Harshida Patel

Reasons for seeking acute care in chronic heart failure

Patients with chronic heart failure (CHF) have frequent episodes of exacerbation leading to recurrent hospitalization.

Fatigue in patients with chronic heart failure - a burden associated with emotional and symptom distress.

Background: The relationship between experience of fatigue and emotional and symptom distress in chronic heart failure (CHF) needs to be thoroughly explored, because fatigue has major impact on daily activities in life. Aims: The purpose was to examine the association between fatigue, as a multidimensional experience and anxiety, depression and symptom distress, and to explore the relationships between individual symptoms and the dimensions of fatigue in patients with CHF. Methods: A consecutive sample of 112 patients with exacerbation of symptoms of CHF answered the Multidimensional Fatigue Inventory (MFI-20), the Hospital Depression and Anxiety (HAD) Scale and the Symptom Distress Scale (SDS). Results: Anxiety was associated with mental fatigue, whereas depression was associated with reduction of activity, low motivation and decreased functioning. Physical fatigue was affected by symptom distress, with women reporting more distress than men. With exception of breathlessness, poor agreement was found between fatigue and the most intensive reported symptoms. Conclusions: The relationship between emotional distress and the experience of fatigue in patients with CHF may have a devastating affect on the patients ability to cope and manage daily activities, including self-care and adherence to recommended treatment.

Home care as an option in worsening chronic heart failure— A pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness

Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care.

Attitudes among healthcare professionals towards ICT and home follow-up in chronic heart failure care

BackgroundeHealth applications for out-of-hospital monitoring and treatment follow-up have been advocated for many years as a promising tool to improve treatment compliance, promote individualized care and obtain a person-centred care. Despite these benefits and a large number of promising projects, a major breakthrough in everyday care is generally still lacking. Inappropriate organization for eHealth technology, reluctance from users in the introduction of new working methods, and resistance to information and communication technology (ICT) in general could be reasons for this. Another reason may be attitudes towards the potential in out-of-hospital eHealth applications. It is therefore of interest to study the general opinions among healthcare professionals to ICT in healthcare, as well as the attitudes towards using ICT as a tool for patient monitoring and follow-up at home. One specific area of interest is in-home follow-up of elderly patients with chronic heart failure (CHF). The aim of this paper is to investigate the attitudes towards ICT, as well as distance monitoring and follow-up, among healthcare professionals working with this patient group.MethodThis paper covers an attitude survey study based on responses from 139 healthcare professionals working with CHF care in Swedish hospital departments, i.e. cardiology and medicine departments. Comparisons between physicians and nurses, and in some cases between genders, on attitudes towards ICT tools and follow-up at home were performed.ResultsOut of the 425 forms sent out, 139 were collected, and 17 out of 21 counties and regions were covered in the replies. Among the respondents, 66% were nurses, 30% physicians and 4% others. As for gender, 90% of nurses were female and 60% of physicians were male. Internet was used daily by 67% of the respondents. Attitudes towards healthcare ICT were found positive as 74% were positive concerning healthcare ICT today, 96% were positive regarding the future of healthcare ICT, and 54% had high confidence in healthcare ICT. Possibilities for distance monitoring/follow-up are good according to 63% of the respondents, 78% thought that this leads to increased patient involvement, and 80% thought it would improve possibilities to deliver better care. Finally, 72% of the respondents said CHF patients would benefit from home monitoring/follow-up to some extent, and 19% to a large extent. However, the best method of follow-up was considered to be home visits by nurse, or phone contact.ConclusionThe results indicate that a majority of the healthcare professionals in this study are positive to both current and future use of ICT tools in healthcare and home follow-up. Consequently other factors have to play an important role in the slow penetration of out-of-hospital eHealth applications in daily healthcare practice.

Psychometric properties of a Swedish version of the Kansas City Cardiomyopathy Questionnaire in a Chronic Heart Failure population.

Background: Valid assessments of health-related Quality of Life (HRQL) are increasingly important in chronic, incurable conditions, such as chronic heart failure (CHF). Aims: To evaluate the psychometric properties of a Swedish version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in hospitalized patients with decompensated CHF. Method and results: The KCCQ and SF-36 were administered to patients (n = 118) with CHF at baseline and then 1 (n = 51) and 4 months (n = 83) after admission. The Swedish version of the KCCQ appears to have acceptable convergent and discriminant validity for all suggested health domains. Cronbachs alpha and test–retest reliability met for most of the scales the minimum of 0.70. Known-groups comparison indicated that the KCCQ discriminated between patients differing in the New York Heart Association (NYHA) classification (criterion validity). The KCCQ was also more responsive to changes in the NYHA classification as compared with the SF-36. However, KCCQ has some weakness in the response distributions for two questions and the convergent validity in one question. Conclusion: Overall, the KCCQ is a valid and reliable instrument in a Swedish CHF population. It yields reliable and valid scores and is quite responsive to clinical change.

Symptomatic recovery and pharmacological management in a clinical cohort with peripartum cardiomyopathy

Abstract Aim: We aimed to characterize the clinical course with focus on pharmacological management of peripartum cardiomyopathy (PPCM) in Sweden. Methods: Twenty-four consecutive patients were retrospectively identified among women presenting with PPCM in Western Sweden. Of these, 14 had concomitant preeclampsia. There was only one fatality. The mean (standard deviation) left ventricular ejection fraction (LVEF) at diagnosis was 35.0 ± 9.9%. Ten women, 47.6%, required intensive care unit (ICU) admission. All patients received β-blockers (BB) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACE-I/ARB), which were tapered off over a mean/median period of 3.3/2.5 years with only one case of worsening heart failure. The mean follow-up for medication was 7.9 ± 2.6 years. Early and late/non-recovery was defined as New York Heart Association (NYHA) functional class I and NYHA II–IV at one year, respectively. Late recovery was associated with larger LVEDD at diagnosis (56.8 versus 62.4 mm) was associated with late recovery, p = .02. Results and conclusions: PPCM had an overall good prognosis in this cohort. Left ventricular dilation at presentation was a predictor of worse prognosis. Concurrent preeclampsia was common, but was associated with better prognosis. Medication was safely discontinued in 75% of patients.

