Dissertations / Theses: 'Heart failure outcomes'

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Jensen, Gwenneth Anne. "Outcomes of heart failure discharge instructions." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3318.

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Acute decompensation of chronic heart failure is common and results in many patients being re-hospitalized every year (Jancin 2008). One of four voluntary core measures deployed by the Joint Commission for evaluation of quality of heart failure care in hospitals is heart failure discharge instructions, also called core measure HF1. Although the core measure is a widely disseminated standardized measure related to discharge education, there is little evidence about its impact on patient or readmission outcomes. The purpose of this study was to determine the relationship between the completion of heart failure discharge instructions as defined by the Joint Commission core measure HF1 in a single site, 500 bed tertiary hospital population in the Upper Midwest and the primary endpoint of subsequent readmission to the hospital 30, 90, 180 and 365 days following an index discharge for primary diagnosis of heart failure. Secondary endpoints included hospital readmission charges and total hospital readmission days per year. Patient characteristics, clinical characteristics, unit factors and index visit utilization variables were controlled. This study also described the relationship between nursing unit factors and completion of HF1. A retrospective, descriptive design, and analyses using primarily generalized linear models, were used to study the relationship of HF1 to utilization outcomes (readmission, hospital days and cost) and unit context (discharge unit and number of inter-unit transfers). Individual level retrospective demographic, clinical, administrative and performance improvement data were used (n = 1034). Results suggested a weak and non-significant association of completion of the core measure HF1 bundle and readmission within 30 days for all cause readmissions (p = .22; OR 1.32), and no association with HF to HF readmissions at 30 days. There was an inverse association 2 after 6 months for all cause readmission, and after 90 days for HF to HF readmission. There was a non-significant trend toward a relationship to total hospital days, but no relationship of HF1 to total annual charges. The study did find a significant relationship between type of discharge nursing unit and HF1 completion, and type of discharge unit and readmission. The discharge nursing unit was quite consistently and strongly related to all cause readmissions in binary (p = .029: OR 1.58) and counts analyses (p = .001; OR 1.52), but was not related to the subset of HF to HF readmissions. The study concludes that there is limited relationship between HF1 and 30 day all cause hospital readmission and total readmission days, but a stronger relationship between HF1 and discharge from a cardiology specialty unit. There was also a relationship between cardiology discharge unit and reduction in all cause readmissions.

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Collins, Diana Lee. "Improving Outcomes for Congestive Heart Failure Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5688.

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Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF program offered in the outpatient setting would result in better symptom management due to patients' enhanced adherence to treatment plans. A total of 10 patients participated in the 6-week program, and all participants demonstrated improvement in their CHF symptoms, which allowed them to be reclassified into a lower class on the New York Heart Association's CHF staging system. Of the 10 participants, 7 were completely compliant with attending weekly visits, performing daily journaling, and adhering to dietary recommendations and medication management; 3 participants demonstrated less compliance with the self-care recommendations during the program, but also showed sufficient improvement in symptoms to be reclassified. The project demonstrated the potential for reducing the symptom burden of CHF through proactive outpatient management, contributing to positive social change by improving the quality of life for these patients. Nurse practitioners may find the program description helpful for developing similar initiatives in their clinical settings.

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Akhatova, Elena. "Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)? : Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)?" Thesis, Umeå universitet, Kemiska institutionen, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-106301.

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Inkrot, Simone [Verfasser]. "Patient-reported outcomes in heart failure / Simone Inkrot." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1100388184/34.

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Chang, Sungwon. "An integrated approach to outcome evaluation : incorporating patient reported outcomes in heart failure." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/2606.

