Meeting the information needs of patients with chronic heart failure

The number of people with chronic heart failure is increasing due to improved survival rates following myocardial infarction, as well as an ageing population. This article provides an overview of the pathophysiology, signs and symptoms and medical management of chronic heart failure and explores some of the information needs of patients with chronic heart failure.     

Advanced heart failure: impact on older patients and informal carers

AIM: This paper reports a study exploring the impact of advanced heart failure on the lives of older patients and their informal carers. BACKGROUND: Prognosis is poor in heart failure, with more than a third of patients dying within 12 months of diagnosis, and end-of-life symptoms are distressing and poorly controlled. Although end-of-life care for people with heart failure has received increased attention in recent years, there are still few data on the impact of advanced heart failure on the lives of patients and their informal carers. METHODS: Focused interviews were conducted with 10 older people with advanced heart failure and their nominated informal carer identified from one district general hospital in the United Kingdom (UK). Joint interviews were conducted with patients and carers in their own home. Thematic analysis was used to identify themes and subthemes. FINDINGS: Heart failure affected all aspects of the lives of patients and carers and, in particular, curtailed everyday activities. Patients were very concerned about the 'burden' their illness placed on their carer, who in all cases was their partner, although carers did not conceptualize the situation in this way. The socially isolating influence of the condition on both patients and carers was compounded by lack of professional input, and confusion about diagnosis was evident. Concerns about the future were common and, although few participants reported having been explicitly told about their prognosis, many made realistic statements about their limited life expectancy. CONCLUSIONS: This older cohort of people suffering from heart failure appears to have needs not unlike those of patients with 'terminal diseases'. When people are diagnosed with more familiar terminal illnesses, in particular cancer, they are given ongoing explanations, reassurance and support. Similar professional input is needed for patients with advanced heart failure and their carers.     

The correlation of standard heart failure assessment and palliative care questionnaires in a multidisciplinary heart failure clinic

Context

Heart failure (HF) is a leading cause of death and disability, and despite optimal care, patients may eventually require palliative care. Little is known about how palliative care questionnaires (the Edmonton Symptom Assessment Scale [ESAS] and the Palliative Performance Scale [PPS]) perform compared with HF assessment using the New York Heart Association (NYHA) functional class and the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Objectives

To assess the utility of a palliative care questionnaire in patients with HF.

Methods

One hundred and five patients (mean age = 65 years, 76% male, mean ejection fraction = 28%) followed in an HF clinic were surveyed with the NYHA, PPS, ESAS, and KCCQ.

Results

The PPS and ESAS were each correlated to the NYHA class (P < 0.0001 for both) and the KCCQ score (PPS: R² = 0.57; ESAS: R² = −0.72; both P < 0.0001). There were 33 patients who either died (10 deaths) or were hospitalized (26 patients) for more than one year. In addition to age and gender, a higher (worse) ESAS score trended toward significance (P = 0.07) and a lower (worse) PPS was a significant (P = 0.04) predictor of all-cause hospitalization or death.

Conclusion

In a cohort of HF patients, we found a modest correlation with NYHA class and KCCQ assessment with the PPS and ESAS, two standard palliative care questionnaires. Given the difficulty in identifying patients with HF eligible for palliative or hospice care, these tools may be of use in clinical practice.     

治疗性沟通对慢性肾衰竭患者生存质量的影响

目的 探讨治疗性沟通对慢性肾衰竭患者生存质量的影响.方法 将80例患者随机分为实验组和对照组,观察组在常规治疗护理的基础上进行治疗性沟通,对照组仅做常规的治疗和护理,6个月后,比较两组患者的生存质量指标（SF-36）.结果 观察组生存质量明显提高（P＜0.05）.结论 治疗性沟通可以提高慢性肾衰竭患者生存质量.     

Information needs of patients with heart failure: Health professionals' perspectives

This study aimed to understand information needs of patients with heart failure from the perspectives of health professionals. The exploratory qualitative study was conducted in 2011. Face‐to‐face interviews were performed to collect data from 24 health professionals. Data were evaluated through content analysis. Information identified by health professionals as essential for patients' learning included risk factors and symptom management, prognosis, medication and lifestyle adjustment. Factors related to both patients and health professionals were recognized as barriers to information acquisition. Moreover, health professionals provided several recommendations for improving the health condition of patients. Information needs identified by health professionals, as well as actual needs expressed by patients, can be incorporated in health education. The effectiveness of educating patients can be improved by addressing needs perceived by both patients and health professionals.     