Experiences of health care in women with Peripartum Cardiomyopathy in Sweden: a qualitative interview study

BackgroundPeripartum cardiomyopathy is often associated with severe heart failure occurring towards the end of pregnancy or in the months following birth with debilitating, exhausting and frightening symptoms requiring person-centered care. The aim of this study was to explore women’s experiences of health care while being diagnosed with peripartum cardiomyopathy.MethodQualitative interviews were conducted with 19 women with peripartum cardiomyopathy in Sweden, following consent. Data were analysed using qualitative content analysis. Confirmability was ensured by peer-debriefing, and an audit trail was kept to establish the credibility of the study.ResultsThe main theme in the experience of health care was, ‘Exacerbated Suffering’, expressed in three subthemes; ‘not being cared about’, ‘not being cared for’ and ‘not feeling secure.’ The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. Women felt they were on an assembly line in midwives’ routine work where knowledge about peripartum cardiomyopathy was lacking and they showed distrust and dissatisfaction with care related to negligence and indifference experienced from healthcare professionals. Feelings of being alone and lost were prominent and related to a sense of insecurity, distress and uneasiness.ConclusionsThis study shows a knowledge gap of peripartum cardiomyopathy in maternity care personnel. This is alarming as the deprecation of symptoms and missed diagnosis of peripartum cardiomyopathy can lead to life-threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms.

Causes and outcomes in studies of fear of childbirth: A systematic review

PROBLEM Fear of childbirth negatively affects women during pregnancy and after birth. AIM To summarise the findings of published studies regarding possible causes/predisposing factors and outcomes of fear of childbirth for childbearing women. DESIGN A systematic review, searching five databases in March 2015 for studies on causes/predisposing factors and outcomes of fear of childbirth, as measured during pregnancy and postpartum. Quality of included studies was assessed independently by pairs of authors. Data were extracted independently by reviewer pairs and described in a narrative analysis. FINDINGS Cross-sectional, register-based and case-control studies were included (n=21). Causes were grouped into population characteristics, mood-related aspects, and pregnancy and birth-related aspects. Outcomes were defined as mood-related or pregnancy and birth-related aspects. Differing definitions of fear of childbirth were found and meta-analysis could only be performed on parity, in a few studies. CONCLUSIONS Stress, anxiety, depression and lack of social support are associated with fear during pregnancy. Need for psychiatric care and presence of traumatic stress symptoms are reported outcomes together with prolonged labour, longer labours, use of epidural and obstetric complications. Nulliparous and parous women have similar levels of fear but for different reasons. Since the strongest predictor for fear in parous women is a previous negative birth experience or operative birth, we suggest it is important to distinguish between fear of childbirth and fear after birth. Findings demonstrate the need for creating woman-centred birthing environments where women can feel free and secure with low risk of negative or traumatic birth experiences and consequent fear.

P92 Poster Patients with Worsening Chronic Heart Failure Require Hospital Care Listen to the Patient

Background Despite advancement in care and extensive research, patients with chronic heart failure experience episodic deterioration, high symptom burden, affected functional capacity and recurrent hospital admissions. Aim & Metods In a cross sectional study we sought to explore the reasons for hospitalisation in patients with deteriorated Chronic Heart Failure. Results The vast majority of patients with worsening Chronic Heart Failure seeking the emergency department required hospital care, predominantly because of co-morbidities. Reason for hospital admission proportion Pneumonia/respiratory disease 35.4% Need to monitor cardiac rhythm 15.6% Communication problem (such as dementia, stroke and aphasia) 22.3% Pulmonary oedema 11.3% Myocardial infarction 6.2% Anaemia* 5.2% Pathologic blood chemistry other than haemoglobin** 3.7% Hypotension 2.1% *S-Haemoglobinb 20 g/L ** S-Creatinine>250 ?mol/L, S-Potassium>5.5 mmol/L or 0.05 ?g/L, Creatine kinase-MB>5 ?g/L, ASAT and ALAT > three times above the normal value Conclusion Patients with severe chronic illness like CHF with symptomatic deterioration could be attended with focus on symptom relieve and without additional emergency room investigations before hospital admission.

1305 Psychometric properties of a Swedish version of the Kansas City Cardiomyopathy Questionnaire- A method to detect symptoms in a chronic heart failure population

Harshida Patel a, b, ⁎, Inger Ekman, John A. Spertus , Scott M. Wasserman, Lars-Olof Persson a Institute of Health and Care Sciences, Sahlgrenska Academy at Göteborg University, Sweden The Vårdal Institute, The Swedish Institute for Health Sciences, POB 187, SE 221 00 Lund, Sweden Section of Cardiology, Department of Medicine, University of Missouri, Kansas City, United States Mid America Heart Institute, Saint Lukes Hospital, Kansas City, Missouri, United States Clinical Development, Amgen, Thousand Oaks, CA, United States ⁎ Corresponding author. Tel.: +46 705 308895. Email: harshidaben.patel@vgregion.se.