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  • 151.
    Lawson, C.
    et al.
    Keele University, England.
    Pati, S.
    Indian Institute Public Health Bhubaneswar, India.
    Green, J.
    Keele University, England.
    Messin, G.
    University of Siena, 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.
    Nante, N.
    University of Siena, Italy.
    Golineili, D.
    University of Siena, Italy.
    Verzuri, A.
    University of Siena, Italy.
    White, S.
    Keele University, England.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Walsh, P.
    Keele University, England.
    Lonsdale, P.
    Keele University, England.
    Kadam, U. T.
    Keele University, England.
    Development of an international comorbidity education framework2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 55, p. 82-89Article in journal (Refereed)
    Abstract [en]

    Context The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions. Aim: Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education. Methods: We surveyed nursing, medical and pharmacy students from England, India, Italy and Sweden to evaluate their understanding of comorbidity care. A list of core comorbidity content was constructed by an international group of higher education academics and clinicians from the same disciplines, by searching current curricula and analysing clinical frameworks and the student survey data. This list was used to develop the International Comorbidity Education Framework. Results: The survey sample consisted of 917 students from England (42%), India (48%), Italy (8%) and Sweden (2%). The majority of students across all disciplines said that they lacked knowledge, training and confidence in comorbidity care and were unable to identify specific teaching on comorbidities. All student groups wanted further comorbidity training. The health education institution representatives found no specific references to comorbidity in current health education curricula. Current clinical frameworks were used to develop an agreed list of core comorbidity content and hence an International Comorbidity Education Framework. Conclusions: Based on consultation with academics and clinicians and on student feedback we developed an International Comorbidity Education Framework to promote the integration of comorbidity concepts into current healthcare curricula.

  • 152.
    Lawson, Claire A.
    et al.
    Univ Leicester, England.
    Solis-Trapala, Ivonne
    Keele Univ, England.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Mamas, Mamas
    Keele Univ, England.
    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.
    Kadam, Umesh T.
    Univ Leicester, England.
    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.
    Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry2018In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, no 3, article id e1002540Article in journal (Refereed)
    Abstract [en]

    Background amp; para;amp; para;Optimally treated heart failure (HF) patients often have persisting symptoms and poor health-related quality of life. Comorbidities are common, but little is known about their impact on these factors, and guideline-driven HF care remains focused on cardiovascular status. The following hypotheses were tested: (i) comorbidities are associated with more severe symptoms and functional limitations and subsequently worse patient-rated health in HF, and (ii) these patterns of association differ among selected comorbidities.amp; para;amp; para;Methods and findings amp; para;amp; para;The Swedish Heart Failure Registry (SHFR) is a national population-based register of HF patients admitted to amp;gt;85% of hospitals in Sweden or attending outpatient clinics. This study included 10,575 HF patients with patient-rated health recorded during first registration in the SHFR (1 February 2008 to 1 November 2013). An a priori health model and sequences-of-regressions analysis were used to test associations among comorbidities and patient-reported symptoms, functional limitations, and patient-rated health. Patient-rated health measures included the EuroQol-5 dimension (EQ-5D) questionnaire and the EuroQol visual analogue scale (EQ-VAS). EQ-VAS score ranges from 0 (worst health) to 100 (best health). Patient-rated health declined progressively from patients with no comorbidities (mean EQVAS score, 66) to patients with cardiovascular comorbidities (mean EQ-VAS score, 62) to patients with non-cardiovascular comorbidities (mean EQ-VAS score, 59). The relationships among cardiovascular comorbidities and patient-rated health were explained by their associations with anxiety or depression (atrial fibrillation, odds ratio [OR] 1.16, 95% CI 1.06 to 1.27; ischemic heart disease [IHD], OR 1.20, 95% CI 1.09 to 1.32) and with pain (IHD, OR 1.25, 95% CI 1.14 to 1.38). Associations of non-cardiovascular comorbidities with patient-rated health were explained by their associations with shortness of breath (diabetes, OR 1.17, 95% CI 1.03 to 1.32; chronic kidney disease [CKD, OR 1.23, 95% CI 1.10 to 1.38; chronic obstructive pulmonary disease [COPD], OR 95% CI 1.84, 1.62 to 2.10) and with fatigue (diabetes, OR 1.27, 95% CI 1.13 to 1.42; CKD, OR 1.24, 95% CI 1.12 to 1.38; COPD, OR 1.69, 95% CI 1.50 to 1.91). There were direct associations between all symptoms and patient-rated health, and indirect associations via functional limitations. Anxiety or depression had the strongest association with functional limitations (OR 10.03, 95% CI 5.16 to 19.50) and patient-rated health (mean difference in EQ-VAS score, -18.68, 95% CI -23.22 to -14.14). HF optimizing therapies did not influence these associations. Key limitations of the study include the cross-sectional design and unclear generalisability to other populations. Further prospective HF studies are required to test the consistency of the relationships and their implications for health.amp; para;amp; para;Conclusions amp; para;amp; para;Identification of distinct comorbidity health pathways in HF could provide the evidence for individualised person-centred care that targets specific comorbidities and associated symptoms.