美托洛尔治疗风湿性心脏病慢性心力衰竭患者的疗效分析

目的探讨美托洛尔治疗风湿性心脏病慢性心力衰竭患者的临床疗效及安全性。方法选取风湿性心脏病慢性心力衰竭患者100例,采用随机数字表法分为研究组和对照组。对照组给予常规治疗,研究组在常规治疗基础上加用美托洛尔。结果与对照组相比,研究组治疗后总有效率显著提高,差异有统计学意义(P0.05)。治疗后,两组患者的SBP、DBP值有显著下降,但在正常值内;两组6 min步行距离与治疗前相比显著增加,LVEF值明显升高,组间比较显示,研究组患者上述指标改善程度明显优于对照组(P0.05)。两组患者在治疗期间均未出现明显的不良反应。结论美托洛尔与常规治疗结合可提高风湿性心脏病慢性心力衰竭患者的临床疗效,有效改善心功能,降低NYHA分级,安全性较高,具有较高的临床价值。     

慢性心力衰竭患者的心率变异性分析

目的探讨慢性心力衰竭患者的心率变异性特点及心功能损害程度与心率变异性的相关性.方法对69例慢性心力衰竭患者和52例健康对照者的心率变异性资料进行对比分析,比较不同程度心功能不全患者的心率变异性差异.结果心力衰竭组正常R-R间期总体标准差、相邻正常R-R间期差值的均方根、相邻正常R-R间期差值〉50 ms的窦性心搏占心搏总数的百分比、总功率、低频功率和高频功率低于健康对照组,低频与高频功率比值高于健康对照组（P〈0.01）.随着心功能受损程度加重,心力衰竭患者的心率变异性进一步减低,其中低频功率较敏感.结论检测心率变异性在心力衰竭患者中的变化可反映自主神经功能受损情况,同时为心力衰竭程度的预测和治疗提供有用的参考指标.     

中文版SF-36量表在心力衰竭患者生存质量评价中的应用研究

目的　探讨中文版SF 3 6量表在慢性心力衰竭患者健康相关生存质量 (HRQOL)评价中的可行性。方法　采用中文版SF 3 6量表对 12 8例心衰患者的HRQOL进行评价。结果　 (1)心衰患者HRQOL各维度的得分随心功能分级增加逐步下降 ,均显著低于我国一般人群 (均P <0 .0 1)。对于不同左室舒张末期直径及运动耐量的患者来说 ,只有部分维度的比较差异有统计学意义 ,而不同左室射血分数组患者间各维度的比较差异并无统计学意义。 (2 )相关分析提示 ,各影响因素仅对部分维度呈中、低度相关 ,多元回归分析发现 ,临床病情对患者HRQOL的影响作用比常见的一些人口学指标更为重要 ,但所有因素对各维度变异的解释作用仅为 2 1.5 %～ 41.8% ,对心衰患者HRQOL综合评分、生理健康内容评分及心理健康内容评分变异的解释作用分别为 5 0 .2 % ,2 7.6% ,42 .7%。结论　 (1)心衰患者的HRQOL较一般人群已出现明显下降。 (2 )常见的一些人口学资料及临床病情共同用于解释患者HRQOL下降的意义有限 ,导致患者HRQOL下降最为主要的因素目前尚不清楚。     

A qualitative analysis of the information needs of informal carers of terminally ill cancer patients

This article discusses issues relating to information arising from a qualitative study of the experiences of informal carers of terminally ill cancer patients. Qualitative data analysis, drawing on methods of literary criticism, revealed that information was a key area in carers' experience. The findings are presented in the context of needing to provide individualized care to every family and deal with information needs relating to the illness and prognosis. The question of who is in possession of what information is raised, and the effect that this can have on couples is discussed, together with the issue of false information which carers may receive. The discussion centres on the complexity of understanding carers' information needs and considers how these are affected by the context within which carers operate. The work of Glaser and Strauss on awareness contexts is discussed in this respect. Finally, the importance of the nurse's role as a sensitive mediator of information is considered.     

基于Pender健康促进模式的干预方案在慢性心力衰竭患者中的应用

目的:探讨基于Pender健康促进模式的干预方案在慢性心力衰竭患者中的应用效果。方法:采用便利抽样法选取2018年7月—2019年4月哈尔滨市某三级甲等医院心内科收治的心力衰竭患者120例为研究对象。按照收治时间分组,2018年7—11月收治的患者60例为对照组,2018年12月—2019年4月收治的患者60例为试验组。最终对照组有52例患者完成研究,试验组有57例患者完成研究。对照组患者采用常规健康宣教,试验组患者采用基于Pender健康促进模式的干预方案。采用心力衰竭患者自我管理量表、汉化的明尼苏达心力衰竭患者生活质量量表(MLHFQ)评价干预效果。结果:干预后试验组患者自我管理行为量表各维度得分均高于对照组,差异有统计学意义(P<0.05)。干预后试验组患者MLHFQ中的情绪领域、其他领域得分高于对照组(P<0.05);两组患者身体领域得分差异无统计学意义(P>0.05)。结论:基于Pender健康促进模式的干预方案能够提高慢性心力衰竭患者的自我管理水平和生活质量,建议推广应用。     

