart failure across Europe2021In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 23, no 9, p. 1432-1436Article in journal (Refereed)
    Abstract [en]

    n/a

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  • 16.
    Ben Avraham, Binyamin
    et al.
    Tel Aviv Univ, Israel.
    Crespo-Leiro, Marisa Generosa
    Univ A Coruna UDC La Coruna, Spain.
    Filippatos, Gerasimos
    Natl & Kapodistrian Univ Athens, Greece; Univ Cyprus, Cyprus.
    Gotsman, Israel
    Hadassah Univ Hosp, Israel.
    Seferovic, Petar
    Belgrade Univ Med Ctr, Serbia.
    Hasin, Tal
    Shaare Zedek Med Ctr, Israel.
    Potena, Luciano
    Bologna Univ Hosp, Italy.
    Milicic, Davor
    Univ Zagreb, Croatia.
    Coats, Andrew J. S.
    Univ Warwick, England.
    Rosano, Giuseppe
    Univ London, England; IRCCS San Raffaele Pisana, Italy.
    Ruschitzka, Frank
    Univ Hosp, Switzerland.
    Metra, Marco
    Univ Brescia, Italy.
    Anker, Stefan
    Charite Univ Med Berlin, Germany.
    Altenberger, Johann
    SKA Rehabilitat zentrum Grossgmain, Austria.
    Adamopoulos, Stamatis
    Onassis Cardiac Surg Ctr, Greece.
    Barac, Yaron D.
    Tel Aviv Univ, Israel.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    De Jonge, Nicolaas
    Univ Med Ctr Utrecht, Netherlands.
    Elliston, Jeremy
    Tel Aviv Univ, Israel.
    Frigeiro, Maria
    Osped Niguarda Ca Granda, Italy; Osped Niguarda Ca Granda, Italy.
    Goncalvesova, Eva
    Odd Srdcovehozlyhavania Transplantade, Slovakia.
    Grupper, Avishay
    Chaim Sheba Med Ctr, Israel; Tel Aviv Univ, Israel.
    Hamdan, Righab
    Beirut Cardiac Inst, Lebanon.
    Hammer, Yoav
    Tel Aviv Univ, Israel.
    Hill, Loreena
    Queens Univ, North Ireland.
    Ben Zadok, Osnat Itzhaki
    Tel Aviv Univ, Israel.
    Abuhazira, Miriam
    Tel Aviv Univ, Israel.
    Lavee, Jacob
    Tel Aviv Univ, Israel; Sheba Med Ctr, Israel.
    Mullens, Wilfried
    Univ Hasselt, Belgium.
    Nalbantgil, Sanemn
    Ege Univ Hosp, Turkey.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Ponikowski, Piotr
    Wroclaw Med Univ, Poland.
    Ristic, Arsen
    Univ Belgrade, Serbia.
    Ruhparwar, Arjang
    Heidelberg Univ, Germany.
    Shaul, Aviv
    Tel Aviv Univ, Israel.
    Tops, Laurens F.
    Leiden Univ Med Ctr, Netherlands.
    Tsui, Steven
    Royal Papworth Hosp, England.
    Winnik, Stephan
    Univ Hosp Zurich, Switzerland; Univ Zurich, Switzerland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Finn
    Rigshosp, Denmark.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider: Part 1: Introduction and at the non-hospital settings in the community2021In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, no 6, p. 4394-4408Article in journal (Refereed)
    Abstract [en]

    The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the destination therapy indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patients pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients.

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  • 17.
    Ben Gal, Tuvia
    et al.
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Ben Avraham, Binyamin
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Abu-Hazira, Miriam
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Frigerio, Maria
    ASST Grande Osped Metropolitano Niguarda, Italy.
    Crespo-Leiro, Maria G.
    Univ A Coruna CHUAC, Spain.
    Oppelaar, Anne Marie
    Univ Utrecht, Netherlands.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Utrecht, Netherlands.
    The consequences of the COVID-19 pandemic for self-care in patients supported with a left ventricular assist device2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 6, p. 933-936Article in journal (Other academic)
    Abstract [en]

    n/a

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  • 18.
    Ben Gal, Tuvia
    et al.
    Tel Aviv Univ, Israel.
    Ben Avraham, Binyamin
    Tel Aviv Univ, Israel.
    Milicic, Davor
    Univ Zagreb, Croatia.
    Crespo-Leiro, Marisa G.
    Univ A Coruna UDC, Spain.
    Coats, Andrew J. S.
    Univ Warwick, England.
    Rosano, Giuseppe
    St Georges Hosp NHS Trust Univ London, England; IRCCS San Raffaele Pisana, Italy.
    Seferovic, Petar
    Belgrade Univ Med Ctr, Serbia.
    Ruschitzka, Frank
    Univ Hosp, Switzerland.
    Metra, Marco
    Univ Brescia, Italy.
    Anker, Stefan
    Charite Univ Med Berlin, Germany.
    Filippatos, Gerasimos
    Natl & Kapodistrian Univ Athens, Greece; Univ Cyprus, Cyprus.
    Altenberger, Johann
    SKA Rehabilitat Zentrum Grossgmain, Austria.
    Adamopoulos, Stamatis
    Onassis Cardiac Surg Ctr, Greece.
    Barak, Yaron
    Tel Aviv Univ, Israel.
    Chioncel, Ovidiu
    Emergency Inst Cardiovasc Dis Prof Dr CC Iliescu, Romania; Univ Med & Pharm Carol Davila, Romania.
    Jonge, Nicolaas
    Univ Med Ctr Utrecht, Netherlands.
    Elliston, Jeremy
    Tel Aviv Univ, Israel.
    Frigerio, Maria
    Osped Niguarda Ca Granda, Italy; Osped Niguarda Ca Granda, Italy.
    Goncalvesova, Eva
    Odd Srdcovehozlyhavania Transplantacie, Slovakia.
    Gotsman, Israel
    Hadassah Univ Hosp, Israel.
    Grupper, Avishai
    Lev Leviev Heart Ctr, Israel; Tel Aviv Univ, Israel.
    Hamdan, Righab
    Beirut Cardiac Inst, Lebanon.
    Hammer, Yoav
    Tel Aviv Univ, Israel.
    Hasin, Tal
    Shaare Zedek Med Ctr, Israel.
    Hill, Loreena
    Queens Univ, North Ireland.
    Ben Zadok, Osnat Itzhaki
    Tel Aviv Univ, Israel.
    Abuhazira, Miriam
    Tel Aviv Univ, Israel.
    Lavee, Jacob
    Tel Aviv Univ, Israel; Sheba Med Ctr, Israel.
    Mullens, Wilfried
    Ziekenhuis Oost Limburg, Belgium; Univ Hasselt, Belgium.
    Nalbantgil, Sanemn
    Ege Univ Hosp, Turkey.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Ponikowski, Piotr
    Univ Hosp, Poland; Wroclaw Med Univ, Poland.
    Potena, Luciano
    Bologna Univ Hosp, Italy.
    Ristic, Arsen
    Univ Belgrade, Serbia.
    Ruhparwar, Arjang
    Heidelberg Univ, Germany.
    Shaul, Aviv
    Tel Aviv Univ, Israel.
    Tops, Laurence F.
    Leiden Univ Med Ctr, Netherlands.
    Tsui, Steven
    Royal Papworth Hosp, England.
    Winnik, Stephan
    Univ Hosp Zurich, Switzerland; Univ Zurich, Switzerland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Finn
    Rigshosp, Denmark.
    Guidance on the management of left ventricular assist device (LVAD) supported patients for the non-LVAD specialist healthcare provider: executive summary2021In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 23, no 10, p. 1597-1609Article in journal (Refereed)
    Abstract [en]

    The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD supported patients. Device-related, and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of LVAD implanting centres. The probability of an LVAD supported patient presenting with medical emergency to a local ambulance team, emergency department medical team and internal or surgical wards in a non-LVAD implanting centre is increasing. The purpose of this paper is to supply the immediate tools needed by the non-LVAD specialized physician - ambulance clinicians, emergency ward physicians, general cardiologists, and internists - to comply with the medical needs of this fast-growing population of LVAD supported patients. The different issues discussed will follow the patients pathway from the ambulance to the emergency department, and from the emergency department to the internal or surgical wards and eventually back to the general practitioner.

