Improve Heart Failure Patients Research Articles

Comparison of Health-Related Quality of Life Between American and Taiwanese Heart Failure Patients

Few investigators have compared health-related quality of life (HRQOL) in heart failure (HF) patients from different countries.The purposes of this study were to compare HRQOL between American (n = 87) and Taiwanese (n = 88) HF patients and to determine factors associated with HRQOL in both groups. In this cross-sectional survey, HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire. American patients rated their HRQOL worse than Taiwanese patients did. Sociodemographics, disease severity, and symptom severity were associated with HRQOL, accounting for 42.4% of the variance in HRQOL in Americans and 57.3% in Taiwanese. Symptom severity was the most important predictor of HRQOL in both groups. Interventions targeting symptom severity could improve HF patients' HRQOL.

Psychosocial Factors Moderate the Relationship between Clinical Status and Dyspnea in Both Taiwanese and American Heart Failure Patients

Introduction: Dyspnea is the most common and distressing symptom of heart failure (HF) patients. Although psychosocial factors likely contribute to dyspnea, only clinical characteristics have been studied in HF. It is necessary to identify all factors influencing dyspnea so that effective symptom management interventions can be developed. Specific Aims: To determine and compare whether psychosocial factors moderate the relationship between clinical characteristics and dyspnea in both Taiwanese (T) and American (Am) HF patients (pts). Method: Dyspnea and psychosocial variables (i.e., depression, anxiety, perceived control, and perceived social support) were compared between two groups of HF pts: 97 T (mean age 66.2 ± 12.1 yrs; 76% male; 28% NYHA III/IV) and 96 Am (mean age 61.6 ± 11.7 yrs; 74% male; 42% NYHA III/IV). Dyspnea was measured using the Modified Pulmonary Function Status and Dyspnea Questionnaire, depression and anxiety using the Brief Symptom Inventory, perceived control using the revised Control Attitudes Scale, and perceived social support using the Perceived Social Support Scale- Revised. Multi-sample LISREL analysis was used to test moderator effects across groups. Result: Dyspnea (11.36 ± 13.76 T, 12.17 ± 13.57 Am, p> .05), depression (0.57 ± 0.70 T, 0.58 ± 0.75 Am, p> .05), and anxiety (0.48 ± 0.60 T, 0.59 ± 0.68 Am, p> .05) in both groups were similar. Perceived control (47.59 ± 6.86 T, 54.01 ± 6.57 Am, p< .05) and perceived social support (44.16 ± 7.72 T, 68.32 ± 14.69 Am, p< .05) were rated better in Am compared to T HF patients. In Am patients, depression (β=0.76, p< .05), anxiety (β=0.85, p< .05) and perceived social support (β=-0.03, p< .05) were moderators of the relationship between clinical status and dyspnea severity. In T patients, only perceived social support (β=0.08, p< .05) moderated the relationship between clinical variables and dyspnea. Conclusion: Although different psychosocial factors moderated the relationship of clinical factors and dyspnea severity in Am and T patients, it is clear that psychosocial factors play substantial roles in the dyspnea symptom experience in HF patients. Attention to these psychosocial factors may improve HF patients’ dyspnea.

Self-care and Quality of Life Outcomes in Heart Failure Patients

Heart failure (HF) disease management programs have been tested, frequently via randomized controlled trials (RCTs), and reported in the literature. One of the interventions often included in disease management programs is self-care. Quality of life (QOL) is an individual outcome that may benefit from self-care interventions. Thus, the purposes of this review article are to (1) identify and critique research designed to test self-care interventions to improve QOL in HF patients, (2) identify gaps in the literature, and (3) provide recommendations for future research. A literature search was conducted for the time period of 1995 to 2007. The search terms were HF and QOL with self-care and self-management. Twenty-one articles that included HF self-care, self-management, or self-monitoring as an intervention with QOL as an outcome were identified. Seventeen of the studies were RCTs, and 4 of the studies used longitudinal, pre/post or repeated measures designs. Of the 17 RCTs, 9 studies demonstrated greater improvement in QOL in the intervention group as compared with the usual care group. Regarding the studies that used repeated measures designs, all 4 of the studies demonstrated greater improvement in QOL from baseline to follow-up. Findings from RCTs of self-care, as an intervention, on HF patient QOL do not allow one to draw strong conclusions about the benefits of this intervention on QOL outcomes. Several factors may have contributed to these equivocal findings (including methodological and conceptual issues). The future study of self-care and its effect on QOL outcomes in HF patients will benefit from multisite, large sample-size RCTs with self-care as the primary intervention, careful definition of terms, and use of conceptual frameworks. Thus, self-care strategies to improve HF patient QOL need to be further tested, and the most efficacious strategies can subsequently provide the basis for changing clinical practice and improving patients' lives.

Prise en charge du patient insuffisant cardiaque : évolution, organisation, application à l'échelle locale

Heart failure is a severe disease wich prevalence and incidence are steadily growing, with high morbidity and mortality rates, and responsible for significant financial cost. This evolution requires our therapeutic approach to be modified, by favouring multidisciplinary management and including patient education. The proof of the effectiveness of these measures is brought by many studies, and therapeutic education is now recommended by the European Society of Cardiology. This new approach of management is set out according to various procedures. In Le Creusot, the therapeutic unit of heart failure management was created in September 2004 and operate on a day hospital pattern. The results are satisfactory knowing that the average duration of spells fell by 33% after one year. Further local initiatives are spreading and need shall arise to pooling equipments and personnels as well as reinforcing collaboration between public and private professionals in order to improve heart failure patients management. In the meantimea more sustained involvement of the autorities is to be hoped.