Symptom clusters and quality of life in Chinese patients with heart failure

BackgroundEffective symptom assessment and management can improve quality of life in patients with heart failure. However, how psychological symptom cluster, physical symptom cluster and heart failure symptom cluster influence the quality of life of patients with heart failure remains unknown.Aims(a) To describe the symptom clusters among Chinese patients with heart failure (HF), (b) explore the relationship between symptom clusters and quality of life (QOL), and (c) detect if physical and psychological symptoms are mediators of the association between heart failure symptom and QOL.MethodsThree hundred and one patients with heart failure completed measures of symptom (MSAS), QOL and demographic and clinical characteristics. Multiple regression analysis was used to analyse the data.FindingsThe mean age of participants was 72.19 years (range 31–96 years). Each patient was approximately accompanied by an average of 11.19 symptoms (range 0–31), and the top six most common symptoms of Chinese HF patients were shortness of breath, difficulty sleeping, difficulty breathing when lying flat, lack of energy, lack of appetite and cough. Both physical symptom cluster and psychological symptom cluster were the mediators of the relationship between heart failure symptom cluster and QOL.ConclusionsThere were mediating effects of physical symptom cluster and psychological symptom cluster between heart failure symptom cluster and QOL in Chinese patients with HF. Operative assessment, management and alleviation of physical symptoms and psychological symptoms should be prioritised in symptom management strategies for the clinical caregivers.     

强化出院指导提高心力衰竭患者生活质量及服药依从性的研究

目的探讨对心力衰竭患者进行强化出院指导对提高其生活质量及依从性的效果。方法将87例心力衰竭患者随机分成干预组（46例）和对照组（41例）。对照组采用常规出院指导；干预组进行强化出院指导，即由经过培训的护理人员在患者出院后对患者进行有计划、有组织的健康教育和指导。采用明尼苏达心力衰竭患者生活质量量表（MLHF）和6min步行试验对2组患者的生活质量情况进行评价，并比较其服药依从性、生活方式改变情况。结果随访6个月后，干预组与对照组健康相关生活质量及6min步行距离比较差异均有统计学意义（P〈0．01）。干预组服药依从性高于对照组，差异有统计学意义（P〈0．05）。结论对心力衰竭患者强化出院指导，有助于改善患者的生活质量及依从性。     

运动康复护理在慢性心力衰竭患者中的应用效果

目的探讨慢性心力衰竭患者运动康复护理的可行性和效果。方法将77例慢性心力衰竭患者采用随机数字表法分研究组和对照组,研究组40例根据病情除了一般常规护理外,进行运动康复护理,对照组37例采取常规护理,两组均进行健康教育和患者自我管理的培训,并将两组进行比较。结果两组试验前一般情况和心功能指标相当,差异无统计学意义（P〉0．05）,两组试验后心功能指标均有进步,但是通过运动康复护理心衰患者的心衰症状和生活质量明显改善,康复护理后心脏射血分数为（50．5±7．2）％,而对照组护理后心脏射血分数为（35．5±5．2）％,康复护理后明显高于对照组,差异具有统计学意义（t=2．45,P〈0．05）,康复护理组和对照组治疗后心率分别为（76．5±6．8）次／min和（88．6±7．3）次／min,心率都有下降,但是康复护理组明显低于对照组,差异具有统计学意义（t=2．14,P〈0．05）。康复护理组和对照组治疗后6min步行距离分别为（451．4±35．5）m和（350．8±31．5）in,较观察前有增加,而康复护理组较对照组明显增加,差异具有统计学意义（t=13．17,P〈0．叭）。结论慢性心功能衰竭患者适时进行运动康复护理可降低慢性心衰患者的心率,提高心脏射血分数,提高6rain步行距离,也就是表明能改善慢性心衰患者心功能和生活质量。     

美托洛尔缓释片治疗慢性心力衰竭患者的疗效观察

目的：观察美托洛尔缓释片治疗慢性心力衰竭（CHF）患者的疗效。方法：对28例CHF患者在常规治疗的基础上,加用美托洛尔缓释片,并与27例常规治疗组患者进行对照比较,观察1年后患者的心功能、再住院率和死亡率。结果：1年后,美托洛尔缓释片组（治疗组）和对照组比较,心功能改善明显（P〈0.05）;再住院率和死亡率降低（P〈0.05）。结论：美托洛尔缓释片可以改善心功能,降低再住院率和死亡率。     