  • 153.
    Lee, Christopher S.
    et al.
    Oregon Health and Science University, OR 97201 USA.
    Bidwell, Julie T.
    Emory University, GA 30322 USA.
    Paturzo, Marco
    University of Roma Tor Vergata, Italy.
    Alvaro, Rosaria
    University of Roma Tor Vergata, Italy.
    Cocchieri, Antonello
    Catholic University, Italy.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Riegel, Barbara
    University of Penn, PA 19104 USA.
    Vellone, Ercole
    University of Roma Tor Vergata, Italy.
    Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up2018In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 47, no 1, p. 40-46Article in journal (Refereed)
    Abstract [en]

    Background: Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF self care to clinical events. Objectives: To identify patterns of self-care behaviors in HF patients and their association with clinical events. Methods: This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n = 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up. Results: Patients (mean age 71.8 +/- 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio = 0.66 10.46-0.96], p = 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events. Conclusions: Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients. (C) 2017 Elsevier Inc. All rights reserved.

  • 154.
    Lee, Geraldine
    et al.
    Kings Coll London, England.
    Marques, Elena
    University of Valencia, Spain.
    Vellone, Ercole
    University of Rome, 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.
    Hopstock, Laila
    Arctic University of Norway, Norway.
    Tagney, Jenny
    University Hospital Bristol NHS Fdn Trust, England.
    Khatib, Rani
    University of Leeds, England.
    ODonnell, Sharon
    Trinity Coll Dublin, Ireland.
    Hronn Svavarsdottir, Margret
    University of Akureyri, Iceland.
    Goossens, Eva
    Leuven University, Belgium.
    Andreae, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Post-Doctoral Mentorship Award - have you considered applying?2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 8, p. 658-658Article in journal (Other academic)
    Abstract [en]

    n/a

  • 155.
    Lenzen, M.
    et al.
    Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
    Scholte, op Reimer W.
    Scholte op Reimer, W., Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands, Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group.
    Norekval, T.M.
    Norekvål, T.M., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    De, Geest S.
    De Geest, S., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Institute of Nursing Science University of Basel, Clinical Nursing Science University Hospital Basel, Switzerland.
    Fridlund, B.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, School of Health Sciences and Social Work, Växjö University, Sweden.
    Heikkila, J.
    Heikkilä, J., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, School of Health and Social Care, Jyväskylä University of Applied Sciences, Finland.
    Jaarsma, T.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Cardiology, University Hospital Groningen, University of Groningen, Netherlands.
    Martensson, J.
    Mårtensson, J., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Nursing Science, School of Health Sciences, Jönköping, Sweden.
    Moons, P.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Center for Health Services and Nursing Research, Catholic University of Leuven, Belgium.
    Smith, K.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Medical School/School of Nursing and Midwifery, University of Dundee, Scotland, United Kingdom.
    Stewart, S.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Devision of Health Sciences, University of South Australia, Adelaide, Australia.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Thompson, D.R.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong.
    Wijns, W.
    Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium.
    Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 2, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Background: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods: We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results: Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80). Conclusion: In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care. © 2006 European Society of Cardiology.

  • 156. Liljeroos, H
    et al.
    Swahn, E
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Nielsen, NE
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Conception of information in grown up congenital heart disease.2004Conference paper (Other academic)
  • 157. Liljeroos, H
    et al.
    Swahn, E
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, NE
    Development of a computer-based educational programme for adults with congenital heart disease.2005Conference paper (Other academic)
  • 158.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Agren, Susanna
    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.
    Franzén Årested, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. 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.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure.2014Conference paper (Refereed)
  • 159.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Univ Calif Irvine, CA USA.
    Introducing nurse-led heart failure clinics in Swedish primary care settings2019In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, no 1, p. 103-109Article in journal (Refereed)
    Abstract [en]

    AimAccording to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients experiences of HF clinics in PC. Methods and resultsThe study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (Pamp;lt;0.001), HF hospital days by 27.3% (Pamp;lt;0.001) and HF emergency room visits by 24% (Pamp;lt;0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. ConclusionNurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.

  • 160.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Chung, Misook L.
    Univ Kentucky, KY 40506 USA.
    Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 527-534Article in journal (Refereed)
    Abstract [en]

    Background: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. Aim: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. Methods: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. Results: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. Conclusion: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.

  • 161.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    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.
    Factors influencing caregiver burden in partners of patients with heart failure, a long term follow up2013Conference paper (Other academic)
  • 162.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, 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, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 163.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 164.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention: a qualitative study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e018236Article in journal (Refereed)
    Abstract [en]

    Objectives To describe nurses documentation of the content in a psychoeducational intervention inspired by Stuifbergens model addressing cognitive, supportive and behavioural needs of patient-partner dyads affected by heart failure. Design A descriptive qualitative design was used analysing nurses documentation in a dialogue guide based on a health promotion model. Settings The dialogue guide was used during three nurse-led sessions at two heart failure clinics in Sweden with patients affected with heart failure and their partners during the years 2005-2008. Participants The dialogue guides from 71 patient-partner dyads were analysed using direct deductive content analyses. Patients mean age was 69 years and 31% were female, partners mean age was 67 years and 69% were female. Results The findings supported the conceptual health promotion model and identified barriers, recourses and self-efficacy described by the dyads within each category. Conclusion The dyads described that during the sessions, they had gained enhanced knowledge and greater confidence to handle their life situation and expressed that they needed psychoeducational support during the whole illness trajectory. The results may guide and help to improve content and quality when caring for patients affected with heart failure and their partners and also when designing new interventions.