  • 19.
    Ben Gal, Tuvia
    et al.
    Rabin Medical Centre, Israel .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Editorial Material: Patients with a Left Ventricular Assist Device: the new chronic patient in cardiology2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 4, p. 378-379Article in journal (Other academic)
    Abstract [en]

    n/a

  • 20.
    Ben Gal, Tuvia
    et al.
    Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Self-care and communication issues at the end of life of recipients of a left-ventricular assist device as destination therapy2013In: Current opinion in supportive and palliative care, ISSN 1751-4266, Vol. 7, no 1, p. 29-35Article in journal (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: The purpose of this review is to provide an overview of self- care and communication issues at the end of life of patients with left-ventricular assist devices (LVADs) for destination therapy, based on recent research on end-of-life communication in other diseases.

    RECENT FINDINGS: For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers.

    SUMMARY: Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families.

  • 21.
    Ben Gal, Tuvia
    et al.
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Yaari, Vicky
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Avraham, Ben
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale2020In: Heart, Lung and Circulation, ISSN 1443-9506, E-ISSN 1444-2892, no 7, p. E121-E130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.

    AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.

    METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.

    RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.

    CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

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  • 22.
    Ben Gal, Tuvia
    et al.
    Rabin Medical Centre, Israel; Tel Aviv University, Israel.
    Piepoli, Massimo F.
    G da Saliceto Polichirurg Hospital, Italy.
    Corra, Ugo
    IRCCS Science Institute Veruno, Italy.
    Conraads, Viviane
    University of Antwerp Hospital, Belgium.
    Adamopoulos, Stamatis
    Onassis Cardiac Surg Centre, Greece.
    Agostoni, Piergiuseppe
    IRCCS, Italy.
    Piotrowicz, Ewa
    Institute Cardiol, Poland.
    Schmid, Jean-Paul
    Tiefenau Hospital, Switzerland; University of Bern, Switzerland.
    Seferovic, Petar M.
    University of Belgrade, Serbia.
    Ponikowski, Piotr
    Wroclaw Medical University, Poland.
    Filippatos, Gerasimos
    Athens University Hospital Attikon, Greece.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Exercise programs for LVAD supported patients: A snapshot from the ESC affiliated countries2015In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 201, p. 215-219Article in journal (Refereed)
    Abstract [en]

    Background: To contribute to the protocol development of exercise training in LVAD supported patients by reviewing the exercise programs for those patients in the ESC affiliated countries. Methods: A subset of data from 77 (26 countries) LVAD implanting centers that participated in the Extra-HF survey (170 centers) was analyzed. Results: Of the 77 LVAD implanting centers, 45 (58%) reported to have a functioning exercise training program (ETP) for LVAD patients. In 21 (47%) of the 45 ETP programs in LVAD implanting centers, patients begin their ETP during their in-hospital post-operative recovery period. Most centers (71%) have an early post-discharge program for their patients, and 24% of the centers offer a long-term maintenance program. The professionals involved in the ETPs are mainly physiotherapists (73%), psychologists, cardiac rehab nurses (22%), or cardiologists specialized in rehabilitation (22%). Not all programs include the treating cardiologist or surgeons. Most of the ETPs (84%) include aerobic endurance training, mostly cycling (73%), or walking (62%) at low intensity intervals. Some programs apply resistance training (47%), respiratory muscle training (55%), or balance training (44%). Reasons for the absence of ETPs are referral of patients to another center (14 centers) and lack of resources (11 centers). Conclusion: There is a great variance in ETPs in LVAD implanting centers. Not all the implanting centers have an ETP, and those that do have adopted a local protocol. Clear guidance on ETP supplied by LVAD implanting centers to LVAD supported patients and more evidence for optimal modalities are needed. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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  • 23.
    Berben, L.
    et al.
    University of Basel, Switzerland .
    Bogert, L
    University of Basel, Switzerland .
    Leventhal, M. E.
    University of Basel, Switzerland .
    Fridlund, Bengt
    Hälsohögskolan i Jönköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Norekvål, T. M.
    Haukeland University Hospital, Norway .
    Smith, K.
    Ninewells Hospital, UK .
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Thompson, David
    Australian Catholic University, Melbourne.
    De Geest, Sabine
    University of Basel, Switzerland .
    Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice2011Conference paper (Refereed)
  • 24.
    Berben, Lut
    et al.
    University of Basel, Switzerland.
    Bogert, Laura
    University of Basel, Switzerland.
    Leventhal, Marcia E
    University of Basel, Switzerland.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Norekval, Tone M
    Haukeland University Hospital, Norway.
    Smith, Karen
    Ninewells Hospital, UK.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    De Geest, Sabina
    University of Basel, Switzerland .
    Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 1, p. 14-21Article in journal (Refereed)
    Abstract [en]

    Background: Complex medication regimens are often required to manage cardiovascular diseases. As non-adherence, which can have severe negative outcomes, is common among cardiovascular patients, various interventions to improve adherence should be implemented in daily practice.

    Aim: To assess which strategies cardiovascular nurses and allied health professionals utilize to (1) assess patients' adherence to medication regimen, and (2) enhance medication adherence via educational/cognitive, counseling/behavioral, and psychological/affective interventions.

    Method: A 45-item questionnaire to assess adherence assessment and interventional strategies utilized by health care professionals in daily clinical practice was distributed to a convenience sample of attendants of the 10th Annual Spring Meeting of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions conference in Geneva (Switzerland) in March 2010. Respondents not in direct clinical practice were excluded. Descriptive statistics were used to describe practice patterns regarding adherence management.

    Results: Of 276 distributed questionnaires, 171 (62%) were returned, of which 34 (20%) were excluded as respondents performed no direct patient care. Questioning patients about non-adherence during follow-up was the most frequently reported assessment strategy (56%). Educational/cognitive adherence enhancing interventions were used most frequently, followed by counseling/behavioral interventions. Psychological/affective interventions were less frequently used. The most frequent intervention used was providing reading materials (66%) followed by training patients regarding medication taking during inpatient recovery (48%). Slightly over two-thirds (69%) reported using a combination of interventions to improve patient's adherence.

    Conclusion: Educational interventions are used most in clinical practice, although evidence shows they are less effective than behavioral interventions at enhancing medication adherence.

  • 25.
    Berglund, Aseel
    et al.
    Linköping University, Department of Computer and Information Science, Software and Systems. Linköping University, Faculty of Science & Engineering.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Berglund, Erik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Understanding and assessing gamification in digital healthcare interventions for patients with cardiovascular disease2022In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 6, p. 630-638Article in journal (Refereed)
    Abstract [en]

    Gamification is defined as the use of game design elements in contexts other than gaming to increase user engagement and experience. Gamification in cardiovascular care can contribute to positively change health behaviour with possible effects and benefits on physical health and mental well-being. Based on previous literature, in this article we describe: the conceptualization of gamification, the five gamification principles for gamified digital health programmes or applications, the six most common game elements used to impact health behaviour applied in gamified digital health interventions and finally scientifically validated instruments to use for assessment of gamification in terms of self-reported psychological outcomes.

