Tialda Hoekstra

Quality of life and survival in patients with heart failure

To examine whether self‐rated disease‐specific and generic quality of life predicts long‐term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well‐defined heart failure (HF) population.

Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction

To compare quality of life (QoL) in heart failure (HF) patients with preserved ejection fraction (HF‐PEF) and HF patients with reduced ejection fraction (HF‐REF) in a well‐defined HF population.

Preferences of heart failure patients in daily clinical practice: quality of life or longevity?

Knowledge of patient preferences is vital for delivering optimal healthcare. This study uses utility measurement to assess the preferences of heart failure (HF) patients regarding quality of life or longevity. The utility approach represents the perspective of a patient; facilitates the combination of mortality, morbidity, and treatment regimen into a single score; and makes it possible to compare the effects of different interventions in healthcare.

Perceived sexual difficulties and associated factors in patients with heart failure

BACKGROUND Sexual dysfunction is a common problem of increasing incidence in patients with heart failure (HF). However, there is no knowledge on which demographic, clinical, and quality of life (QoL) aspects are related to difficulties in sexual activity nor on the course of sexual difficulties in patients with HF. METHODS Data on sexual difficulties were collected at 1 and 18 months after an HF hospitalization (n = 792, mean age 69 ± 12 years, 35% female, mean left ventricular ejection fraction 33% ± 14%) by the question on sexuality of the Minnesota living with HF questionnaire. Demographic and clinical factors were assessed from medical records and QoL by Minnesota living with HF questionnaire, Medical Outcome Study 36-item General Health Survey, and Ladder of Life. RESULTS In total, 48% (n = 380) of the patients perceive difficulties in sexual activity at 1 month after discharge, and 70% continued to perceive this at 18 months. Furthermore, 27% of the patients without difficulties at 1 month developed them during follow-up. Living with a partner (OR 3.76, 95% CI 2.58-5.48), younger age (OR 0.96, 95% CI 0.94-0.97)), male gender (OR 3.08, 95% CI 2.10-4.43), overall well-being (OR 1.13, 95% CI 1.00-1.27), and physical (OR 1.06, 95% CI 1.06-1.08) and emotional (OR 1.07, 95% CI 1.03-1.10) QoL were independently associated with perceived difficulties in sexual activity. CONCLUSIONS Perceived difficulties in sexual activity are common in patients with HF, particularly in younger and male patients and continue over time. Patients who perceive difficulties in sexual activity report a significant lower QoL and overall well-being than those who do not.

Sexual problems in elderly male and female patients with heart failure

Objectives To investigate perceived sexual problems in a large group of younger and older patients with heart failure (HF), with and without a partner, focusing on a broad range of perceived sexual problems, and compare this with a sample of healthy community-dwelling elderly people. Design Cross-sectional study. Setting 17 HF clinics and general practices in The Netherlands. Participants 438 patients with HF and 459 healthy community-dwelling elderly people. Main Outcome Measures Differences in sexual functioning, related factors and perceived causes of sexual problems between patients with HF and healthy community controls. Results In total, 59% of HF patients reported sexual problems, mostly problems with erectile function. HF patients with a partner (67%) and younger patients (65%) reported significantly more sexual problems than healthy community controls (58%, p=0.011 and 53%, p=0.011, respectively). Multivariate analyses show that sexual problems in HF patients with a partner were more common in men (OR 2.73, 95% CI 1.572 to 4.753) and in those with a prescription of β-blockers (OR 2.00, 95% CI 1.10 to 3.586). In younger patients, sexual problems were independently associated with male gender (OR 3.21, 95% CI 2.099 to 4.908) and having a partner (OR 2.00, 95% CI 1.283 to 3.110). HF patients mainly attribute their sexual problems to symptoms of HF. Conclusion Sexual problems are common in patients with HF, particularly in younger patients and those with a partner. As patients attribute their sexual problems mostly to HF symptoms, adequate treatment and education of HF patients is needed.

Nurse-led interventions in heart failure care : Patient and nurse perspectives.

Background: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes. Aim: To describe the perspectives of patients and nurses on delivered care in two DMPs. Methods: In total 442 patients (62% male; age 68 ± 12 years; LVEF 33% ± 14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs. Results: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III–IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses. Conclusion: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals.

The assessment by insurance physicians of functional limitations related to mental disorders among disability benefit claimants

SamenvattingWe investigated under- and over-recognition of functional limitations related to mental disorders by insurance physicians (IPs) in disability benefit claimants with and without mental disorders. The sample consisted of 247 persons claiming disability after two years of sickness absence. All respondents were interviewed using the Composite International Diagnostic Interview (CIDI) generating mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) present in the past thirty days. Functional limitations related to mental disorders as reported by IPs were extracted from registry. Under-recognition of functional limitations related to mental disorders for any mental disorder was found in 15.7%, for mood disorders in 7.1% and for anxiety disorders in 16.4%. Over-recognition of functional limitations related to mental disorders for any mental disorder was found in 41.2%, for mood disorders in 48.4% and for anxiety disorders in 44.8%. Under-recognition of functional limitations related to mental disorders is limited. Apparently IPs primarily focus on functional limitations and impairments, and not on the causal illness. Over-recognition of functional limitations related to mental disorders is more pronounced.