Quality of life in patients with heart failure: the perspective of primary health care

Objective

To measure and identify the dimensions and determinants of health-related quality of life (HRQoL) in patients with chronic heart failure.

Methods

We performed a cross-sectional study, in which HRQoL was measured with the short-form (SF)-36 and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in 544 clinically-stable patients with chronic heart failure managed by 97 primary care physicians.

Results

The mean age of the patients was 77.6 years (SD: 9.9) and was significantly higher in women. A total of 31.2% were in New York Heart Association (NYHA) grade III-IV and 88.6% had at least one chronic condition. In both questionnaires, physical dimensions scored worse than emotional dimensions. After adjustment was made for multiple regression, seven variables entered into one of the five models and explained between 22% and 36% of the variance.

Conclusions

HRQoL in patients with chronic heart failure is impaired across all domains. Being female and being in NYHA functional class III-IV, as well as other factors such as depression, osteoarticular disease, hospital admission, body mass index and age, were associated with poorer self-perceived HRQoL.     

Heart failure diagnosis in primary health care: clinical characteristics of problematic patients. A clinical judgement analysis study

Background  

Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment. However, clinical diagnosis of heart failure is known to be difficult, especially in mild cases or early in the course of the disease. The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure.     

Functional status outcome measures in home health care patients with heart failure

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches.     

Improvement of primary care for patients with chronic heart failure: a pilot study

Background  

Many patients with chronic heart failure (CHF) receive treatment in primary care, but data have shown that the quality of care for these patients needs to be improved. We aimed to evaluate the impact and feasibility of a programme for improving primary care for patients with CHF.     

Mental health patients in primary health care services in Nepal

Patients attending two primary care settings in Nepal (a village health post and a district hospital outpatient department) were screened for psychiatric morbidity using the Self Reporting Questionnaire. Approximately one-quarter of all patients screened were found to have psychiatric morbidity. Women presenting were found to have higher frequency of "psychiatric caseness" than men. All these psychiatric patients presented with physical complaints, none with psychological, and the most common physical symptoms presented were abdominal pain, headache and cough. Health worker recognition of these cases was 29% in the health post and 0% in the hospital. Conclusions are drawn regarding the need for sufficient and relevant psychiatric teaching in health worker curriculae.     

Impaired health status and care dependency in patients with advanced COPD or chronic heart failure

Purpose  

Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status.     

Diastolic heart failure: a review and primary care perspective

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF.     

Improved care for patients with congestive heart failure

BACKGROUND: Congestive heart failure (CHF) affects 4.9 million people, mostly elderly, in the United States; 550,000 new cases are diagnosed each year. Evidence-based treatment approaches offer opportunities to reduce mortality, complications, and rehospitalization rates. STRATEGIES TO IMPROVE CARE FOR PATIENTS WITH CONGESTIVE HEART FAILURE: Seven key components of care tailored to the patient's clinical condition and comorbidities that should be provided to all patients with CHF, in the absence of contraindications or intolerance: (1) left ventricular systolic function assessment, (2) angiotension-converting enzyme-inhibitor or angiotensin receptor blockers at discharge for CHF patients with systolic dysfunction (left ventricular ejection fraction < 40%), (3) anticoagulation at discharge for CHF patients with chronic or recurrent atrial fibrillation, (4) smoking cessation advice and counseling, (5) discharge instructions that address activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen, (6) influenza immunization (seasonal), and (7) pneumococcal immunization. Hospitals should also consider beta-blocker therapy at discharge for stabilized patients without contraindications. CONCLUSION: The 5 Million Lives Campaign's focus on delivering reliable, evidence-based care for patients with CHF is part of an overall strategy to reduce medically induced harm.     

Morbidity in primary health care: patients versus visits

The introduction of the Family and Community Medicine specialist in Spain implied the beginning of an epidemiological approach in the activities of primary care, and the publication of the first studies on cared morbidity. Variations in tolerance threshold to illness by patients, differences in perception of health problems by physicians, the lack of a consensus on the definition of events that should be registered, together with the lack of a census of the eligible population are important problems for the development of such studies. The majority of studies published in our country have not overcome all these problems in an acceptable way.     

Structured chronic primary care and health-related quality of life in chronic heart failure

Background  

Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association between optimal management and HRQOL.     

Preventive care in heart failure

The heart failure is a common, costly, disabling and fatal cardiac disorder with high mortality and a continuously growing health problem in the population. The goals of the comprehensive non-pharmacological and pharmacological care programs focus on the decrease of mortality, prevention, improve the quality of life, reducing the hospital readmissions and decreasing costs. The management approach of heart failure as a chronic illness spanning the home, outpatient and inpatient settings involve multidisciplinary team care. Nurses can play an important role in any form of care. The organization of care may be different, closely adapted to the needs of patient population and the financial resources of health care. The new strategy includes measures aiming individual care for patients at high risk of developing left-ventricular dysfunction to reduce the impact of heart failure on public and individual health. Author reported the comprehensive management program of specialized heart failure outpatient clinic in Gottsegen Gy?rgy Hungarian Institute of Cardiology.     

The origins of primary health care and selective primary health care

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.     

Mental health and satisfaction with primary health care in female patients.

PURPOSE AND OBJECTIVES: Patient satisfaction is an important outcome in patient care and is increasingly being used as an indicator of quality of care within large health systems. This study examined whether consideration of specific mental health factors, including posttraumatic stress disorder (PTSD), can improve our understanding of patient satisfaction in primary care settings. METHODS: Questionnaires were mailed to all women who used the VA San Diego Healthcare System primary care clinic in 1998. Two hundred twenty-one (56%) women who were invited to participate in this study completed questionnaires. Participants provided information about physical and mental health and satisfaction with their primary medical care. RESULTS: Age and general mental health were negatively associated and PTSD was positively associated with overall satisfaction with care and satisfaction with the provider. General mental health was significantly related to satisfaction with the clinic. CONCLUSIONS: These findings support the importance of specific mental health symptoms, and trauma-related symptoms in specific, in determining satisfaction.     

老年慢性心力衰竭患者出院后医院与社区协同健康管理研究

目的探讨医院、社区协同健康管理对出院后老年慢性心力衰竭（CHF）患者的影响,为建立社区老年CHF患者综合管理模式提供依据。方法纳入228例老年CHF患者为研究对象,以社区为单位将患者随机分为社区管理组（106例）与协同管理组（122例）。社区管理组出院后转社区卫生服务机构管理,医院不再提供后续健康干预治疗;协同管理组由医院、社区协同管理。1年后比较两组患者用药依从性、因心力衰竭再住院率、病死率、平均再住院天数、医疗费用及明尼苏达心力衰竭生活质量（LiHFe）评分。结果两组一般临床资料无明显差异,具有可比性。经过1年的健康管理,与社区管理组相比,协同管理组用药依从性明显提高（）（2=8．97,P〈0．05）。协同管理组再住院率、人均住院天数、住院费用与社区管理组相比均明显降低,差异有统计学意义（X^2=9．91,t=3．78、3．61,P〈0．05）。在进行健康管理前,两组患者的LiHFe评分差异无统计学意义（X^2=0．42、0．81、0．66、0．44、0．41,P〉0．05）,出院1年后,协同管理组的各项评分均优于社区管理组,差异有统计学意义（t=6．37、11．81、6．16、9．64、9．／3,P〈0．05）。但两组患者的病死率差异无统计学意义（X^2=0．247,P〉0．05）。结论医院、社区协同健康管理是老年CHF患者降低再住院率、减轻医疗负担、提高生活质量切实有效的管理措施。