[Show abstract][Hide abstract] ABSTRACT: Background
Adherence to recommendations for physical activity is low in both male and female patients with heart failure (HF). Men are more physically active than women. In order to successfully promote physical activity, it is therefore essential to explore how much and why HF patients are physically active and if this is related to sex. The aim of this study was therefore to evaluate physical activity in HF patients, to describe the factors related to physical activity, and to examine potential barriers and motivations to physical activity with special focus on sex differences.
The study had a cross-sectional survey design. HF patients living at home received a questionnaire during May–July 2014, with questions on physical activity (from the Short Form-International Physical Activity Questionnaire), and potential barriers and motivations to physical activity.
A total of 154 HF patients, 27% women, with a mean age of 70±10 were included. In total, 23% of the patients reported a high level of physical activity, 46% a moderate level, and 34% a low level. Higher education, self-efficacy, and motivation were significantly associated with a higher amount of physical activity. Symptoms or severity of the disease were not related to physical activity. All the potential barriers to exercise were reported to be of importance. Psychological motivations were most frequently rated as being the most important motivation (41%) to be physically active. Physical motivations (33%) and social motivations were rated as the least important ones (22%). Women had significantly higher total motivation to be physically active. These differences were found in social, physical, and psychological motivations.
One-third of the HF patients had a low level of physical activity in their daily life. Severity of the disease or symptoms were not related, whereas level of education, exercise self-efficacy, and motivation were important factors to take into account when advising a HF patient about physical activity. Women reported higher motivation to be physically active than men, but there was no difference in the reported level of physical activity.
Preview · Article · Nov 2015 · Patient Preference and Adherence
[Show abstract][Hide abstract] ABSTRACT: To cope when living with heart failure (HF), patients might need information on the disease trajectory. Therefore the guidelines advise that health care providers initiate discussions about prognosis and end-of-life.
Purpose: The aim of this study was to describe the prevalence of discussing prognosis and end-of-life with HF patients at nurse-led HF clinics.
Methods: A national prevalence survey was conducted targeting nurses at outpatient HF clinics (n=61) and at primary health care centres (n=20). The HF nurses (n=111) completed a registration form for every HF patient they met in their practice a pre-specified week. They registered which items had been discussed during the patients' visits, including prognosis and end-of-life. Open-ended questions were asked on the reasons for or for not discussing these issues. The relationship between discussion of prognosis and demographic and clinical characteristics were analysed with t-test or Chi-square.
Results: Data was collected in 611 HF patients (mean age, 70±12, 191 female, 88% in NYHA class II or III). Items that were most often discussed included symptoms (96%), adherence to treatment (91%) and physical activity (86%). In 34% of the patients, prognosis was discussed during the visit. In 53% of the patients, the nurses found it relevant to discuss prognosis, but in a later stage of the patients' HF trajectory. In 4% of the patients, end-of-life was discussed, 22% of the nurses did not think it was relevant at all to discuss it, but more than half of them thought it would be relevant in a later stage (64%). Discussion of prognosis was not related to patients age, gender, months with HF or NYHA-class (p>0.01). There were no differences between outpatient HF clinics and primary health care centres in the prevalence of discussing prognosis.
Results from the open-ended questions suggest that the nurses often perceived that discussions were not needed since the patients were not so ill. If prognosis or end-of-life were discussed, it was often initiated by the patients themselves.
Conclusions: Prognosis and end-of-life was rarely discussed by HF nurses. Most nurses did not find it relevant to initiate such conversations at this specific time, independently of length or severity of HF. By not making policy about discussing prognosis or end-of life, or if patients do not ask about it themselves, there is a danger that these topics will be postponed forever.
Full-text · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Purpose: Social support, mostly provided by partners of Heart Failure patients, is known to be associated with positive health outcome in HF patients. Behavioral models suggest that social support has an impact through the influence of health behaviors. Partners of HF patients provide motivational support by encouraging patients to comply with their HF treatment regimen. In this study we hypothesized that motivational support of partners would be positively associated with self-care in HF patients.
Method: Using a cross-sectional design, self-care in HF patients was measured with the European Hear Failure Self-care Behavior scale containing of 12 items measuring different aspects of self-care (EHFScB-12). Support of partners was measured with the Dutch Objective Burden Inventory (DOBI) measuring the amount of different kinds of support as reported by partners. The DOBI contains 38 items in total, in this study the subscale motivational support was used. The study population consisted of HF patients (and their partners) that participated in the Dutch COACH trial on the effects of education and counseling. Patients and partners were asked to complete a questionnaire while at home, 12 months after the index hospitalization.
Results: In total 394 HF patients (44% NYHA III-IV, 24% female, mean age 67 (sd 11) and their 394 partners (76% female, mean age 67 (sd 12)) completed the questionnaire. The total score on self-care behavior in HF patients was 23 (range 12-60, sd 5.7). Partners provided motivational support with a mean score of 1.4 (range 1-3, sd 0.4). The amount of motivational support provided by partners was not associated with the level of self-care in the HF patients (Spearman's rho 0.08, p=0.12). Furthermore, no significant single item correlations between e.g. "motivating my partner to adhere to diet prescriptions" and "I eat a low salt diet" were found.
Conclusion: Partners of HF patients report their efforts in trying to support patients to comply with their HF treatment regimen. However, this support does not seem to affect patient's self-care behavior. Further research is necessary to gain insight in effective support strategies in patients and families coping with HF.
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population. METHODS: The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms. RESULTS: The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components. CONCLUSIONS: There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved.
Full-text · Article · Jun 2012 · European Journal of Cardiovascular Nursing
[Show abstract][Hide abstract] ABSTRACT: Arrhythmias can appear with a variety of symptoms, all from vague to pronounced and handicapping symptoms. Therefore, patient-reported outcomes (PROs) concerning symptom burden are important to assess and take into consideration in the care and treatment of patients with arrhythmias. The main purpose was to develop and validate a disease-specific questionnaire evaluating symptom burden in patients with different forms of arrhythmias.
A literature review was conducted and arrhythmia patients were interviewed. Identified symptoms were evaluated by an expert panel consisting of cardiologists and nurses working daily with arrhythmia patients. SF-36 and Symptoms Checklist (SCL) were used in the validation of the new questionnaire Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA). Homogeneity was evaluated with Spearman's correlations and Cronbach's alpha coefficient (α) was used to evaluate internal consistency. Construct validity was evaluated using item-total correlations and convergent and discriminant validity. For this, Spearman's correlations were calculated between the ASTA symptom scale, SCL and SF-36. Concurrent validity was validated by Spearman's correlations between the ASTA symptom scale and SCL.
The correlations between the different items in the ASTA symptom scale showed generally sufficient homogeneity. Cronbach's coefficient was found to be satisfactory (α = 0.80; lower bound 95% CI for α = 0.76). Construct validity was supported by item-total correlations where all items in the symptom scale were sufficiently correlated (≥0.3). Convergent and discriminant validity was supported by the higher correlations to the arrhythmia-specific SCL compared to the generic SF-36. Concurrent validity was evaluated and there were sufficiently, but not extremely strong correlations found between the ASTA symptom scale and SCL.
The nine items of the ASTA symptom scale were found to have good psychometric properties in patients with different forms of arrhythmias. Arrhythmia patients suffer from both frequent and disabling symptoms. The validated ASTA questionnaire can be an important contribution to PROs regarding symptom burden in arrhythmia patients.
Full-text · Article · Apr 2012 · Health and Quality of Life Outcomes
[Show abstract][Hide abstract] ABSTRACT: 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.
Full-text · Article · Mar 2012 · Current Cardiology Reports