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  • 26.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Utility of single-item questions to assess physical inactivity in patients with chronic heart failure2020In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 7, no 4, p. 1467-1476Article in journal (Refereed)
    Abstract [en]

    Aim The purpose of this study was to explore the utility of two single-item self-report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross-sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self-reported physical activity or low self-reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: rho = 0.24, P = 0.016 for SR1 and rho = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self-reported physical activity group (P &lt; 0.001). Conclusions There might be utility in the single SR question for high-specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.

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  • 27.
    Bloom, Michelle W.
    et al.
    SUNY Stony Brook, NY 11794 USA.
    Greenberg, Barry
    University of Calif San Diego, CA 92093 USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic University, Australia.
    Januzzi, James L.
    Harvard University, MA USA.
    Lam, Carolyn S. P.
    National Heart Centre Singapore, Singapore; Duke National University of Singapore, Singapore.
    Maggioni, Aldo P.
    Italian Assoc Hospital Cardiologists ANMCO Research Centre, Italy.
    Trochu, Jean-Noel
    CHU Nantes, France; University of Nantes, France; INSERM, France; INSERM, France.
    Butler, Javed
    SUNY Stony Brook, NY 11794 USA.
    Heart failure with reduced ejection fraction2017In: NATURE REVIEWS DISEASE PRIMERS, ISSN 2056-676X, Vol. 3, article id 17058Article in journal (Refereed)
    Abstract [en]

    Heart failure is a global public health problem that affects more than 26 million people worldwide. The global burden of heart failure is growing and is expected to increase substantially with the ageing of the population. Heart failure with reduced ejection fraction accounts for approximately 50% of all cases of heart failure in the United States and is associated with substantial morbidity and reduced quality of life. Several diseases, such as myocardial infarction, certain infectious diseases and endocrine disorders, can initiate a primary pathophysiological process that can lead to reduced ventricular function and to heart failure. Initially, ventricular impairment is compensated for by the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, but chronic activation of these pathways leads to worsening cardiac function. The symptoms of heart failure can be associated with other conditions and include dyspnoea, fatigue, limitations in exercise tolerance and fluid accumulation, which can make diagnosis difficult. Management strategies include the use of pharmacological therapies and implantable devices to regulate cardiac function. Despite these available treatments, heart failure remains incurable, and patients have a poor prognosis and high mortality rate. Consequently, the development of new therapies is imperative and requires further research.

  • 28.
    Blum, Moritz
    et al.
    Icahn Sch Med Mt Sinai, NY USA; Deutsch Herzzentrum Charite Med Heart Ctr Charite, Germany; German Heart Inst Berlin, Germany.
    Goldstein, Nathan E.
    Icahn Sch Med Mt Sinai, NY USA.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Allen, Larry A.
    Univ Colorado, CO USA.
    Gelfman, Laura P.
    Icahn Sch Med Mt Sinai, NY USA; James J Peters Vet Affairs Med Ctr, NY USA; Mt Sinai Med Ctr, NY 10029 USA.
    Palliative care in heart failure guidelines: A comparison of the 2021 ESC and the 2022 AHA/ACC/HFSA guidelines on heart failure2023In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article, review/survey (Refereed)
    Abstract [en]

    The role of palliative care for patients with heart failure (HF) is discussed in both most recent HF guidelines, the 2021 ESC guideline and the 2022 AHA/ACC/HFSA guideline. This review compares the definitions, concepts and specific recommendations regarding palliative care for patients with HF in these two guidelines. Both HF guidelines define palliative care as a multidisciplinary approach aimed at alleviating physical, psychological and spiritual distress of patients and caregivers. Both agree emphatically on the importance of palliative care across all stages of HF with integration early in the illness trajectory. Also, the guidelines concur that palliative care should include symptom management, communication about prognosis and life-sustaining therapies, as well as advance care planning. Despite this consensus, only the AHA/ACC/HFSA guideline gives official recommendations on the provision of palliative care. Moreover, the AHA/ACC/HFSA guideline advocates for a needs-based approach to palliative care allocation while the ESC guideline ties palliative care closely to advanced HF and end-of-life care. The ESC guideline highlights the need for regular symptom assessment and provides detailed guidance on symptom management. The AHA/ACC/HFSA guideline elaborates further on shared decision-making, caregiver and bereavement support, as well as hospice care, and distinguishes between primary palliative care (provided by all clinicians) and secondary (specialty-level) palliative care. Although there is strong agreement on the importance and components of palliative care for patients with HF, there are nuanced differences between the two HF guidelines. Most notably, only the AHA/ACC/HFSA guideline issues recommendations for the provision of palliative care.

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  • 29.
    Brunner-La Rocca, H.P.
    et al.
    Heart Failure Clinic, Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands.
    Fleischhacker, L.
    Fleischhacker GmbH, Schwerte, Germany.
    Golubnitschaja, O.
    EPMA, Brussels, Belgium.
    Heemskerk, F.
    RIMS bvba, Overijse, Belgium.
    Helms, T.
    German Foundation for the Chronically Ill, Fürth, Germany.
    Hoedemakers, T.
    Sananet Care BV, Sittard, Netherlands.
    Allianses, S.H.
    RIMS bvba, Overijse, Belgium.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kinkorova, J.
    Medical Faculty Pilsen, Pilsen, Czech Republic.
    Ramaekers, J.
    Sananet Care BV, Sittard, Netherlands.
    Ruff, P.
    Exploris AG, Zürich, Switzerland.
    Schnur, I.
    sense.ly, San Francisco, USA.
    Vanoli, E.
    Mulimedica SPA, Milano, Italy.
    Verdu, J.
    Medtronic Iberica SA, Madrid, Spain.
    Zippel-Schultz, B.
    German Foundation for the Chronically Ill, Fürth, Germany.
    Challenges in personalised management of chronic diseases-heart failure as prominent example to advance the care process2016In: EPMA Journal, ISSN 1878-5077, Vol. 7, article id 2Article, review/survey (Refereed)
    Abstract [en]

    Chronic diseases are the leading causes of morbidity and mortality in Europe, accounting for more than 2/3 of all death causes and 75 % of the healthcare costs. Heart failure is one of the most prominent, prevalent and complex chronic conditions and is accompanied with multiple other chronic diseases. The current approach to care has important shortcomings with respect to diagnosis, treatment and care processes. A critical aspect of this situation is that interaction between stakeholders is limited and chronic diseases are usually addressed in isolation. Health care in Western countries requires an innovative approach to address chronic diseases to provide sustainability of care and to limit the excessive costs that may threaten the current systems. The increasing prevalence of chronic diseases combined with their enormous economic impact and the increasing shortage of healthcare providers are among the most critical threats. Attempts to solve these problems have failed, and future limitations in financial resources will result in much lower quality of care. Thus, changing the approach to care for chronic diseases is of utmost social importance.

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  • 30.
    Brännström, Margareta
    et al.
    Umeå University, Umeå, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Struggling with issues about cardiopulmonary resuscitation (CPR) for end-stage heart failure patients.2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 379-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Integrating heart failure and palliative care teams combines unique expertise from both cardiology and palliative care. However, professionals from the two arenas of life-saving cardiology and palliative care may well have different experiences with and approaches to patient care. Little is known how to optimally discuss cardiopulmonary resuscitation with patients and their relatives and what challenges are for healthcare providers.

    OBJECTIVE: The aim of this study was to describe the experiences and thoughts of members of an integrated heart failure and palliative care team concerning talking about CPR with end-stage heart failure patients.

