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.     

慢性心力衰竭患者自我管理现状及其影响因素

目的 探讨慢性心力衰竭(CHF)患者自我管理现状及其影响因素.方法 以2019年1-12月在上海市某医院就诊的CHF患者为研究对象进行自我管理能力调查,采用描述流行病学方法 进行分析,并采用单、多因素分析方法 对自我管理能力得分影响因素进行分析.结果 本研究共对985例CHF患者自我管理能力进行调查,CHF患者自我管理...     

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。     

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients

Background  

Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV₁%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.     

Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study

Background

Although osteoarthritis (OA) often affects older persons, it has a profound effect on individuals actively employed. Despite reports of reduced productivity among workers with OA, data are limited regarding the impact of OA among workers. The objective of this study was to evaluate the impact of self-rated OA severity on quality of life, healthcare resource utilization, productivity and costs in an employed population relative to employed individuals without OA.

Methods

This cross-sectional analysis used data derived from the 2009 National Health and Wellness Survey (NHWS). Multivariable analyses characterized outcomes and costs (direct medical costs and indirect) among workers (full-time, part-time, or self-employed) ?? 20 years of age who were diagnosed with OA and who self-rated their OA severity as mild, moderate, or severe relative to workers without OA. Evaluated outcomes included productivity, assessed using the Work Productivity and Impairment (WPAI) scale; health-related quality of life, using the SF-12v2 Health Survey; and healthcare resource utilization.

Results

4,876 workers reported being diagnosed with OA (45.0% mild, 45.9% moderate, and 9.1% severe); 34,896 workers comprised the non-OA comparator cohort. There was a greater proportion of females in the OA cohort (55.5% vs 45.6%; P < 0.0001) and more individuals in the 40-64 year and ?? 65 year age ranges (P < 0.0001). As OA severity increased, workers reported more frequent pain, poorer quality of life, greater use of specific healthcare resources (hospitalizations) and reduced productivity. All outcomes indicated a significantly greater burden among workers with OA relative to those without OA (P < 0.0001). Estimated total annual costs per worker were $9,801 for mild OA, $14,761 for moderate OA, $22,111 for severe OA compared with $7,901 for workers without OA (P < 0.0001).

Conclusions

Workers with OA were characterized by significant disease and economic burdens relative to workers without OA that substantially increased with greater self-rated OA severity. Greater levels of OA severity were associated with reductions in quality of life and productivity, and increases in healthcare resource utilization and costs.     

Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study

ABSTRACT: BACKGROUND: Longitudinal studies analyzing the correlations between disease-specific and generic questionnaires at different time points in patients with advanced COPD are lacking. The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George's Respiratory Questionnaire, SGRQ) correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36) at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. METHODS: Demographic and clinical characteristics were assessed in 105 outpatients with advanced COPD at baseline. Disease-specific health status (SGRQ) and generic health status (EQ-5D, AQoL, SF-36) were assessed at baseline, four, eight, and 12 months. Correlations were determined between SGRQ and EQ-5D, AQoL, and SF-36 scores and changes in these scores. Agreement in direction of change was assessed. RESULTS: Eighty-four patients (80%) completed one-year follow-up and were included for analysis. SGRQ total score and EQ-5D index score, AQoL total score and SF-36 Physical Component Summary measure (SF-36 PCS) score were moderately to strongly correlated. The correlation of the changes between the SGRQ total score and EQ-5D index score, AQoL total score, SF-36 PCS, and SF-36 Mental Component Summary measure (SF-36 MCS) score were weak or absent. The direction of changes in SGRQ total scores agreed slightly with the direction of changes in EQ-5D index score, AQoL total score, and SF-36 PCS score. CONCLUSIONS: At four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores. The correlations between changes over time were weak or even absent. Disease-specific health status questionnaires and generic health status questionnaires should be used together to gain complete insight in health status and changes in health status over time in patients with advanced COPD.     

A single health status question had important prognostic value among outpatients with chronic heart failure

OBJECTIVE: Health status is an important marker of the impact of disease on function among patients with chronic heart failure (CHF). However, the prognostic value of CHF-specific health status on long-term mortality has not been adequately evaluated. Our objective was to assess CHF-specific health status and 5-year mortality among outpatients with CHF. STUDY DESIGN AND SETTING: We analyzed data from 494 Veterans Affairs outpatients with diagnoses of CHF and objective evidence of left ventricular dysfunction who enrolled in a quality improvement intervention. We extracted information about comorbid diagnoses, severity of illness (Charlson index), health care utilization, drug therapy, laboratory, and vital sign data along with generic and CHF-specific health status. We then identified multivariate correlates of subsequent mortality at 5 years. RESULTS: Five-year mortality was 44%. Age (chi2=26.1, hazard ratio [HR]=1.63, confidence interval [CI]: 1.35, 1.97; P<0.0001) and Charlson index (chi2=12.9, HR=1.39, CI: 1.16, 1.67; P=0.0003) were significantly associated with 5-year mortality. Controlling for clinical, lab, medication, and administrative data, a single-item assessing change in CHF-specific health status was independently associated with 5-year mortality (chi2=11.4, HR=0.87, CI: 0.80, 0.94, P=0.0007). CONCLUSIONS: Given the strength of the association with mortality, health care providers should routinely assess this single-item change in health status among outpatients with CHF to identify higher risk patients and guide therapy.     

