Ewa Billing

Perceived loneliness and social support in patients with chronic heart failure

Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated. Aim: The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality. Methods: One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year. Results: Loneliness was reported by 29 (20%) participants. They were more often women (p < 0.001) and younger (p = 0.024). Patients who perceived loneliness had fewer social contacts (p = 0.033), reported lower occurrence of emotional contacts (p = 0.004), were less satisfied with social contacts and close relationships (p < 0.001). Those reporting loneliness had more days hospitalised (p = 0.044), and more readmissions to hospital (p = 0.027), despite not having more severe CHF. Conclusion: Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.

Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study

Objective: To investigate the long-term effect of expanded cardiac rehabilitation on a composite end-point, consisting of cardiovascular death, myocardial infarction or readmission for cardiovascular disease, in patients with coronary artery disease. Design: Single-centre prospective randomized controlled trial. Setting: University hospital. Subjects: Two hundred and twenty-four patients with acute myocardial infarction or undergoing coronary artery by-pass grafting. Intervention: Patients were randomized to expanded cardiac rehabilitation (a one-year stress management programme, increased physical training, staying at a ‘patient hotel’ for five days after the event, and cooking sessions), or to standard cardiac rehabilitation. Main measures: Data on cardiovascular death, myocardial infarction, readmission for cardiovascular disease and days at hospital for cardiovascular reasons were obtained from national registries of the Swedish National Board of Health and Welfare. Results: The primary end-point occurred in 121 patients altogether (54%). The number of cardiovascular events were reduced in the expanded rehabilitation group compared with the standard cardiac rehabilitation (53 patients (47.7%) versus 68 patients (60.2%); hazard ratio 0.69; P = 0.049). This was mainly because of a reduction of myocardial infarctions in the expanded rehabilitation group. During the five years 12 patients (10.8%) versus 23 patients (20.3%); hazard ratio 0.47; P = 0.047 had a myocardial infarction. Days at hospital for cardiovascular reasons were significantly reduced in patients who received expanded cardiac rehabilitation (median 6 days) compared with standard cardiac rehabilitation (median 10 days; P = 0.02). Conclusion: Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons.

A randomized controlled trial evaluating the effect of a support and education programme for spouses of people affected by stroke

Objective: To determine whether a nurse-led support and education programme for spouses of patients affected by stroke improved the psychological health of the spouses. Design: A longitudinal, open, randomized controlled trial. Sample: One hundred spouses of stroke patients were randomly assigned to either an intervention or a control group. Setting: The study was conducted in a hospital setting. Intervention: The intervention consisted of six group meetings during six months, with a follow-up after further six months. Comparison between the intervention and the control groups was made at baseline, after six and 12 months using analysis with repeated measures. Main measures: The Comprehensive Psychopathological Rating Scale — Self-Affective for psychological health. Results: No significant difference was found between the intervention and control groups concerning overall psychological health. However, a subanalysis revealed that those who participated more frequently in the group meetings (five or six times) had significantly stronger psychological health (P<0.05). Knowledge about stroke increased over time in both groups, but participants in the intervention group learned more (P = 0.041). Conclusion: Encouraging participation in the group meetings of a support programme might have a positive effect on psychological health.

Evaluation of an educational programme for family members of patients living with heart failure : a randomised controlled trial

AIMS AND OBJECTIVES To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. BACKGROUND When a person is diagnosed with heart failure, the daily life of the family members is also affected. DESIGN Randomised controlled trial. METHODS A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. RESULTS There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2) = 0·35) and depression (p = 0·021, R(2) = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). CONCLUSION Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. RELEVANCE TO CLINICAL PRACTICE Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

Pharmacokinetics of Felodipine and Effect on Digoxin Plasma Levels in Patients with Heart Failure