    METHOD: We used a descriptive qualitative design, conducting group interviews during 2011 with professionals from different disciplines working with heart failure patients over a 1-year period. A qualitative content analysis was performed to examine the interview data.

    RESULTS: Professional caregivers in integrated heart failure and palliative homecare are struggling with the issue of CPR of end-stage heart failure patients. They wrestle with the question of whether CPR should be performed at all in these terminally ill patients. They also feel challenged by the actual conversation about CPR with the patients and their relatives. Despite talking them about CPR with patients and relatives is difficult, the study participants described that doing so is important, as it could be the start of a broader end-of-life conversation.

    CONCLUSION: Talking with patient and relatives about CPR in end-stage heart failure, as suggested in the current heart failure guidelines, is a challenge in daily clinical practice. It is important to discuss the difficulties within the team and to decide whether, whom, how and when to talk about CPR with individual patients and their relatives.

  • 31.
    Byrne, Molly
    et al.
    National University of Ireland, Ireland.
    Doherty, Sally
    RCSI, Ireland.
    Fridlund, Bengt G. A.
    Jonköping University, Sweden.
    Martensson, Jan
    Jonköping University, Sweden.
    Steinke, Elaine E.
    Wichita State University, KS USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Devane, Declan
    National University of Ireland, Ireland.
    Sexual counselling for sexual problems in patients with cardiovascular disease2016In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 2, p. CD010988-Article, review/survey (Refereed)
    Abstract [en]

    Background Sexual problems are common among people with cardiovascular disease. Although clinical guidelines recommend sexual counselling for patients and their partners, there is little evidence on its effectiveness. Objectives To evaluate the effectiveness of sexual counselling interventions (in comparison to usual care) on sexuality-related outcomes in patients with cardiovascular disease and their partners. Search methods We searched CENTRAL, MEDLINE, EMBASE, and three other databases up to 2 March 2015 and two trials registers up to 3 February 2016. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs, including individual and cluster RCTs. We included studies that compared any intervention to counsel adult cardiac patients about sexual problems with usual care. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included three trials with 381 participants. We were unable to pool the data from the included studies due to the differences in interventions used; therefore we synthesised the trial findings narratively. Two trials were conducted in the USA and one was undertaken in Israel. All trials included participants who were admitted to hospital with myocardial infarction (MI), and one trial also included participants who had undergone coronary artery bypass grafting. All trials followed up participants for a minimum of three months post-intervention; the longest follow-up timepoint was five months. One trial (N = 92) tested an intensive (total five hours) psychotherapeutic sexual counselling intervention delivered by a sexual therapist. One trial (N = 115) used a 15-minute educational video plus written material on resuming sexual activity following a MI. One trial (N = 174) tested the addition of a component that focused on resumption of sexual activity following a MI within a hospital cardiac rehabilitation programme. The quality of the evidence for all outcomes was very low. None of the included studies reported any outcomes from partners. Two trials reported sexual function. One trial compared intervention and control groups on 12 separate sexual function subscales and used a repeated measures analysis of variance (ANOVA) test. They reported statistically significant differences in favour of the intervention. One trial compared intervention and control groups using a repeated measures analysis of covariance (ANCOVA), and concluded: "There were no significant differences between the two groups [for sexual function] at any of the time points". Two trials reported sexual satisfaction. In one trial, the authors compared sexual satisfaction between intervention and control and used a repeated measured ANOVA; they reported "differences were reported in favour of the intervention". One trial compared intervention and control with a repeated measures ANCOVA and reported: "There were no significant differences between the two groups [for sexual satisfaction] at any of the timepoints". All three included trials reported the number of patients returning to sexual activity following MI. One trial found some evidence of an effect of sexual counselling on reported rate of return to sexual activity (yes/no) at four months after completion of the intervention (relative risk (RR) 1.71, 95% confidence interval (CI) 1.26 to 2.32; one trial, 92 participants, very low quality of evidence). Two trials found no evidence of an effect of sexual counselling on rate of return to sexual activity at 12 week (RR 1.01, 95% CI 0.94 to 1.09; one trial, 127 participants, very low quality of evidence) and three month follow-up (RR 0.98, 95% CI 0.88 to 1.10; one trial, 115 participants, very low quality of evidence). Two trials reported psychological well-being. In one trial, no scores were reported, but the trial authors stated: "No treatment effects were observed on state anxiety as measured in three points in time". In the other trial no scores were reported but, based on results of a repeated measures ANCOVA to compare intervention and control groups, the trial authors stated: "The experimental group had significantly greater anxiety at one month postMI". They also reported: "There were no significant differences between the two groups [for anxiety] at any other time points". One trial reporting relationship satisfaction and one trial reporting quality of life found no differences between intervention and control. No trial reported on satisfaction in how sexual issues were addressed in cardiac rehabilitation services. Authors conclusions We found no high quality evidence to support the effectiveness of sexual counselling for sexual problems in patients with cardiovascular disease. There is a clear need for robust, methodologically rigorous, adequately powered RCTs to test the effectiveness of sexual counselling interventions for people with cardiovascular disease and their partners.

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  • 32.
    Byrne, Molly
    et al.
    National University of Ireland, Galway.
    Doherty, Sally
    Royal College of Surgeons in Ireland, Dublin.
    Murphy, Andrew W
    National University of Ireland, Galway.
    McGee, Hannah M
    Royal College of Surgeons in Ireland, Dublin.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Communicating about sexual concerns within cardiac health services: Do service providers and service users agree?2013In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, no 3, p. 398-403Article in journal (Refereed)
    Abstract [en]

    Objective

    Sexual assessment and counselling is a recommended, yet underprovided and challenging, aspect of cardiac rehabilitation. We compared the views of cardiac healthcare providers and patients in terms of their experiences of communication about sexual issues.

    Methods

    Cardiac patients (n = 382) completed telephone surveys and hospital cardiac rehabilitation staff (n = 60) and general practitioners (n = 61) returned postal questionnaires.

    Results

    Patients reported that sex was rarely discussed, yet nearly half of patients said they would have liked this opportunity. Most general practitioners (70%) reported not addressing sex with their patients and the majority of cardiac rehabilitators (almost 61%) reported that sexual problems were poorly addressed in their service. Patients perceived fewer barriers to communication (the main barrier was lack of privacy) than health professionals (the primary barrier for general practitioners was lack of time, and for cardiac rehabilitation staff, lack of training).

    Conclusion

    All participants agreed that sexual assessment and counselling is currently poorly implemented. A gap exists: patients, who generally want sexual issues to be addressed, perceive fewer barriers to communication than healthcare providers, who fear causing anxiety and discomfort by raising sexual issues with their patients.

    Practice implications

    Developing brief interventions for healthcare providers and information materials for patients are recommended.

  • 33.
    Byrne, Molly
    et al.
    National University of Ireland, Galway.
    Doherty, Sally
    Royal College of Surgeons in Ireland, Dublin.
    Murphy, Andrew W
    National University of Ireland, Galway.
    McGee, Hannah M
    Royal College of Surgeons in Ireland, Dublin.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The CHARMS Study: cardiac patients' experiences of sexual problems following cardiac rehabilitation2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 6, p. 558-566Article in journal (Refereed)
    Abstract [en]

    Background:Sexual problems are common among cardiac patients. Further information is required on patients' experiences of sexuality and preferences for sexual counselling.

    Aim:To characterise sexual dysfunction and related factors among patients following cardiac rehabilitation and examine related treatment delivery.

    Methods:Telephone interviews with 382 patients (32% response rate) recruited from six hospital rehabilitation centres.