Practices of clinical examination of heart failure patients in primary health care

The aim of this cross-sectional cohort study was to examine practices of clinical examination of heart failure patients in three primary health care regions in northern Finland. Altogether, 825 randomly selected heart failure patients aged 45 years or older, who had special reimbursement for drugs for the treatment of heart failure, were included. Main outcome measures were the frequency of medical visits and the mode of clinical examinations during control visits and symptomatic visits due to heart failure made by general practitioners. The prevalence of heart failure was 2% among those aged 45-75 years and 18% among the older ones. No differences existed in the incidence of all medical visits made as a result of heart failure, between the regions. ECG recordings, auscultation of the heart and lungs, measurements of blood pressure and recordings of ankle swelling were carried out in 72%, 79%, 85%, 90% and 59% of cases of control visits, and in 78%, 63%, 79%, 77% and 49% of cases in symptomatic visits, respectively. Chest X-ray examinations and recording of liver size were seldom carried out: 16% and 12% in control visits, and 19% and 11% in symptomatic visits, respectively. Important prognostic markers of heart failure were recorded even more rarely: jugular venous pressure, in 1% of control visits and 3% of symptomatic visits and the third heart sound not at all. NYHA grading had been carried out in 8% and echocardiography in 13% of cases. The prevalence of heart failure was higher than in many clinical studies, suggesting high number of false positive heart failure diagnoses made in primary health care. Some clinical examinations of significant prognostic value in heart failure are underused by general practitioners. Therefore, further education among general practitioners is needed to improve the practices of clinical examination in heart failure patients.     

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.     

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.     

探讨美托洛尔治疗老年性慢性心力衰竭

目的研究美托洛尔在老年性慢性心力衰竭治疗中的剂量及耐受性。方法对NYHA分级心功能Ⅱ～Ⅳ级129例老年患者在常规心衰治疗基础上加用美托洛尔，从极小剂量开始，逐渐增加剂量，目标分别为：①心率下降到55～60次／min（不低于50次／min）；②稍加剂量心功能下降Ⅰ级以上；③收缩压不低于90mmHg（ImmHg=0、133kPa）。结果美托洛尔平均维持量为（80．7±34．1，mg／d）（6．25～200mg／d）。其中88例（66．O％）达心率目标，44例（34．2％）达心衰目标，本研究血压无显著变化。随访患者多因不适当减量或停用美托洛尔。结论在治疗期间内，心力衰竭（NYHAⅡ级～Ⅳ级）患者对美托洛尔耐受性较好。     

Elderly persons with chronic kidney failure: health status alterations

This study aimed to describe health condition changes as experienced by elderly with Chronic Kidney Failure (CKF), under Continuous Ambulatory Peritoneal Dialysis (CAPD) treatment at the Dialysis and Kidney Transplantation Unit of a public hospital in Ribeir?o Preto -- SP, Brazil. Participants were six elderly under CAPD treatment, aged 61 to 74 years. The theoretical and methodological framework was thematic oral history as proposed by Meihy. Data analysis led to the category of changes in elderly's health condition and disclosed the diagnosis of the disease, signs and symptoms of CKF, causes and irreversibility.     

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.     

慢性心力衰竭治疗质量指标体系的建立

目的 建立一套适合中国慢性心力衰竭治疗质量评价的指标体系,为下一步慢性心衰治疗质量评价提供量化工具.方法 检索PubMed、EMBASE等数据库,同时参考〈慢性心力衰竭诊断治疗指南〉筛选出候选指标.选择来自北京、上海、哈尔滨的15名专家组成专家组.应用德尔菲法咨询专家意见,根据专家打分的均数和选择率确定最终的指标体系.纳入标准为：均数≥3.5,选择率≥50.0%.结果 发放专家咨询表15份,专家积极系数为100%,每份均符合要求.经过三轮Delphi,由最初52个候选指标筛选出22个指标,构成慢性心衰治疗质量评价的指标体系,包括2个结构指标,18个过程指标（15个院内指标,3个出院指标）,2个结局指标.指标体系中,均数〉4分的有12个,选择率≥80.0%的9个.利尿剂的均数和选择率最大,分别为4.7和100%;院内感染率≤7%的均数和选择率最小,分别为3.5和53.3%.指标均数的范围为3.5~4.7,选择率的范围为53.3%~100.0%.结论 本研究建立的慢性心力衰竭治疗质量评价指标体系与国外相关组织建立的稍有不同,符合我国国情,能全面客观的评价慢性心衰的治疗质量,发现其中的不足,以促进我国慢性心衰治疗质量的改善.     

Cardiac rehabilitation in patients with a congenital heart disease, an implantable cardioverter defibrillator or chronic heart failure

Cardiac rehabilitation is no longer just used to treat patients after the manifestation of a coronary artery disease such as a myocardial infarct, after a PTCA or after a coronary bypass operation. Patients with a congenital heart disease, patients who have received an implantable cardioverter defibrillator (ICD) and patients with stable chronic heart failure are also suitable candidates for a multidisciplinary cardiac rehabilitation programme. The new Dutch guidelines for cardiac rehabilitation, published in 2004, can be helpful in identifying potential candidates for a programme. Physical training is often a component of the treatment, but psycho-social counselling and education targeted at reducing anxiety and uncertainty, accepting the heart disease and learning to cope with it, can be just as important as those aspects targeted at improving the physical condition. Cardiac rehabilitation that includes physical training is safe for patients with congenital heart disease, for patients who have undergone an ICD implantation and for patients with stable chronic heart failure, as long as the pretraining exercise test is given a guiding role in selecting the appropriate physical work load. Patients with stable chronic heart failure should continue their physical training in order to maintain its beneficial physical and psychological effects.