  • 165.
    Liljeroos, Maria
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden.
    Ågren, Susanna
    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 Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and 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.
    Perceived caring needs in patient-partner dyads affected by heart failure: A qualitative study.2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2928-2938Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support.

    BACKGROUND: Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused.

    DESIGN: A qualitative study design was used.

    METHODS: Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses.

    RESULTS: The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others.

    CONCLUSIONS: There is a need to improve education and support for patient-partner dyads affected by heart failure.

    RELEVANCE TO CLINICAL PRACTICE: The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.

  • 166.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    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.
    Perceived needs of supportive care in patient-partner dyads affected by heart failure2013Conference paper (Other academic)
  • 167.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Self-assessed needs of supportive care in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 168.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Self-assessed needs of supportive care in patient-partner dyads affected by heart failure2011Conference paper (Refereed)
  • 169.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    The cognitive, supportive and behaviour needs of participants in a nurse-led intervention targeting patients with heart failure and their partners2015Conference paper (Other academic)
  • 170.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden; Ersta Skondal University of Collage, Sweden; Ersta Hospital, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138058-Article in journal (Refereed)
    Abstract [en]

    Background To date, contemporary heart failure care remains patient-focused, but awareness of the partners and families situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners. Methods This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support. Results The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients. Conclusion This study may be regarded as a first step in trying to understand dyads need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes.

  • 171.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. School of Health and Caring Sciences, Faculty of Health, Social Work and Behavioral Sciences, Linnaeus University, Kalmar, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial2017In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 2, p. 367-379Article in journal (Refereed)
    Abstract [en]

    Background

    Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role.

    Objective

    Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden.

    Design

    A randomized controlled study design, with a follow-up assessment after 24 months.

    Setting and participants

    Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden.

    Intervention

    A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners’ physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity.

    Results

    One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.

    Discussion and conclusion

    Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial.

  • 172.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Årested, Kristofer
    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.
    A long-term follow up of experiences of and factors influencing caregiver burden in partners of patients with heart failure2013Conference paper (Other academic)
  • 173.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    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.
    Long term effects of an integrated educational and psychosocial intervention in partners to patients affected by heart failure2014Conference paper (Other academic)
  • 174.
    Lin, Chung-Ying
    et al.
    Hong Kong Univ Sci and Technol, Peoples R China.
    Pakpour, Amir H.
    Qazvin Univ Med Sci, Iran; Jonkoping Univ, Sweden.
    Brostrom, Anders
    Jonkoping Univ, Sweden.
    Fridlund, Bengt
    Jonkoping Univ, Sweden.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus Univ, Sweden.
    Strömberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. ACU, Australia.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Background: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). Objective: The aim of this study was to investigate the EHFScB-9s factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. Methods: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). Results: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFSCB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legstfeet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). Conclusions: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

  • 175.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of a digital pen and paper tool to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence2011Conference paper (Other academic)
  • 176.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of the digital pen to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence - a pilot study2011Conference paper (Other academic)
  • 177.
    Ljung Faxen, Ulrika
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Orsini, Nicola
    Karolinska Inst, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Andersson, Daniel C.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Linde, Cecilia
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Savarese, Gianluigi
    Karolinska Inst, Sweden.
    N-terminal pro-B-type natriuretic peptide in chronic heart failure: The impact of sex across the ejection fraction spectrum2019In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 287, p. 66-72Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to assess sex-specific differences in N-terminal B-type natriuretic peptide (NT-proBNP) regarding concentrations, predictors of high concentrations, and prognostic role, in a large and unselected population with chronic heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). Methods and results: In 9847 outpatients with HFpEF, HFmrEF, and HFrEF (49 vs. 35 vs. 25% females, respectively) from the Swedish HF Registry, median NT-proBNP concentrations were 1598 ng/L in females vs. 1310 ng/L in males in HFpEF, 1764 vs. 1464 ng/L in HFmrEF, and 2543 vs. 2226 ng/L in HFrEF (p amp;lt; 0.05 for all). The differences persisted after multiple adjustment. The largest sex-difference in NT-proBNP levels was observed in HFpEF with sinus rhythm, where median concentrations were 1.4 folds higher in females (923 vs. 647 ng/L). Independent predictors of NT-proBNP levels (defined as above the different medians according to sex and HF phenotype) were overall consistent across sexes and EF. NT-proBNP levels were similarly associated with risk of all-cause death/HF hospitalization in both sexes regardless of EF. Conclusion: Concentrations of NT-proBNPwere higher in females across the EF spectrum, with larger relative differences in HFpEF with sinus rhythm. However, similar predictors of high levels were observed in both sexes. There were no sex-differences in the prognostic role of NT-proBNP. These findings support the use of NT-proBNP for prognostic purposes in chronic HF, regardless of sex. (c) 2019 Elsevier B.V. All rights reserved.

  • 178.
    Luttik, Maria
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, .
    Goossens, E
    KU Leuven, University of Leuven.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Mårtensson, J
    Jönköping University, School of Health and Welfare, Department of Nursing, Jönköping, Sweden.
    Thompson, D R
    Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia.
    Moons, P
    7KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium Institute of Health and Care Sciences, University of Gothenburg, Sweden..
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Norrköping. Undertaking Nursing Interventions Throughout Europe (UNITE) research group..
    Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 299-308Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.

    AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.

    METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).

    RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.

    CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.

  • 179.
    Luttik, Marie Louise
    et al.
    Hanze University of Appl Science, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Changing needs of heart failure patients and their families during the illness trajectory: A challenge for health care2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 5, p. 298-300Article in journal (Other academic)
    Abstract [en]

    n/a

  • 180. Luttik, ML
    et al.
    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.
    Agren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Caregiving tasks and caregiver burden over time: effects on an intervention for patients with post-operative heart failure and their partners.2014Conference paper (Refereed)
  • 181.
    Lycholip, Edita
    et al.
    Vilnius Univ, Lithuania; Vilnius Univ Hosp Santaros Clin, Lithuania.
    Aamodt, Ina Thon
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Simbelyte, Toma
    Vilnius Univ, Lithuania.
    Puronaite, Roma
    Vilnius Univ Hosp Santaros Clin, Lithuania; Vilnius Univ Hosp Santaros Clin, Lithuania; Vilnius Univ, Lithuania.
    Hillege, Hans
    Univ Groningen, Netherlands.
    de Vries, Arjen
    Univ Groningen, Netherlands.
    Kraai, Imke
    PRA Hlth Sci Early Dev Serv, Netherlands.
    Strömberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania; Vilnius Univ Hosp Santaros Clin, Lithuania.
    The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study2018In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, p. 1113-1122Article in journal (Refereed)
    Abstract [en]

    Introduction: Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited. Aims: This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. Methods: In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69 +/- 11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). Results: The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p amp;lt; 0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, p amp;lt; 0.05), lower left ventricular ejection fraction (LVEF) (per 5%, p amp;lt; 0.05), lower New York Heart Association (NYHA) class (class III vs class II, p amp;lt; 0.05). The subgroups of patients who had an initial EHFScBs total score amp;gt; 28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score amp;lt;= 8, demonstrated the greatest potential to improve self-care during the study. Conclusion: TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life. lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.

  • 182.
    Lycholip, Edita
    et al.
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Paleviciute, Egle
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Aamodt, Ina Thon
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    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.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Non-invasive home lung impedance monitoring in early post-acute heart failure discharge: Three case reports2019In: WORLD JOURNAL OF CLINICAL CASES, ISSN 2307-8960, Vol. 7, no 8, p. 951-960Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Patients discharged after hospitalization for acute heart failure (AHF) are frequently readmitted due to an incomplete decongestion, which is difficult to assess clinically. Recently, it has been shown that the use of a highly sensitive, non-invasive device measuring lung impedance (LI) reduces hospitalizations for heart failure (HF); it has also been shown that this device reduces the cardiovascular and all-cause mortality of stable HF patients when used in long-term out-patient follow-ups. The aim of these case series is to demonstrate the potential additive role of non-invasive home LI monitoring in the early post-discharge period. CASE SUMMARY We present a case series of three patients who had performed daily LI measurements at home using the edema guard monitor (EGM) during 30 d after an episode of AHF. All patients had a history of chronic ischemic HF with a reduced ejection fraction and were hospitalized for 6-17 d. LI measurements were successfully made at home by patients with the help of their caregivers. The patients were carefully followed up by HF specialists who reacted to the values of LI measurements, blood pressure, heart rate and clinical symptoms. LI reduction was a more frequent trigger to medication adjustments compared to changes in symptoms or vital signs. Besides, LI dynamics closely tracked the use and dose of diuretics. CONCLUSION Our case series suggests non-invasive home LI monitoring with EGM to be a reliable and potentially useful tool for the early detection of congestion or dehydration and thus for the further successful stabilization of a HF patient after a worsening episode.

  • 183.
    McDonagh, Theresa A
    et al.
    Royal Bromptom Hospital, UK.
    Blue, Lynda
    British Heart Foundation, UK.
    Clark, Andrew L
    Castle Hill Hospital, UK.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ekman, Inger
    Sahlgrenska Academy, University of Gothenburg.
    Lainscak, Mitja
    Östergötlands Läns Landsting. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science. Division of Cardiology, Golnik, Slovenia.
    McDonald, Kenneth
    St. Vincents University Hospital, Ireland.
    Ryder, Mary
    St. Vincents University Hospital, Ireland.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jaarsma, Tiny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    European Society of Cardiology Heart Failure Association Standards for delivering heart failure care2011In: EUROPEAN JOURNAL OF HEART FAILURE, ISSN 1388-9842, Vol. 13, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This document aims to summarize the key elements which should be involved in, as well as some more desirable features which can improve the delivery of care in a HF management programme, while bearing in mind that the specifics of the service may vary from site to site. We envisage a situation whereby all patients have access to the best possible care, including improved access to palliative care services, informed by and responsive to advances in diagnosis management and treatment. The goal should be to provide a seamless system of care across primary and hospital care so that the management of every patient is optimal, no matter where they begin or continue their health-care journey.