    Results:Seventy-nine per cent were male; average age was 64 years (SD 9.8). Forty-seven per cent of the total sample reported no sexual relations in the previous year, and nearly a half of sexually active respondents reported at least one sexual problem. Erectile dysfunction (reported by 33%) and lack of interest in sex (reported by 10%) were the most common problems for men and women respectively. Twenty-three per cent reported that sex had deteriorated for them since their cardiac event, and for half of these this was considered a serious problem. In logistic regression analysis, higher anxiety (Hospital Anxiety and Depression Scale) and being male were associated with reporting a sexual problem (χ(2) = 37.85, p<0.001). Sixty-six per cent reported that sex was never discussed by a health professional and satisfaction with this aspect of care was low. Patients wanted these issues to be addressed and the majority (63%) claimed they would find it easy to discuss sexual problems with a health professional.

    Conclusions:Sexual inactivity and sexual problems are common in this group. Health professionals should address sexual issues with their patients, ideally in a private setting and within the broader context of addressing psychological wellbeing.

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  • 34.
    Byrne, Molly
    et al.
    National University of Ireland, Ireland.
    Murphy, Patrick
    National University of Ireland, Ireland.
    DEath, Maureen
    National University of Ireland, Ireland.
    Doherty, Sally
    Royal Coll Surgeons Ireland, Ireland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease2017In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, no 5, p. 666-674Article in journal (Refereed)
    Abstract [en]

    Background: Relationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. Aim: To document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. Methods: Semistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and chi(2) tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. Outcomes: Data were gathered on demographic and clinical variables, sexual problems, and relationship satisfaction, including satisfaction with the physical, emotional, affection, and communication aspects of relationships. Results: Just less than one third of participants (n = 61, 30.3%) reported that sex had changed for the worse since their cardiac event or diagnosis, with approximately half of these stating that this was a serious problem for them. Satisfaction with relationships was high among patients surveyed; more than 70% of the sample reported being very or extremely satisfied with the physical and emotional aspects and showing affection during sex. Satisfaction with communication about sex was lower, with only 58% reporting being very or extremely satisfied. We did not find significant associations between reporting of sexual problems or deterioration of sex as a result of disease and relationship satisfaction. Clinical Implications: Cardiac rehabilitation programs should address these sexual problems, potentially by enhancing communication within couples about sex. Strengths and Limitations: The strength is that data are presented on the sexual experiences and relationship satisfaction of a relatively large sample of people diagnosed with cardiac disease, a relatively underexplored research area. Limitations include the possibility of selection bias of study participants and bias associated with self-report measurement. Conclusions: Sexual problems were significant in this population but were not related to relationship satisfaction in this cross-sectional survey. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

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  • 35.
    Cacciata, Marysol C.
    et al.
    Vet Affairs Long Beach Healthcare Syst, CA 90822 USA.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Kuriakose, Mebin
    Univ Calif Irvine, CA USA.
    Lee, Jung-Ah
    Univ Calif Irvine, CA USA.
    Lombardo, Dawn
    Univ Calif Irvine Hlth, CA USA.
    Evangelista, Lorraine S.
    Univ Texas Med Branch, TX 77555 USA.
    Facilitators and Challenges to Exergaming Perspectives of Patients With Heart Failure2022In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 37, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Background Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure. Objectives In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure. Methods Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34-69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis. Results The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement. Conclusion Exergaming can increase individuals physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants preferences and capacities, participants past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.

  • 36.
    Cao, Qi
    et al.
    University of Groningen, Netherlands.
    Buskens, Erik
    University of Groningen, Netherlands.
    Feenstra, Talitha
    University of Groningen, Netherlands; National Institute Public Health and Environm, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hillege, Hans
    University of Groningen, Netherlands; University of Groningen, Netherlands.
    Postmus, Douwe
    University of Groningen, Netherlands.
    Continuous-Time Semi-Markov Models in Health Economic Decision Making: An Illustrative Example in Heart Failure Disease Management2016In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 36, no 1, p. 59-71Article in journal (Refereed)
    Abstract [en]

    Continuous-time state transition models may end up having large unwieldy structures when trying to represent all relevant stages of clinical disease processes by means of a standard Markov model. In such situations, a more parsimonious, and therefore easier-to-grasp, model of a patients disease progression can often be obtained by assuming that the future state transitions do not depend only on the present state (Markov assumption) but also on the past through time since entry in the present state. Despite that these so-called semi-Markov models are still relatively straightforward to specify and implement, they are not yet routinely applied in health economic evaluation to assess the cost-effectiveness of alternative interventions. To facilitate a better understanding of this type of model among applied health economic analysts, the first part of this article provides a detailed discussion of what the semi-Markov model entails and how such models can be specified in an intuitive way by adopting an approach called vertical modeling. In the second part of the article, we use this approach to construct a semi-Markov model for assessing the long-term cost-effectiveness of 3 disease management programs for heart failure. Compared with a standard Markov model with the same disease states, our proposed semi-Markov model fitted the observed data much better. When subsequently extrapolating beyond the clinical trial period, these relatively large differences in goodness-of-fit translated into almost a doubling in mean total cost and a 60-d decrease in mean survival time when using the Markov model instead of the semi-Markov model. For the disease process considered in our case study, the semi-Markov model thus provided a sensible balance between model parsimoniousness and computational complexity.

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  • 37.
    Carnesten, Hillewi
    et al.
    Malardalen Univ, Sweden.
    von Heideken Wagert, Petra
    Malardalen Univ, Sweden.
    Gustin, Lena Wiklund
    Malardalen Univ, Sweden; UiT The Arctic Univ Norway, Norway.
    Toivanen, Susanna
    Malardalen Univ, Sweden.
    Skoglund, Karin
    Malardalen Univ, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Med Ctr Utrecht, Netherlands.
    Andreae, Christina
    Malardalen Univ, Sweden; Uppsala Univ, Sweden.
    Struggling in the dehumanized world of COVID-An exploratory mixed-methods study of frontline healthcare workers' experiences2024In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aim: To explore healthcare workers' experiences of the changed caring reality during the COVID-19 pandemic in Sweden. Design: An online fully mixed-methods design. Methods: A web-based self-reported questionnaire with fixed and open-ended answers collected data from March to April 2021, analysed in three steps. First, free-text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta-inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting. Results: Meta-inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality, comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post-traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy. Conclusions: Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID-19 pandemic and to prevent mental health illness in future crisis. Patient or Public Contribution: No patient or public contribution. Summary: The pandemic outbreak exposed frontline healthcare workers to unparallelled stress shown as negative for their mental health in several meta-analyses and systematic reviews. In-depth understanding on experiences and how symptoms of post-traumatic stress disorder relate to coping mechanisms have been scarcely explored. This study contributes to understanding on healthcare workers' experiences and the relation between lower sense of coherence and increased risk of developing symptoms of post-traumatic stress disorder. Implications for Practice/Policy: This study might guide how to prepare for resilience in future emergencies.