SummarySome calcium antagonist drugs used in hypertension and cardiac diseases have been shown to increase plasma digoxin levels mainly as a result of reduced renal clearance. Felodipine is a new dihydropyridine calcium antagonist drug with cardiovascular effects, whose pharmacokinetics and effects on plasma digoxin levels have been studied in patients with left ventricular failure. 12 patients (11 men) on long term digoxin therapy were given 2.5 or 5mg felodipine bid for 7 days followed by 1 week on 10mg bid. Plasma levels of digoxin and felodipine were measured before dosage and 30, 60 and 90 minutes and 2, 3, 4, 6, 8,10 and 24 hours after the first dose and after 1 week of therapy (steady state). The area under plasma concentration versus time curve was calculated after the first dose and in steady state both for digoxin and felodipine. The absorption characteristics Cmax and Tmax were calculated both for felodipine and digoxin on the different felodipine doses. There was a linear relationship between dose and plasma level of felodipine. Plasma half-life in the 4- to 10-hour period of felodipine was 5.5 hours after a 10mg single dose, and 12 hours after 10mg bid. Felodipine 2.5mg, 5mg and 10mg all transiently increased peak plasma digoxin concentrations (by about 40%) at 1 hour after intake. Urinary excretion of digoxin during the day was unchanged, but impaired renal clearance may account for the transient increase in digoxin plasma level after felodipine.

Adaptation of the Psoriatic Arthritis Quality of Life (PsAQoL) instrument for Sweden

Objective: The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is the first disease-specific patient-derived instrument for assessing QoL in patients with PsA and has been extensively validated in this population. The aim of the adaptation process reported here was to develop a Swedish version of the PsAQoL that was equivalent to, and met the same psychometric and acceptability standards as, the original instrument, which was developed in the UK. Method:Translation of the original questionnaire into Swedish was performed by a professional and a lay panel. Field testing for face and content validity was performed by interviewing 13 patients. Finally, 123 patients with PsA were included in a test–retest postal survey designed to test reproducibility and construct validity. The PsAQoL was administered on two occasions approximately 2 weeks apart. The Nottingham Health Profile (NHP) was used as a comparator instrument. Results: The Swedish version of the PsAQoL questionnaire showed good reliability at both time points and, as expected, correlated with the NHP. The scale was able to distinguish between groups based on self-reported general health and flare-up. Patients with active symptoms of both arthritis and psoriasis had worse QoL. The results also indicated that duration of disease has a progressive impact on PsAQoL scores. Conclusions: This study provides evidence that the adapted PsAQoL can be used for clinical studies in Swedish patients. The instrument provides valuable information on the long-term effects of PsA on QoL.

Determinants of Lifestyle Changes after a First Myocardial Infarction

Ninety-eight men aged <60 years with a first myocardial infarction were followed for 6 months. The aim was to characterize patients who succeeded in changing their lifestyles by modifying risk factors and to correlate them to subjective and objective outcome. We focused on the interplay between the patients causal attribution of the infarction and compared this with the influence of background factors. The patient attribution most often predicted positive objective outcome and subjective functioning. This study shows that background factors are of prognostic value, but the patients attribution and his own ideas about coping add information on the outcome of the rehabilitation as evaluated by more specific outcome measures.

Psychosocial variables in relation to various risk factors in patients with stable angina pectoris

Objectives. To evaluate relationships between psychosocial variables and common risk factors such as age, concomitant diseases (hypertension, diabetes mellitus, myocardial infarction, heart failure) and smoking habits in patients with stable angina pectoris.

Cardiac rehabilitation and psychosocial gender differences

Tertiary prevention comprising treatment, care and rehabilitation of patients with heart disease is an important task for nurses and other health care professionals. This is achieved through a combination of medico-physical and psychosocial interventions, related to the male or female patients personal, expressed problems and the personnels knowledge. Therefore, the aim of this literature study was to highlight the comprehensiveness of the cardiac rehabilitation concept from a Nordic perspective and with focus on psychosocial gender differences. The Nordic examples of cardiac rehabilitation programmes, involving a multidisciplinary team and comprising health education, physical exercise and stress management, include no specific efforts for women. However, the efficacy of out-patient programmes is still poorly documented and there is a need to increase the attendance of eligible patients, particularly women, in these programmes. There are differences between the genders concerning the need for support from personnel and laymen in order to better reach patients compliance. Taking the psychosocial characteristics specific to women into account, could be the first step towards increased attendance rates for women as well as reaching the proximal and distal targets with regards to cardiac rehabilitation.

Risk prediction in stable angina pectoris

Although stable angina pectoris often carries a favourable prognosis, it remains important to identify patients with an increased risk of cardiovascular (CV) complications. Many new markers of disease activity and prognosis have been described. We evaluated whether common and easily accessible markers in everyday care provide sufficient prognostic information.