  • 184. Moons, P
    et al.
    Scholte op Reimer, W
    De Geest, S
    Fridlund, B
    Högskolan i Jönköping.
    Heikkila, J
    Jaarsma, T
    Mårtensson, J
    Smith, K
    Stewart, S
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Thompson, D.R.
    Involvement, education and activities of nurse specialists in adult congenital heart disease programmes.2006Conference paper (Other academic)
  • 185.
    Moons, P
    et al.
    Katholieke Universiteit Leuven, Belgium.
    Scholte op Reimer, W
    Erasmus Medical Center, Rotterdam.
    De Geest, S
    University of Basel.
    Fridlund, B
    Växjö University, Sweden.
    Heikkila, J
    Jyväskylä University.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Martensson, J
    School of Health Sciences, Jönköping.
    Smith, K
    University of Dundee.
    Stewart, S
    University of South Australia, Adelaide.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Thompson, D R
    The Chinese University of Hong Kong.
    Nurse specialists in adult congenital heart disease: the current status in Europe2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 60-67Article in journal (Refereed)
    Abstract [en]

    AIM: Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the care for adults with congenital cardiac anomalies in Europe. METHODS: The Euro Heart Survey on Adult Congenital Heart Disease has previously showed that 20 out of 48 specialist centres (42%) have nurse specialists affiliated with their programme. Fifteen of these 20 centres (75%) validly completed a web-based survey tool. RESULTS: Specialist centres had a median number of 2 nurse specialists on staff, corresponding with 1 full-time equivalent. In most centres, the nurse specialists were also affiliated with other cardiac care programmes, in addition to congenital heart disease. The involvement of nurse specialists was not related to the caseload of inpatients and outpatient visits. Physical examination was the most prevalent activity undertaken by nurse specialists (93.3%), followed by telephone accessibility (86.7%), patient education (86.7%), co-ordination of care (73.3%), and follow-up after discharge (73.3%). Patient education covered mainly prevention and prophylaxis of endocarditis (100%), cardiovascular risk factors (92.3%), sport activities (92.3%), the type and characteristics of the heart defect (92.3%), the definition and aetiology of endocarditis (84.6%), cardiac risk in case of pregnancy (84.6%), and heredity (84.6%). Two third of the nurse specialists were involved in research. CONCLUSION: This survey revealed gaps in the provision of care for these patients in Europe and demonstrated that there is room for improvement in order to provide adequate chronic disease management. The results of this study can be used by individual hospitals for benchmarking.

  • 186.
    Moons, Philip
    et al.
    Katholieke University Leuven.
    Fleck, Desiree
    Childrens Hospital Philadelphia.
    Jaarsma, Tiny
    University Groningen.
    Norekval, Tone M
    Haukeland Hospital.
    Smith, Karen
    University of Dundee.
    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.
    Thompson, David R
    University of Leicester.
    Budts, Werner
    University Hospital Leuven.
    What do cardiovascular nurses know about the hematological management of patients with Eisenmenger syndrome?2009In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, ISSN 1474-5151, Vol. 8, no 4, p. 246-250Article in journal (Refereed)
    Abstract [en]

    Aim: We investigated the level of knowledge of hematological management of patients with Eisenmenger syndrome among general cardiovascular nurses and nurses who specialize in congenital heart disease (CHD). Methods: We conducted a survey at two international conferences attended by cardiovascular nurses. Nurses were asked to complete a questionnaire comprising two questions and three clinical case scenarios. Overall, 89 nurses participated (response rate 90.8%), 43 of whom specialized in CHD. Results: The level of knowledge displayed among cardiovascular nurses is poor. About one-third of nurses not specialized in CHD recognized the definition of Eisenmenger syndrome and knew what normal hematocrit levels are. With respect to the cases presented, less than 10% of the nurses could give a correct answer. The level of knowledge of specialized nurses was significantly higher, but also here, important gaps in the level of knowledge could be observed. Less than two-thirds knew the reference values of hematocrit and knew the appropriate management in two cases. Less than half of the specialized nurses knew about the procedure of isovolumic phlebotomy. Conclusion: The level of knowledge displayed by cardiovascular nurses regarding the hematological management of patients with Eisenmenger syndrome is poor. Also the knowledge of nurses specialized in CHD could be improved.

  • 187.
    Moser, Debra K.
    et al.
    University of Kentucky, College of Nursing, Lexington, USA .
    Dickson, Victoria
    New York University College of Nursing, USA .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Lee, Christopher
    Oregon Health & Science University, Portland, USA .
    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.
    Riegel, Barbara
    University of Pennsylvania, School of Nursing, Philadelphia, USA .
    Role of self-care in the patient with heart failure2012In: Current Cardiology Reports, ISSN 1523-3782, E-ISSN 1534-3170, Vol. 14, no 3, p. 265-275Article in journal (Refereed)
    Abstract [en]

    Optimal outcomes and quality of life for patients with heart failure depend on engagement in effective self-care activities. Self-care is a complex set of activities and most clinicians are not adequately prepared to assist their patients to engage in effective self-care. In this paper, we provide an overview of self-care that includes definitions, the importance of self-care to outcomes, the physiologic basis for better outcomes with good self-care, cultural perspectives of self-care, and recommendations for the improvement of self-care. Promotion of effective self-care by all clinicians could substantially reduce the economic and personal burden of repeated rehospitalizations among patients with heart failure.