  • 38.
    Celutkiene, Jelena
    et al.
    Vilnius Univ, Lithuania; State Res Inst Ctr Innovat Med, Lithuania.
    Pudil, Radek
    Charles Univ Prague, Czech Republic; Univ Hosp Hradec Kralove, Czech Republic.
    Lopez-Fernandez, Teresa
    La Paz Univ Hosp, Spain.
    Grapsa, Julia
    Barts Hlth Trust, England.
    Nihoyannopoulos, Petros
    Natl & Kapodistrian Univ Athens, Greece; Imperial Coll London, England.
    Bergler-Klein, Jutta
    Med Univ Vienna, Austria.
    Cohen-Solal, Alain
    Univ Paris, France.
    Farmakis, Dimitrios
    Univ Cyprus, Cyprus; Natl & Kapodistrian Univ Athens, Greece.
    Tocchetti, Carlo Gabriele
    Univ Naples Federico II, Italy; Univ Naples Federico II, Italy.
    von Haehling, Stephan
    Univ Gottingen, Germany.
    Barberis, Vassilis
    Amer Heart Inst, Cyprus.
    Flachskampf, Frank A.
    Uppsala Univ, Sweden.
    Ceponiene, Indre
    Lithuanian Univ Hlth Sci, Lithuania.
    Haegler-Laube, Eva
    Univ Bern, Switzerland.
    Suter, Thomas
    Univ Bern, Switzerland.
    Lapinskas, Tomas
    Lithuanian Univ Hlth Sci, Lithuania.
    Prasad, Sanjay
    Royal Brompton Hosp, England; Imperial Coll, England.
    de Boer, Rudolf A.
    Univ Groningen, Netherlands.
    Wechalekar, Kshama
    Royal Brompton Hosp, England.
    Anker, Markus S.
    Charite, Germany; Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Germany; DZHK German Ctr Cardiovasc Res, Germany; Charite, Germany.
    Iakobishvili, Zaza
    Tel Aviv Univ, Israel; Clalit Hlth Serv, Israel.
    Bucciarelli-Ducci, Chiara
    Univ Hosp Bristol NHS Trust, England; Univ Hosp Bristol NHS Trust, England; Univ Bristol, England.
    Schulz-Menger, Jeanette
    DZHK German Ctr Cardiovasc Res, Germany; Expt & Clin Res Ctr Joint Cooperat Charite Univer, Germany; Max Delbrueck Ctr Mol Med, Germany; HELIOS Klinikum Berlin Buch, Germany.
    Cosyns, Bernard
    Univ Ziekenhuis Brussel, Belgium.
    Gaemperli, Oliver
    Hirslanden Hosp, Switzerland.
    Belenkov, Yury
    Sechenov Univ, Russia.
    Hulot, Jean-Sebastien
    Univ Paris, France.
    Galderisi, Maurizio
    Federico II Univ Hosp, Italy.
    Lancellotti, Patrizio
    Univ Liege Hosp, Belgium.
    Bax, Jeroen
    Leiden Univ, Netherlands.
    Marwick, Thomas H.
    Baker Heart & Diabet Inst, Australia.
    Chioncel, Ovidiu
    Emergency Inst Cardiovasc Dis CC Iliescu, Romania; Univ Med & Pharm Carol Davila, Romania.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Med Ctr Utrecht, Netherlands; Univ Utrecht, Netherlands.
    Mullens, Wilfried
    Univ Hasselt, Belgium.
    Piepoli, Massimo
    Guglielmo da Saliceto Hosp, Italy; Univ Parma, Italy.
    Thum, Thomas
    Hannover Med Sch, Germany.
    Heymans, Stephane
    Maastricht Univ, Netherlands; Queen Mary Univ London, England; Katholieke Univ Leuven, Belgium.
    Mueller, Christian
    Univ Basel, Switzerland; Univ Basel, Switzerland.
    Moura, Brenda
    Univ Porto, Portugal; Univ Porto, Portugal.
    Ruschitzka, Frank
    Univ Hosp Zurich, Switzerland.
    Zamorano, Jose Luis
    Univ Hosp Ramon y Cajal, Spain; Univ Alcala De Henares, Spain; Inst Salud Carlos III ISCIII, Spain.
    Rosano, Giuseppe
    IRCCS San Raffaele Pisana, Italy; Univ London, England.
    Coats, Andrew J. S.
    IRCCS San Raffaele Pisana, Italy.
    Asteggiano, Riccardo
    Cardiologist in Practice, Turin, Italy.
    Seferovic, Petar
    Univ Belgrade, Serbia; Serbian Acad Arts & Sci, Serbia.
    Edvardsen, Thor
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Lyon, Alexander R.
    Imperial Coll, England; Royal Brompton Hosp, England.
    Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC)2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 9, p. 1504-1524Article in journal (Refereed)
    Abstract [en]

    Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed.

  • 39.
    Cewers, Emilie
    et al.
    Linköping University, Faculty of Medicine and Health Sciences.
    Joensson, Adam
    Linköping University, Faculty of Medicine and Health Sciences.
    Weinstein, Jean Marc
    Ben Gurion Univ Negev, Israel.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    PHYSICAL ACTIVITY RECOMMENDATIONS FOR PATIENTS WITH HEART FAILURE BASED ON SEX: A QUALITATIVE INTERVIEW STUDY2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 7, p. 532-538Article in journal (Refereed)
    Abstract [en]

    Objective: Physical activity is an essential part of managing heart failure. However, adherence to activity recommendations is low, especially in female patients. The aim of this study was to investigate the perceptions of healthcare providers regarding sex differences in physical activity, motivation, barriers, and whether adaptations in care based on sex might be meaningful. Methods: This is a qualitative study; data were collected in semi-structured interviews with healthcare providers. The data were analysed using qualitative content analysis. Results: The major overarching theme was that healthcare providers feel that "Men and women are equal, but different". This theme was explained in terms of 7 sub-themes with associated categories, as follows: "Men and women prefer and perform different physical activity regardless of health status", "Male and female heart failure patients have different motivations for, and barriers to, being active", "Factors related to differences in physical activity and physical capacity between male and female heart failure patients", "Heart failure has more impact on physical activity and physical capacity than patients sex", and "Tailoring activity advice for heart failure patients based on sex." Discussion: Healthcare providers had clear opinions regarding the existence of sex differences that might affect patients care. Several differences were identified in male and female heart failure patients in terms of physical activity. There seems to be a conflict between fear of discriminating and the value of personalizing care.

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  • 40.
    Chen, Yuntao
    et al.
    Univ Groningen, Netherlands.
    Voors, Adriaan A.
    Univ Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lang, Chim C.
    Univ Dundee, Scotland.
    Sama, Iziah E.
    Univ Groningen, Netherlands.
    Akkerhuis, K. Martijn
    Erasmus MC, Netherlands.
    Boersma, Eric
    Erasmus MC, Netherlands.
    Hillege, Hans L.
    Univ Groningen, Netherlands.
    Postmus, Douwe
    Univ Groningen, Netherlands.
    A heart failure phenotype stratified model for predicting 1-year mortality in patients admitted with acute heart failure: results from an individual participant data meta-analysis of four prospective European cohorts2021In: BMC Medicine, E-ISSN 1741-7015, Vol. 19, no 1, article id 21Article in journal (Refereed)
    Abstract [en]

    Background Prognostic models developed in general cohorts with a mixture of heart failure (HF) phenotypes, though more widely applicable, are also likely to yield larger prediction errors in settings where the HF phenotypes have substantially different baseline mortality rates or different predictor-outcome associations. This study sought to use individual participant data meta-analysis to develop an HF phenotype stratified model for predicting 1-year mortality in patients admitted with acute HF. Methods Four prospective European cohorts were used to develop an HF phenotype stratified model. Cox model with two rounds of backward elimination was used to derive the prognostic index. Weibull model was used to obtain the baseline hazard functions. The internal-external cross-validation (IECV) approach was used to evaluate the generalizability of the developed model in terms of discrimination and calibration. Results 3577 acute HF patients were included, of which 2368 were classified as having HF with reduced ejection fraction (EF) (HFrEF; EF &lt; 40%), 588 as having HF with midrange EF (HFmrEF; EF 40-49%), and 621 as having HF with preserved EF (HFpEF; EF &gt;= 50%). A total of 11 readily available variables built up the prognostic index. For four of these predictor variables, namely systolic blood pressure, serum creatinine, myocardial infarction, and diabetes, the effect differed across the three HF phenotypes. With a weighted IECV-adjusted AUC of 0.79 (0.74-0.83) for HFrEF, 0.74 (0.70-0.79) for HFmrEF, and 0.74 (0.71-0.77) for HFpEF, the model showed excellent discrimination. Moreover, there was a good agreement between the average observed and predicted 1-year mortality risks, especially after recalibration of the baseline mortality risks. Conclusions Our HF phenotype stratified model showed excellent generalizability across four European cohorts and may provide a useful tool in HF phenotype-specific clinical decision-making.

