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1.
Chunhua Ma 《Heart & lung : the journal of critical care》2018,47(2):136-141
Objectives
To explore whether five variables of the health belief model were factors influencing self-care behaviors in young and middle-aged adults with hypertension.Background
The self-care behaviors of young and middle-aged adults with hypertension are suboptimal in China, and the factors associated with self-care behaviors have rarely been studied in the population.Methods
A questionnaire survey was adopted in the study. 382 eligible participants were recruited from two tertiary teaching hospitals using the convenience sampling.Results
The predictors of self-care behaviors in young and middle-aged adults with hypertension included age, complications related to hypertension, perceived susceptibility, severity, benefits, barriers and self-efficacy. Five aspects of health beliefs model accounted for 47.0% of total variance.Conclusions
The perceived susceptibility, severity, benefits, barriers, and self-efficacy were key factors affecting self-care behaviors in young and middle-aged adults with hypertension. A health education program targeting improving health beliefs for the population should be developed. 相似文献2.
Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up
Christopher S. Lee Julie T. Bidwell Marco Paturzo Rosaria Alvaro Antonello Cocchieri Tiny Jaarsma Anna Strömberg Barbara Riegel Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(1):40-46
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 [0.46–0.96], 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. 相似文献3.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献4.
Barbara Riegel Victoria Vaughan Dickson Christopher S. Lee Marguerite Daus Julia Hill Elliane Irani Solim Lee Joyce W. Wald Stephen T. Moelter Lisa Rathman Megan Streur Foster Osei Baah Linda Ruppert Daniel R. Schwartz Alfred Bove 《Heart & lung : the journal of critical care》2018,47(2):107-114
Background
Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF.Methods
We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months.Results
In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received.Conclusion
Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention. 相似文献5.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464
Background
Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.Objective
Describe the arrival time distribution of HF patients presenting to the ED.Method
The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.Results
HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.Conclusions
The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED. 相似文献6.
Kelly D. Stamp Marilyn Prasun Christopher S. Lee Tiny Jaarsma Mariann R. Piano Nancy M. Albert 《Heart & lung : the journal of critical care》2018,47(2):169-175
Background
Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.Objectives
A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.Methods
A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.Results
Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.Conclusions
Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research. 相似文献7.
Ubolrat Piamjariyakul Noreen C. Thompson Christy Russell Carol E. Smith 《Heart & lung : the journal of critical care》2018,47(3):211-215
Background
African Americans with heart failure (HF) have the highest rates of depression among all ethnicities in the USA.Objectives
To compare the effects by race on depressive symptoms and topics discussed in the first clinic appointment after HF hospitalization.Methods
This study is a secondary analysis of data from a randomized clinical trial testing a patient group discussion of HF self-management with 93 Caucasians and 77 African Americans.Results
Reduction in depressive symptoms was significantly greater among African American patients within the intervention group (F = 3.99, p = .047) than controls. There were significant differences by race in four topics (dietitian referral, appointment date, help preparing discussion questions, and advice on worsening HF symptoms) concerning patient-physician discussions.Conclusion
The intervention showed greater effect in reducing depressive symptoms among African Americans than Caucasians. Preparing patients for discussions at physician appointments on diet, depressive symptoms, and HF symptoms is recommended. 相似文献8.
Sandra A. Carey Kristen M. Tecson Kyle Bass Joost Felius Shelley A. Hall 《Heart & lung : the journal of critical care》2018,47(4):285-289
Background
Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including “activation” (engagement and ability to self-manage).Objective
To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy.Methods
Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy.Results
Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression.Conclusions
Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy. 相似文献9.
Zachary L. Cox Pikki Lai Connie M. Lewis JoAnn Lindenfeld Sean P. Collins Daniel J. Lenihan 《Heart & lung : the journal of critical care》2018,47(4):290-296
Background
Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use.Objective
Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center.Methods
Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243). All 30-day hospital readmissions were documented. The primary outcome was risk discrimination (c-statistic) compared to national models.Results
A customized model demonstrated improved discrimination (c-statistic 0.72; 95% CI 0.69 – 0.74) compared to national models (c-statistics of 0.60 and 0.61) with a c-statistic of 0.63 in the validation cohort. Compared to national models, a customized model demonstrated superior readmission risk profiling by distinguishing a high-risk (38.3%) from a low-risk (9.4%) quartile.Conclusions
A customized model improved readmission risk discrimination from HF hospitalizations compared to national models. 相似文献10.
Oronzo Chialà Ercole Vellone Leonie Klompstra Giorgio Alberto Ortali Anna Strömberg Tiny Jaarsma 《Heart & lung : the journal of critical care》2018,47(5):465-470
Background
Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.Objectives
The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.Methods
This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.Results
The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.Conclusions
The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. 相似文献11.