  • 188.
    Moser, Debra K.
    et al.
    University of Kentucky, KY 40506 USA.
    Suk Lee, Kyoung
    University of Wisconsin, WI 53706 USA.
    Wu, Jia-Rong
    University of N Carolina, NC 27515 USA.
    Mudd-Martin, Gia
    University of Kentucky, KY 40506 USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Huang, Tsuey-Yuan
    Chang Gung University of Science and Technology, Taiwan.
    Fan, Xui-Zhen
    Shandong University, Peoples R China.
    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.
    Lennie, Terry A.
    University of Kentucky, KY 40506 USA.
    Riegel, Barbara
    University of Penn, PA 19104 USA.
    Identification of symptom clusters among patients with heart failure: An international observational study2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 10, p. 1366-1372Article in journal (Refereed)
    Abstract [en]

    Background: Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered. Objectives: To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia. Design: Cross-sectional, observational study. Settings: In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States. Participants: A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions. Methods: Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Wards method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores. Results: There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters. Conclusion: Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.

  • 189. Moser, Debra
    et al.
    Thylén, Ingela
    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.
    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.
    Shared decision-making about end-of-life care for heart failure patients with an implantable cardioverter defibrillator: a national cohort study.2014Conference paper (Refereed)
    Abstract [en]

    Background

    Whether to deactivate an implantable cardioverter defibrillator (ICD) at end-of-life is an important question for patients with an ICD. Expert consensus statements recommend physicians discuss end-of-life issues with ICD patients before and after implantation and promote shared decision-making. The degree to which these recommendations are followed in patients with HF is unknown. The purpose of this study was to compare attitudes and knowledge about the ICD at end-of-life between ICD recipients with and without HF to determine how well HF patients could participate in end-of-life decisions.

    Methods

    Every ICD patient in Sweden is enrolled in a national registry. We mailed a survey about attitudes, knowledge and experiences (the End-of-Life-ICD Questionnaire) related to the ICD and end-of-life issues to all registry patients. Data on quality of life (Euro-QOL), anxiety and depression (Hospital Anxiety and Depression Scale) were collected to determine if these affected attitudes or knowledge.

    Results

    Of the 5,535 patients in the registry, 3,067 (1606 with HF; age 66±11 years; 21% women) participated. Despite patients with HF reporting worse quality of life (p<0.001), and greater depression (p<0.001) and anxiety (p<0.001) than their counterparts without HF, their attitudes and knowledge about the ICD at end-of-life were very similar. Only 39% of HF patients discussed illness trajectory with their doctor, fewer (14%)discussed deactivation with their doctor, and only 8% discussed their wishes with their family. A total of 40% of HF patients did not want to discuss deactivation with their doctor, and 64% felt that such discussions were warranted only as their prognosis worsened or they neared end-of-life (70%). Patients with HF had misconceptions about the ICD: 71% incorrectly believed the ICD always delivered shocks at the end-of-life; 27% believed ICD deactivation was the same as active euthanasia; 26% believed the ICD could only be deactivated by surgical removal; and 36% thought the ICD could be deactivated without their knowledge. With regard to deactivation of the ICD, 62% did not want it deactivated or could not make a choice even if they were dying of cancer. With regard to ICD generator replacement if needed, 54% of HF patients wanted it changed or were undecided (34%) in the context of being seriously ill with another condition; 65% wanted it changed or could not make a choice (26%) even if they were of advanced age. None of these attitudes or knowledge items differed from those of patients without HF.

    Conclusion

    ICD recipients with HF hold many perceptions about the ICD at end-of-life that could interfere with effective decision-making. Without better knowledge about their ICD and its performance at the end-of-life, or without discussions with doctors and family members about these issues, HF patients with an ICD are ill-prepared to engage in shared decision-making about their ICD and its use at the end-of-life.

  • 190.
    Mourad, G
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Hallert, C
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Strömberg, A
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Symptoms of depression in patients with unexplained chest pain2010Conference paper (Refereed)
  • 191.
    Mourad, G
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Röndahl, Gert
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Strömberg, A
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Symtoms of anxiety and depression and the role of social support in patients with chest pain.2010Conference paper (Refereed)
  • 192.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. 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. 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 Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Societal costs of non-cardiac chest pain compared with ischemic heart disease - a longitudinal study2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 1, p. 403-Article in journal (Refereed)
    Abstract [en]

    Background

    Non-cardiac chest pain (NCCP) is a common complaint. Our aim was to present a detailed description of the costs of patients with NCCP compared to patients with acute myocardial infarction (AMI) and Angina Pectoris (AP) from a societal perspective.

    Methods

    Data on healthcare utilization and annual societal costs, including direct healthcare costs and indirect costs due to productivity loss, were collected from different databases. The participants consisted of 199 patients from a general hospital in Sweden (99 with NCCP, 51 with AMI, 49 with AP), mean age of 67 years, 59% men.

    Results

    NCCP, AMI, and AP patients had on average 54, 50 and 65 primary care contacts and 3, 4, and 4 hospital admissions during a period of 2 years. Length of hospital stay was 6, 11 and 11 days. On average, 14%, 18%, and 25% of NCCP, AMI and AP patients were on sick-leave annually, and about 12% in each group received a disability pension. The mean annual societal costs of NCCP, AMI and AP patients were €10,068, €15,989 and €14,737.

    Conclusions

    Although the annual societal cost of NCCP patients was lower than in AMI and AP patients, the cost was still considerable (€10,068). Taken into account the high prevalence of NCCP, the cumulative annual national cost of these patients could be more than the double of AMI and AP if all patients incurred the same costs as in this study. Targeted interventions are important in order to support patients with NCCP and minimize healthcare utilization and costs.