综合护理干预对慢性心力衰竭患者治疗的影响

目的:探讨综合护理干预对慢性心力衰竭患者治疗的影响。方法:将156例慢性心力衰竭患者随机分为常规护理组和综合护理组各78例,常规护理组给予常规的慢性心力衰竭护理,综合护理组在常规护理基础上实施综合护理干预。治疗干预3个月,观察、比较两组治疗前后生活质量、治疗依从性和心功能的变化。结果:3个月后,综合护理组患者在生活质量、治疗依从性和心功能改善方面均优于常规护理组(P<0.05,P<0.01)。结论:综合护理干预对提高慢性心力衰竭患者的生活质量和治疗依从性、改善患者的心脏功能和预后方面具有重要的作用。     

中医辨证施护及中药穴位贴敷对改善慢性心力衰竭患者生活质量的影响

目的评价中医辨证施护及中药穴位贴敷对慢性心力衰竭（CHF）患者生活质量的影响。方法采用随机数字表法,将湖南省中医药研究所附属医院心内科确诊为CHF的76名患者分为治疗组39例和对照组37例,两组均给予CHF常规护理,治疗组加用中医辨证施护、中药穴位贴敷等综合护理措施。两组以1个月为1个疗程,分别评价治疗前后疗效及患者的明尼苏达心力衰竭生活质量调查表（LiHFe）评分、检测患者的6min步行试验距离和左室射血分数（LVEF）。结果两组患者。O功能分级比较,治疗组总有效率为92．3％,对照组总有效率为75．7％,两组比较差异有统计学意义（u=2．12,P〈0．05）;治疗后,治疗组与对照组相比较,LiHFe评分分别为（30．25±2．15）分比（36．12±3．27）分,差异有统计学意义（t=9．29;P〈0．01）;6min步行距离为分别为（302．27±21．39）m比（256．35±26．28）m,差异有统计学意义（t=7．71;P〈0．01）;LVEF分别为（61．26±8．13）％比（55．32±7．66）％,差异有统计学意义（t=3．27;P〈0．01）。结论通过运用中医辨证施护和中药穴位贴敷对CHF患者进行护理干预,可以明显提高CHF患者的疗效,显著改善其生活质量。     

基于时机理论的家庭护理对慢性心力衰竭患者自我管理的效果研究*

目的: 探讨以时机理论为框架的家庭护理对慢性心力衰竭患者自我管理的影响。方法: 选择2018年1月至12月入住心内科首次心力衰竭发作的患者23例为观察组。在常规护理与随访的基础上给予以时机理论为基础的家庭护理;对照组为2017年1月至12月心内科住院的首次心力衰竭发作的25例患者。接受心内科常规护理与随访;比较两组出院6个月时的自我管理、生活质量及再入院率。结果: 出院6个月时,观察组的自我管理优于对照组。生活质量得分、再入院率低于对照组,差异有统计学意义（P<0.05）。结论: 基于时机理论的家庭护理能有效提高CHF患者的自我管理能力,改善其生活质量,降低再入院率。     

心力衰竭患者的心率变异分析研究

目的探讨慢性心力衰竭(CHF)患者心率变异性(HRV)的变化,研究了HRV各指标与心功能程度(NYHA分级)、原发病、心衰类型的关系。方法选取CHF患者76例与正常对照组24例进行回顾性分析。结果正常对照组比较,CHF试验组SDNN,SDANN降低,差异有统计学意义。结论CHF患者HRV部分指标变化可作为判定CHF严重程度的参考指标。各项HRV指标变化大小可能与CHF患者的原发病无关,但部分似与心衰类型有关。     

慢性心力衰竭患者心功能分级与心率变异相关性分析及护理

目的:探讨慢性心力衰竭患者心功能分级与心率变异的相关性及护理方法.方法:将90例慢性心力衰竭患者和30例健康对照者共分为4组,健康对照组30例,心功能Ⅱ级、Ⅲ级、Ⅳ级患者各30例,分析各组的心率变异性,比较各组与健康对照组心率变异的的差异,根据患者HRV分析结果,给予适当的观察和护理.结果:慢性心力衰竭患者心率变异各指标(SDNN,SDNNindex,SDANN,RMSSD,PNN50)低于健康对照组.心功能Ⅱ级患者HRV部分指标低于健康对照组(P<0.05),心功能Ⅲ级患者HRV各指标均明显低于健康对照组(P<0.05或P<0.01),心功能Ⅳ级患者HRV各指标的降低更显著(P<0.01),心力衰竭组患者HRV随心功能分级升高而降低.结论:心力衰竭患者心率变异性降低,降低程度与心功能分级呈负相关,心率变异分析可预测心力衰竭患者病情,指导临床治疗和护理.