Patient-Reported Economic Burden and the Health Status of Heart Failure Patients

Background Heart failure (HF) guidelines recommend treatment with multiple medications to improve survival, functioning, and quality of life. Yet, HF treatments can be costly, resulting in significant economic burden for some patients. To date, there are few data on the impact of patients' perceived difficulties in affording medical care on their health outcomes. Methods and Results Comprehensive clinical data, health status, and the perceived economic burden of 539 HF outpatients from 13 centers were assessed at baseline and 1 year later. Health status was quantified with the Kansas City Cardiomyopathy Questionnaire overall summary score. Cross-sectional and longitudinal (1-year) analyses were conducted comparing the health status of patients with and without self-reported economic burden. Patients with economic burden had significantly lower health status scores at both baseline and 1 year later. Although baseline perceptions of economic burden were associated with poorer health status, patients' perceived difficulty affording medical care at 1 year was a more important determinant of lower 1-year health status. Conclusion HF patients reporting difficulty affording their medical care had lower perceived health status than those reporting little to no economic burden. More research is needed to further evaluate this association and to determine whether addressing perceived economic difficulties affording health care can improve HF patients' health status.

Antiinflammatory Effects of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

Cardiac resynchronization therapy (CRT) pacing has been proposed as an additional treatment to medical therapy to improve heart failure patients with left ventricular asynchrony. The aim of this study was to evaluate the influence of CRT treatment on proinflammatory cytokines in patients with heart failure. Twenty patients, with a mean age 64 +/- 2 years, with severe chronic heart failure NYHA class II-IV (mean ejection fraction 25 +/- 2%), were included in the study. Patients were treated with CRT pacing, after failure of optimal therapy. Blood samples were taken at baseline, 3 months after pacing therapy, and after a subsequent 3-month period of no pacing for the assessment of proinflammatory cytokines TNF-alpha and its receptors (sTNFR-I, sTNFR-II), IL-6, adhesion molecules sICAM-1 and sVCAM-1, and the apoptotic indices sFas and sFas-Ligand. Levels of TNF-alpha, sTNFR-I, and sTNFR-II were reduced at the end of 3 months of CRT therapy and further reduced at the end of the no pacing period (P < 0.05, compared to baseline). Levels of IL-6 also declined after 3 months of CRT pacing (from 8.9 +/- 2.5 pg/mL to 4.7 +/- 1.3 pg/mL, P < 0.05) and this was maintained during the no pacing period (3.9 +/- 1.1 pg/mL P < 0.05 compared to baseline). The adhesion molecule sICAM-1 levels also reduced (from 265 +/- 17 ng/mL to 235 +/- 12, P < 0.05) after 3 months of CRT pacing and remained unchanged at the end of the no pacing period (219 +/- 12 ng/mL, P < 0.05 compared to baseline values). Major proinflammatory cytokines and the adhesion molecule sICAM-1 are reduced with CRT therapy and this effect is maintained for at least 3 months after discontinuation of pacing.

Sélection des patients à la stimulation biventriculaire

In heart failure patients with a large QRS width, biventricular pacing has been shown to improve the fonctional status as well as hemodynamic parameters. However, there are non-responders despite of wide QRS complexes (between 15 and 35%). Patients selection might not rely only on electrical parameters. From an electrophysiological concept, clinicians moved toward a more electromechanical analysis, by using non-invasive tools such as Tissue Doppler imaging. Thereby, more than the QRS width, identification of intra-left ventricular asynchrony appears to be a crucial criterion for selecting responders to biventricular pacing. From this fact, several studies have demonstrated the efficacy of biventricular pacing to improve heart failure patients with narrow QRS but with intra-left ventricular asynchrony. Another parameter has been thought to be predominant, i.e. the left ventricular pacing site. If the pacing lead is located within a “slow conduction” area (at this time very difficult to identify during the implant procedure), biventricular pacing will generate a new asynchrony counteracting the beneficial expected. Thus, biventricular pacing appears to be more an electromechanical concept than exclusively electrical for selecting responders. Still, the optimal location of the left ventricular pacing lead remains to be determined.

The development of an interactive education program for heart failure patients: the Kodak Photo CD Portfolio concept

Written information, as well as movie and video film, and computer programs have been used for information and education of patients. CD-ROM is now about to be used for the same purpose. The CD has several advantages over computer programs, such as high capacity and low production, duplication and distribution costs. It is unerasable and insensitive to electromagnetic forces. Heart failure (HF) is a common disease with poor prognosis. Due to diagnostic and treatment improvements new guidelines on evaluation and care of patients with HF have been published. Some advocate educational programs as a routine part of the care. Patients with HF (mostly elderly persons) use many drugs and need considerable education for effective self-care. To improve HF patients' knowledge of the disease and the drug treatment of the disease we have made an interactive, computer generated education program which is presented on a Kodak Photo CD Portfolio disc. The major steps and efforts in the development of the program, which uses a new principle, are explained, including some hardware and software issues. The program can be viewed on an ordinary TV set and run by the patients themselves. Unlike many educational products for health care professionals and patients, this product has now been included in a randomised patient education trial.