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  • 41.
    Chiala, Oronzo
    et al.
    Univ Roma Tor Vergata, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ortali, Giorgio Alberto
    Casa Cura Villa della Querce Nemi, Italy.
    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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    RELATIONSHIPS AMONG MEASURES OF PHYSICAL FITNESS IN ADULT PATIENTS WITH HEART FAILURE2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 8, p. 607-615Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the relationships among 3 measures of physical fitness (exercise capacity, muscle function and functional capacity) in patients with heart failure, and to determine whether these measures are influenced by impairment of movement. Methods: Secondary analysis of baseline data from the Italian subsample (n= 96) of patients with heart failure enrolled in a randomized controlled trial, the HF-Wii study. Exercise capacity was measured with the 6-min walk test, muscle function was measured with the unilateral isotonic heel-lift, bilateral isometric shoulder abduction and unilateral isotonic shoulder flexion, and functional capacity was measured with the Duke Activity Status Index. Principal component analysis was used to detect covariance of the data. Results: Exercise capacity correlated with all of the tests related to muscle function (r=0.691-0.423, pamp;lt; 0.001) and functional capacity (r = 0.531). Moreover, functional capacity correlated with muscle function (r=0.482-0.393). Principal component analysis revealed the bidimensional structure of these 3 measures, thus accounting for 58% of the total variance in the variables measured. Conclusion: Despite the correlations among exercise capacity, muscle function and functional capacity, these measures loaded on 2 different factors. The use of a wider range of tests will help clinicians to perform a more tailored assessment of physical fitness, especially in those patients with heart failure who have impairment of movement.

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  • 42.
    Chiala, Oronzo
    et al.
    Univ Roma Tor Vergata, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ortali, Giorgio Alberto
    Cardiopulm Rehabil Casa Cura Villa Querce Nemi, Italy.
    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. Univ Calif Irvine, CA USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic Univ, Australia.
    Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure2018In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 47, no 5, p. 465-470Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity. Objectives: The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients. Methods: This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment. Results: The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT. Conclusions: The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. (C) 2018 Elsevier Inc. All rights reserved.

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  • 43.
    Chioncel, Ovidiu
    et al.
    Emergency Inst Cardiovasc Dis Prof CC Iliescu, Romania; Univ Med & Pharm Carol Davila, Romania.
    Parissis, John
    Attikon Univ Hosp, Greece; Natl Kapodistrian Univ Athens, Greece.
    Mebazaa, Alexandre
    Univ Paris Diderot, France.
    Thiele, Holger
    Univ Leipzig, Germany; Heart Inst, Germany.
    Desch, Steffen
    Univ Leipzig, Germany; Heart Inst, Germany.
    Bauersachs, Johann
    Hannover Med Sch, Germany.
    Harjola, Veli-Pekka
    Univ Helsinki, Finland.
    Antohi, Elena-Laura
    Emergency Inst Cardiovasc Dis Prof CC Iliescu, Romania; Univ Med & Pharm Carol Davila, Romania.
    Arrigo, Mattia
    Univ Hosp Zurich, Switzerland.
    Gal, Tuvia B.
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    Collins, Sean P.
    Vanderbilt Univ, TN 37212 USA.
    DeBacker, Daniel
    Univ Libre Bruxelles, Belgium.
    Iliescu, Vlad A.
    Emergency Inst Cardiovasc Dis Prof CC Iliescu, Romania; Univ Med & Pharm Carol Davila, Romania.
    Jankowska, Ewa
    Wroclaw Med Univ, Poland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Med Ctr Utrecht, Netherlands.
    Keramida, Kalliopi
    Natl Kapodistrian Univ Athens, Greece; Attikon Univ Hosp, Greece.
    Lainscak, Mitja
    Gen Hosp Murska Sobota, Slovenia; Univ Ljubljana, Slovenia.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Lyon, Alexander R.
    Imperial Coll London, England; Royal Brompton Hosp, England.
    Masip, Josep
    Univ Barcelona, Spain; Hosp Sanitas CIMA, Spain.
    Metra, Marco
    Univ Brescia, Italy.
    Miro, Oscar
    Hosp Clin Barcelona, Spain; Univ Barcelona, Spain.
    Mortara, Andrea
    Policlin Monza, Italy.
    Mueller, Christian
    Univ Hosp Basel, Switzerland.
    Mullens, Wilfried
    Ziekenhuis Oost, Belgium; Hasselt Univ, Belgium.
    Nikolaou, Maria
    Attikon Univ Hosp, Greece.
    Piepoli, Massimo
    Univ Parma, Italy; St Anna Sch Adv Studies, Italy.
    Price, Susana
    Royal Brompton Hosp & Harefield NHS Fdn Trust, England.
    Rosano, Giuseppe
    St Georges Hosp NHS Trust Univ London, England; Ctr Clin & Basic Res IRCCS San Raffaele Pisana, Italy.
    Vieillard-Baron, Antoine
    UVSQ, France; Univ Hosp Ambroise Pare, France.
    Weinstein, Jean M.
    Soroka Univ, Israel.
    Anker, Stefan D.
    Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Germany; German Ctr Cardiovasc Res DZHK, Germany; Charite, Germany.
    Filippatos, Gerasimos
    Univ Athens, Greece; Univ Cyprus, Cyprus.
    Ruschitzka, Frank
    Univ Hosp Zurich, Switzerland.
    Coats, Andrew J. S.
    IRCCS San Raffaele Pisana, Italy.
    Seferovic, Petar
    Univ Belgrade, Serbia; Serbian Acad Arts & Sci, Serbia.
    Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 8, p. 1315-1341Article in journal (Refereed)
    Abstract [en]

    Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patients underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management.

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  • 44.
    Clark, Alexander M
    et al.
    University of Alberta, Canada.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strachan, Patricia
    Stony Brook University , USA.
    Davidson, Patricia M
    Curtin University, Sydney, Australia. .
    Jerke, Megan
    Beattie, James M
    Heart of England NHS Foundation Trust, Birmingham.
    Duncan, Amanda S
    Ski, Chantal F
    Thompson, David R
    Effective communication and ethical consent in decisions related to ICDs2011In: Nature reviews. Cardiology, ISSN 1759-5010Article in journal (Refereed)
    Abstract [en]

    This Review examines recommendations and principles that promote good decision-making with regard to the insertion, deactivation, and potential malfunction of implantable cardioverter-defibrillators (ICDs). This guidance is important because ICDs are now used for primary and secondary prevention of arrhythmias in more than 20 diverse clinical populations, which accounts for the exponential increase in insertion rates over the past decade. Current guidelines require clinicians to provide personalized, culturally appropriate, and easy to understand information to patients on the benefits and harms of proposed treatment choices; however, obtaining valid informed consent for insertion and deactivation of ICDs is challenging. Initiating early conversations with patients and continuing this dialogue over time, implementation of localized care protocols, increased collaboration (particularly between cardiac and palliative care teams), and the provision of training for all health professionals involved in the care of these patients, can help to ensure that adequate informed consent is maintained throughout their care. In addition to providing information, health professionals should identify and address high levels of anxiety in patients and their next of kin and promote effective communication throughout decision making. In the future, use of standardized checklists or decision aids based on a clear understanding of the principles underlying key topics could support this process.