  • 193.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. 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.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Depressive symptoms and health care utilization: -a comparison between patients with non-cardiac chest pain and patients with ischemic heart disease2012Conference paper (Other academic)
    Abstract [en]

    Background: More than half of patients admitted to hospital for acute chest pain are diagnosed as having non-cardiac chest pain (NCCP). While there are well established guidelines for diagnosing and treating patients with ischemic heart disease (IHD), an international consensus approach to treat patients with NCCP is lacking. This lack of structured care may possibly cause mental distress in patients and increased health care utilization.

    Objectives: To compare depressive symptoms and health care utilization in patients admitted for NCCP and patients with acute myocardial infarction (AMI) and angina pectoris (AP) post-hospitalization and at one-year follow-up.

    Methods: A cross-sectional, descriptive and comparative design was used. In total 131 patients with NCCP, 66 with AMI and 70 with AP completed two depression screening questionnaires 2-3 weeks after the hospital stay and one year later. Data on health care utilization were collected from a population-based diagnose-related database.

    Results: Depressive symptoms were found in 27% of the participants post-hospitalization and in 26% one year later. At follow-up, 17 patients had recovered from their depressive symptoms, 37 patients had continuous depressive symptoms, and 26 patients had developed depressive symptoms. No difference in depressive symptoms was found between the different diagnose groups neither at baseline nor at follow-up. Patients diagnosed with NCCP visited health care providers in primary care as often as patients diagnosed with AMI, but had fewer hospital admissions. Patients with AP and patients with depressive symptoms utilized most health care services.

    Conclusion: Persisting depressive symptoms are frequently seen among patients with NCCP as well as in patients with IHD. NCCP patients utilize as much primary care resources as AMI patients. This might imply a need for interventions targeting depressive symptoms in patients with both NCCP and IHD.

  • 194.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    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.
    Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease2012In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 41, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up. METHODS: One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database. RESULTS: More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services. CONCLUSIONS: Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms.

  • 195.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Svensson, E
    Formerly Swedish Defence Research Agency, Stockholm, Sweden.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?2017In: Abstract book, Sage Publications, 2017, Vol. 16 (S1), p. S3-S3, article id 24Conference paper (Other academic)
    Abstract [en]

    Background: Patients with non-cardiac chest pain (NCCP) suffer psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms, which can increase healthcare use. It is unknown how these variables are related and whether the relationships differ between patients with or without history of cardiac disease.

    Objective: To explore and model the associations between somatization, fear of body sensations, cardiac anxiety, depressive symptoms, and healthcare use in patients with NCCP with or without history of cardiac disease.

    Methods: Data were collected in Sweden in 670 patients (mean age 65±16 years, 51% women) within one month from discharge using the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, and Patient Health Questionnaire-9. Structural Equation Modelling analyses were used to explore the relationships between somatization, fear of body sensations, cardiac anxiety, depressive symptoms and healthcare use in NCCP patients with or without history of cardiac disease.

    Results: About 40% of the NCCP patients had previous diagnosis of cardiac disease. Patients with NCCP and a history of cardiac disease were older (71 vs. 60 years), had more comorbidities (4.7 vs. 2.8), and reported significantly higher scores in somatization (p=0.02), cardiac anxiety (p<0.001), and depressive symptoms (p=0.02), and greater healthcare use (p<0.001). Depressive symptoms were not directly associated with healthcare use (Chi-Square=68.28, df=10, P-value=0.000, RMSEA=0.099, CFI=0.96). In patients with history of cardiac disease, the impact of depressive symptoms on healthcare use was mediated by somatization, fear of body sensations, and cardiac anxiety (Chi-Square=7.61, df=8, P-value=0.48, RMSEA=0.000, CFI=0.99). In patients with no history of cardiac disease, the impact of depressive symptoms on healthcare use was directly mediated by cardiac anxiety (Chi-Square=4.17, df=7, P-value=0.76, RMSEA=0.000, CFI=0.99).

    Conclusions: The associations between psychological distress and healthcare use were different for patients with or without cardiac disease. In both groups depressive symptoms had no direct association with healthcare use.

  • 196.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Svensson, Erland
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?2018In: BMC Psychiatry, ISSN ISSN 1471-244X, Vol. 18, no 1, article id 172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.

    METHODS: In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.

    RESULTS: A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.

    CONCLUSIONS: In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.

  • 197.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Röndahl, Gerd
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. 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. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Symptoms of anxiety and depression and the role of social support in patients with chest pain.2010Conference paper (Refereed)
    Abstract [en]