Quin E. Denfeld James O. Mudd Wohaib Hasan Jill M. Gelow Shirin O. Hiatt Kerri Winters-Stone Christopher S. Lee 《Heart & lung : the journal of critical care》2018,47(4):281-284
Background
The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear.Objective
To quantify the relationship between plasma β-adrenergic receptor kinase-1 (βARK1) and physical symptoms among adults with HF.Methods
We performed a secondary analysis of data collected from two studies of adults with HF. Plasma βARK1 was quantified using an enzyme-linked immunosorbent assay. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS). Generalized linear modeling was used to quantify the relationship between βARK1 and HFSPS scores.Results
The average age (n = 94) was 54.5 ± 13.1 years, 76.6% were male, and a majority (83.0%) had Class III or IV HF. βARK1 was significantly associated with HFSPS scores (β = 0.22 ± 0.10, p = 0.038), adjusting for other predictors of physical symptoms (model R2 = 0.250, F(7, 70) = 3.34, p = 0.004).Conclusions
Higher βARK1 is associated with worse physical HF symptoms, pinpointing a potential pathophysiologic underpinning. 相似文献12.
Ashish Correa Achint Patel Kinsuk Chauhan Harshil Shah Aparna Saha Mihir Dave Priti Poojary Abhishek Mishra Narender Annapureddy Shaman Dalal Ioannis Konstantinidis Renu Nimma Shiv Kumar Agarwal Lili Chan Girish Nadkarni Sean Pinney 《Journal of cardiac failure》2018,24(7):442-450
Background
Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.Methods
We used the Nationwide Inpatient Sample (2002–2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).Results
We identified 11,205,743 HF hospitalizations. Across 2002–2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36–2.63; P?<?.01) and adverse discharge (aOR 2.04, 95% CI 1.95–2.13; P?<?.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002–2013. LoS and cost also decreased across this period.Conclusions
The incidence of D-AKI in HF hospitalizations doubled across 2002–2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes. 相似文献13.
14.
Wenjia Guo Tingting Lv Fei She Guobin Miao Yuanwei Liu Rong He Yajun Xue Nang Kham Nu Jing Yang Kun Li Ping Zhang 《Heart & lung : the journal of critical care》2018,47(5):516-524
Background
Heart rate variability (HRV), modulated by cardiac autonomic function, is impaired in obstructive sleep apnea (OSA). However, the effect of continuous positive airway pressure (CPAP) on HRV is debated.Objectives
To investigate the associations between CPAP and HRV in OSA.Methods
Based on literature from five databases published through August 2017, we performed a meta-analysis of cohort studies of OSA treated with CPAP. The change of low-frequency band (LF), high-frequency band (HF) and the ratio between LF and HF (LHR) were analyzed.Results
Eleven studies were included. Decreased LF (SMD = ?0.32, 95%CI: ?0.62,?0.01; P = 0.043) and HF (SMD = ?0.51, 95%CI: ?0.95, ?0.08, P = 0.020) were shown while measured on CPAP. When measured off CPAP, HF was increased remarkably (SMD: 0.31, 95%CI: 0.02, 0.60, P = 0.034).Conclusions
CPAP can improve autonomic activity, which might be one mechanism to reduce the risk of cardiovascular diseases in OSA. 相似文献15.
Arnold Piek Wouter C. Meijers Nicolas F. Schroten Ron T. Gansevoort Rudolf A. de Boer Herman H.W. Silljé 《Journal of cardiac failure》2017,23(1):12-19
Background
The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.Methods
Serum HE4 levels in patients (n?=?101) with stable CHF with reduced left ventricular ejection fraction (LVEF <45%) from the Vitamin D CHF (VitD-CHF) study (NCT01092130) were compared with those in age- and sex-matched healthy control subjects (n?=?58) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study.Results
HE4 levels were higher in CHF compared with control subjects (69.2 pmol/L [interquartile range 55.6-93.8] vs 56.1 pmol/L [46.6-69.0]; P?<?.001) and were higher with increasing New York Heart Association functional class. Levels were associated with HF risk factors, including age, gender, diabetes, smoking and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). HE4 demonstrated strong associations with kidney function and HF fibrosis biomarkers. In a multivariable model, we identified creatinine, NT-proBNP, galectin-3, high-sensitive troponin T, and smoking as factors associated with HE4. Independently from these factors, HE4 levels predicted death and HF rehospitalization (5-year follow-up, hazard ratio 3.8; confidence interval 1.31–11.1; P?=?.014).Conclusions
HE4 levels are increased in CHF, correlate with HF severity and kidney function, and predict HF outcome. 相似文献16.
Yiyin Chen Marjorie Funk Jia Wen Xianghua Tang Guixiang He Hong Liu 《Heart & lung : the journal of critical care》2018,47(1):24-31
Background
Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.Objective
To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.Methods
This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).Results
Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.Conclusions
A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. 相似文献17.
Eda Unal Konstantinos Giakoumidakis Ehsan Khan Evridiki Patelarou 《Heart & lung : the journal of critical care》2018,47(4):351-359
Objective
The aim of this study was to identify, retrieve, critically appraise and synthesize information regarding existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD).Methods
A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included.Results
The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused on CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD.Conclusion
Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn. 相似文献18.
James M. Walter Chitaru Kurihara Thomas C. Corbridge Ankit Bharat 《Heart & lung : the journal of critical care》2018,47(4):398-400
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.Objectives
To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.Methods
We use a clinical case to illustrate chugging and discuss potential management strategies.Results
Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.Conclusions
Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS. 相似文献19.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86