  • 45.
    Conraads, Viviane M
    et al.
    University of Antwerp Hospital.
    Deaton, Christi
    University of Manchester.
    Piotrowicz, Ewa
    Institute Cardiol, Warsaw.
    Santaularia, Nuria
    Xarxa Assistencial University of Manresa.
    Tierney, Stephanie
    University of Manchester.
    Piepoli, Massimo F
    AUSL Piacenza.
    Pieske, Burkert
    Medical University of Graz.
    Schmid, Jean-Paul
    University Hospital Bern.
    Dickstein, Kenneth
    University of Bergen.
    Ponikowski, Piotr P
    Mil Hospital.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Adherence of heart failure patients to exercise: barriers and possible solutions A position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology2012In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 14, no 5, p. 451-458Article in journal (Refereed)
    Abstract [en]

    The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly recommended by the recent guidelines issued by the European Society of Cardiology, but it is still severely underutilized in this particular patient population. This position paper addresses the problem of non-adherence, currently recognized as a main obstacle to a wide implementation of physical training. Since the management of chronic heart failure and, even more, of training programmes is a multidisciplinary effort, the current manuscript intends to reach cardiologists, nurses, physiotherapists, as well as psychologists working in the field.

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  • 46.
    Coyne, James C
    et al.
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Luttik, Marie-Louise
    University of Groningen.
    van Sonderen, Eric
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Sanderman, Robbert
    University of Groningen.
    Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients2011In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 73, no 7, p. 557-562Article in journal (Refereed)
    Abstract [en]

    Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.

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  • 47.
    de Boer, Rudolf A
    et al.
    University of Groningen, the Netherlands.
    Cao, Qi
    University of Groningen, the Netherlands.
    Postmus, Douwe
    University of Groningen, the Netherlands.
    Damman, Kevin
    University of Groningen, the Netherlands.
    Voors, Adriaan A
    University of Groningen, the Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    van Veldhuisen, Dirk J
    University of Groningen, the Netherlands.
    Arnold, William D
    Alere San Diego, Inc., San Diego, California.
    Hillege, Hans L
    University of Groningen, the Netherlands.
    Silljé, Herman H W
    University of Groningen, the Netherlands.
    The WAP four-disulfide core domain protein HE4: a novel biomarker for heart failure.2013In: JACC. Heart failure, ISSN 2213-1787, Vol. 1, no 2, p. 164-169Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study investigated clinical determinants and added prognostic value of HE4 as a biomarker not previously described in heart failure (HF).

    BACKGROUND: Identification of plasma biomarkers that help to risk stratify HF patients may help to improve treatment.

    METHODS: Plasma HE4 levels were determined in 567 participants of the COACH (Coordinating study evaluating outcomes of Advising and Counseling in Heart failure). Patients had been hospitalized for HF and were followed for 18 months. The primary endpoint of this study was a composite of all-cause mortality and HF hospitalization.

    RESULTS: HE4 showed a strong correlation with HF severity, according to New York Heart Association functional class and brain natriuretic peptide (BNP) levels (p < 0.001). HE4 also showed a positive correlation with GDF15 (p < 0.001) and, in addition, correlated with kidney function (estimated glomerular filtration rate [eGFR]; p < 0.001). Cox regression analysis revealed that a doubling of HE4 levels was associated with a hazard ratio (HR) of 1.73 (95% confidence interval [CI]: 1.53 to 1.95) for the primary outcome (p < 0.001). After correction for age, gender, BNP, and eGFR, the HR was 1.46 (95% CI: 1.23 to 1.72; p < 0.001), and after additional adjustment for GDF15, the HR lowered to 1.30 (95% CI: 1.07 to 1.59; p = 0.009). The area under the curve in the receiver-operating characteristic curve analysis increased from 0.727 to 0.752 when HE4 was included in the clinical evaluation (p = 0.051). The integrated discrimination improvement and net reclassification index for reclassification showed significant improvements when HE4 was added to the clinical model, and this remained significant after BNP inclusion in the model.

    CONCLUSIONS: HE4 plasma levels are correlated with markers of HF severity, show prognostic value, and can improve risk assessment in HF.

  • 48.
    de Boer, Rudolf A
    et al.
    University of Groningen.
    Lok, Dirk J A
    Deventer Hospital, The Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    van der Meer, Peter
    University of Groningen.
    Voors, Adriaan A
    University of Groningen.
    Hillege, Hans L
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Predictive value of plasma galectin-3 levels in heart failure with reduced and preserved ejection fraction2011In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 43, no 1, p. 60-68Article in journal (Refereed)
    Abstract [en]

    AIMS: galectin-3 is an emerging biomarker which has been studied in relatively small heart failure (HF) cohorts with predominantly systolic HF. We studied the prognostic value of base-line galectin-3 in a large HF cohort, with preserved and reduced left ventricular ejection fraction (LVEF), and compared this to other biomarkers.

    METHODS: we studied 592 HF patients who had been hospitalized for HF and were followed for 18 months. The primary end-point was a composite of all-cause mortality and HF hospitalization.

    RESULTS: a doubling of galectin-3 levels was associated with a hazard ratio (HR) of 1.97 (1.62-2.42) for the primary outcome (P < 0.001). After correction for age, gender, BNP, eGFR, and diabetes the HR was 1.38 (1.07-1.78; P = 0.015). Galectin-3 levels were correlated with higher IL-6 and CRP levels (P < 0.002). Changes of galectin-3 levels after 6 months did not add prognostic information to the base-line value (n = 291); however, combining plasma galectin-3 and BNP levels increased prognostic value over either biomarker alone (ROC analysis, P < 0.05). The predictive value of galectin-3 was stronger in patients with preserved LVEF (n = 114) compared to patients with reduced LVEF (P < 0.001).

    CONCLUSIONS: galectin-3 is an independent marker for outcome in HF and appears to be particularly useful in HF patients with preserved LVEF.

  • 49.
    De Geest, Sabina
    et al.
    University of Basel.
    Dunbar, Sandra
    Emory University, Atlanta.
    Froelicher, Erika
    School of Nursing, University of California-San Francisco.
    Grady, Kathleen
    Rush University, Chicago.
    Hayman, Laura
    New York University.
    Jaarsma, Tiny
    University Hospital Groningen, Holland.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Building bridges: the American Heart Association-European Society of Cardiology's International Nursing Collaboration.2003In: Progress in Cardiovascular Nursing, ISSN 0889-7204, E-ISSN 1751-7117, Vol. 18, no 4, p. 194-196Article in journal (Refereed)
    Abstract [en]

    n/a

  • 50.
    De Geest, Sabina
    et al.
    University of Basel, Switzerland.
    Dunbar, Sandra
    Emory University, Atlanta.
    Froelicher, Erika
    School of Nursing, UCSF, San Francisco.
    Grady, Kathleen
    Rush University, Chicago.
    Hayman, Laura
    New York University.
    Jaarsma, Tiny
    University Hospital Groningen.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Building bridges: the American Heart Association-European Society of Cardiology's International Nursing Collaboration2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 4, p. 251-253Article in journal (Refereed)
    Abstract [en]

    This paper described the formal collaboration between the American Heart Association's Council on Cardiovascular Nursing and the European Society of Cardiology's Working Group on Cardiovascular Nursing. This collaboration comprises following dimensions: (1). further expansion on collaboration on annual conferences; (2). development of mentoring initiatives; (3). initiation of research collaboration; (4). development of joint guidelines; and (5). appointment of liaison persons of AHA to ESC and vice versa.

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