    Background and aim: Being admitted to a coronary care unit due to chest pain is stressful. Limited data is available on anxiety and depression in chest pain patients during the acute phase. Social support may act as a buffer to the psychological impact of an acute cardiac event. Therefore, the aim of this study was to describe the prevalence of symptoms of anxiety and depression and their relationship to social support in patients admitted to a coronary care unit (CCU) for acute chest pain. Methods: The study had a descriptive, cross sectional design based on data collected by standardised questionnaires. Data was collected consecutively at a university hospital in central Sweden between October 2006 and October 2007. Eligible for the study were patients younger than 75 years, hospitalized due to chest pain at the CCU, who spoke and read Swedish and were in a general state of health to participate in the study. Patients were asked to answer three different questionnaires: State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS) and Medical Outcome Study-Social Support Survey (MOS-SSS) within 24 hours after being admitted to CCU. Results:A total of 337 patients were included in the study (mean age 60.5 years, 73 % men, 73 % married). Only two patients were free from symptoms of anxiety and depression, while 7 % of the patients had clinically significant levels of both anxiety and depression. A total 71 % had a clinically significant or severe level of anxiety and 22 % were at a borderline level for anxiety. A total of 14 % had a clinically significant level of depression and 67 % were at a borderline level of depression. Regression analysis showed that social support was independently related to anxiety and depression. Conclusion: Patients admitted to CCU experience extreme levels of psychological distress in the acute phase and social support seems to play an important role. Assessment of anxiety and depression as well as interventions including support and information should be considered in the CCU setting in order to improve mental well-being of patients with chest pain.

  • 198.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Röndahl, Gerd
    Linköping University, Department of Social and Welfare Studies. 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, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Symptoms of anxiety and depression and the role of social support in patients with chest pain2010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 229-229Conference paper (Refereed)
    Abstract [en]

    n/a

  • 199.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    The association between somatization and health care utilization in patients with non-cardiac chest pain2015In: Abstracts, Oxford University Press, 2015, Vol. 36, p. 283-283, article id P1665Conference paper (Other academic)
    Abstract [en]

    Background: Chest pain is one of the most common reasons for care-seeking, but often patients are diagnosed as non-cardiac (NCCP). NCCP patients suffer from cardiac anxiety, defined as fear of cardiac-related stimuli and sensations, which is strongly associated with increased healthcare utilization. Research indicates that somatization, defined as report of somatic symptoms that have no pathophysiological cause, is a relatively common cause in chest pain patients. The prevalence of somatization in NCCP patients and its association with cardiac anxiety and healthcare utilization needs further investigation.

    Purpose: To describe the prevalence of somatization and its association with cardiac anxiety and healthcare utilization in NCCP patients.

    Methods: Data in this cross sectional study was collected from 552 patients diagnosed with NCCP in four Swedish hospitals within one month from discharge. Patients had a mean age of 64±17 years, and 51% were women. Somatization was measured with the Patient Health Questionnaire-15 and cardiac anxiety with the Cardiac Anxiety Questionnaire. Healthcare utilization, i.e. number of healthcare contacts the year before study inclusion was self-reported by the patients. To determine the association between somatization, cardiac anxiety and healthcare utilization, a logistic hierarchical regression analysis was used with cardiac anxiety inserted in the first block, somatization in the second block, and a variable where these two were multiplied in the third block.

    Results: In total, 283 (51%) patients reported at least moderate levels of somatization and 229 (42%) patients reported cardiac anxiety. Of the total, 89 (16%) had only somatization; 88 (16%) had only cardiac anxiety; and 194 (35%) had both somatization and cardiac anxiety. Somatization was strongly related to cardiac anxiety (r=.54, p<.010). About 26% of the patients reported 2-3 healthcare contacts and 14% reported more than 3 healthcare contacts due to chest pain. Both somatization (r=.37, p<.010) and cardiac anxiety (r=.46, p<.010) were significantly related to number of healthcare contacts. The logistic hierarchical regression showed that cardiac anxiety (OR=1.09, CI=1.07-1.11, p< .001) and somatization (OR=1.08, CI=1.03-1.13, p< .001) were associated with increased healthcare utilization. The multiplicative interaction term between these variables was not significant (OR=1.09, CI=0.996-1.00, p .901).

    Conclusions: Somatization was frequently reported by NCCP patients and associated with cardiac anxiety and increased healthcare contacts. Somatization may therefore be important to target with interventions.

  • 200.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study2016In: The patient, ISSN 1178-1653, Vol. 9, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and make substantial use of healthcare resources.

    OBJECTIVE: To explore the prevalence of depressive symptoms, cardiac anxiety, and fear of body sensations in patients discharged with a NCCP diagnosis; and to describe how depressive symptoms, cardiac anxiety, and fear of body sensations are related to each other and to healthcare-seeking behavior.

    METHODS: Cross-sectional design. Data were collected between late October 2013 and early January 2014 in 552 patients with NCCP from four hospitals in southeast Sweden, using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire, and Body Sensations Questionnaire.

    RESULTS: About 26 % (n = 141) of the study participants reported at least moderate depressive symptoms, 42 % (n = 229) reported at least moderate cardiac anxiety, and 62 % (n = 337) reported some degree of fear of body sensations. We found strong positive relationships between depressive symptoms and cardiac anxiety (r s = 0.49; P < 0.01), depressive symptoms and fear of body sensations (r s = 0.50; P < 0.01), and cardiac anxiety and fear of body sensations (r s = 0.56; P < 0.01). About 60 % of the participants sought care because of chest pain once, 26 % two or three times, and the rest more than three times. In a multivariable regression analysis, and after adjustment for multimorbidity, cardiac anxiety was the only variable independently associated with healthcare-seeking behavior.

    CONCLUSION: Patients with NCCP and many healthcare consultations had high levels of depressive symptoms and cardiac anxiety, and moderate levels of fear of body sensations. Cardiac anxiety had the strongest relationship with healthcare-seeking behavior and may therefore be an important target for intervention to alleviate suffering and to reduce healthcare use and costs.

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