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Globally individuals and health care systems are facing the burden of chronic illness. The impact of the increasing burden of non-communicable diseases is experienced by individuals and health care systems. Across the globe health care systems are struggling to meet the increasing demands for services within the confines of rising costs and needs for accountability. Beyond costs and treatment allocations, there is an increasing mandate to provide care that is patient centred and appropriate to the needs of the individual. The Innovative Care in Chronic Condition (ICCC) framework has been successful in driving health care reforms to meet the needs of individuals with chronic illness internationally. Deriving metrics that allow monitoring of conditions at the level of the patient, provider and health care system are of increasing importance. Comprising this thesis is a series of studies to investigate outcomes that includes the patient’s perspective in the evaluation of clinical interventions. To achieve this, chronic heart failure, was used as an exemplar of a chronic condition.Chronic heart failure (CHF) is the final common pathway for many cardiac conditions. As a consequence has emerged as a major public health problem and represents as an excellent exemplar of living with a chronic illness. CHF patients commonly experience high levels of ill-health, disability and mortality placing a heavy burden on health care systems. Hospitalisations are frequent and costly to both CHF patients and to society. People with CHF live with a limited quality of life and physical ability and the prognosis for CHF is poor. Given the nature of debilitating symptoms, and their potential impact on physical, social and psychological aspects of life, patient’s perspective in outcome assessment is essential in providing effective care.Specifically this study sought to: •Examine patient reported outcomes in clinical management and in clinical research •Investigate patient important outcomes, their utility, relevance and acceptability amongst patients, clinicians, researchers and administrators •Test composite outcomes model that integrate patient important outcomes in clinical trials researchPatient reported outcomes (PROs) is a strategy to capture the patient perspective and experience on their health status. The use of PROs can be incorporated in clinical assessments, monitoring of clinical progress as well as clinical research. Despite their frequent use in research, evidence suggests that to date they have had a limited influence on clinical practice and policy. As part of this thesis an integrative review was conducted to explore the potential utility of PROs at the policy level. By using the ICCC framework, PROs were indeed essential to improve the management of CHF at the micro, meso and macro levels of decision making.One of the key challenges in using PROs and outcomes important to individuals in CHF is limited methodological and reporting quality. This is cited as a reason why many clinicians are sceptical of the utility of PROs. To explore issues in reporting a review was conducted on RCTs of pharmacological therapy in CHF that reported health related quality of life (HRQoL) as a primary or secondary outcome. Using the Minimum Standard Checklist for evaluating the quality of reporting of HRQoL outcomes resulted in 26 (19.1%) studies being considered ‘very limited’ in terms of methodological and reporting rigour, and 91 (66.9%) were evaluated as ‘limited’ and only 19 (14.0%) studies were considered to be of a ‘probably robust’ quality. In fact, the quality of HRQoL reporting has not improved over time. Some of the issues identified are limited discussions, methodological shortcomings, and poor HRQoL reporting. This review has underscored the importance of standardising of the reporting of HRQoL measures.Although capturing the patient’s perspective via PROs is important, they may not be the only outcome measures important to patients. Currently, no single CHF outcome measure captures all dimensions of the quality of care from the patient’s perspective. To identify outcome measures in CHF deemed important to patients, a structured literature review was undertaken. The conceptual and methodological challenges and opportunities in each outcome measure were identified as important to patients with CHF. That is mortality, hospitalisation and PROs were identified as important to patients but also meaningful and relevant to the provider and health care system as well. These outcome measures were proposed as a core outcome set that represent the minimum set of outcomes that should be measured and reported in CHF.A number of composite outcome measures have been developed to capture the perspective of the patient, clinician as well as including objective measures of health. Three validated composite outcomes, the Packer’s Score, Cleland’s Patient Journey and the composite endpoint used in the African American Heart Failure Trial (A-HeFT) were examined in a secondary analysis of a prospective, multi-center randomized controlled trial of 280 hospitalized CHF patients in the Which Heart failure Intervention is most Cost-effective & Consumer Friendly in Reducing Hospital Care (WHICH?) Trial in order to assess the comparability and interpretability of the measures in a pragmatic clinical trial. Correlation coefficients demonstrated substantial associations amongst all three composite endpoints. Although there was a considerable agreement across the three measures when estimating deteriorating condition, these was less when estimating improvements.This thesis has described both the importance and complexity of including outcome measures that are meaningful to patients in both the assessment of individuals’ needs, testing interventions, monitoring outcomes and assessing process and outcome measures at a health systems level. This thesis has also extended the discussion and debate around PROs to discuss Patient Important Outcomes, which is outcomes that patients notice and for which they would be willing to undergo a treatment with associated risk, cost, or inconvenience for it to be the only thing that changed. Using CHF as an exemplar has provided useful insights into the dimensions and complexities of measuring outcomes in chronic and complex conditions. As the burden of chronic disease continues to increase refining the metrics of outcome measurements will be equally as important as refining novel therapies. This will be critical to develop and implement interventions to meet the growing numbers of people living with chronic illness.

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Kadri, Amer N., Vivek Menon, Yasser M. Sammour, Rama D. Gajulapalli, Chandramohan Meenakshisundaram, Leen Nusairat, DIvyanshu Mohananey, et al. "Outcomes of patients with severe tricuspid regurgitation and congestive heart failure." BMJ Publishing Group, 2019. http://hdl.handle.net/10757/652470.

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Objectives A substantial number of patients with severe tricuspid regurgitation (TR) and congestive heart failure (CHF) are medically managed without undergoing corrective surgery. We sought to assess the characteristics and outcomes of CHF patients who underwent tricuspid valve surgery (TVS), compared with those who did not. Methods Retrospective observational study involving 2556 consecutive patients with severe TR from the Cleveland Clinic Echocardiographic Database. Cardiac transplant patients or those without CHF were excluded. Survival difference between patients who were medically managed versus those who underwent TVS was compared using Kaplan-Meier survival curves. Multivariate analysis was performed to identify variables associated with poor outcomes. Results Among a total of 534 patients with severe TR and CHF, only 55 (10.3%) patients underwent TVS. Among the non-surgical patients (n=479), 30% (n=143) had an identifiable indication for TVS. At 38 months, patients who underwent TVS had better survival than those who were medically managed (62% vs 35%; p<0.001). On multivariate analysis, advancing age (HR: 1.23; 95% CI 1.12 to 1.35 per 10-year increase in age), moderate (HR: 1.39; 95% CI 1.01 to 1.90) and severe (HR: 2; 95% CI 1.40 to 2.80) right ventricular dysfunction were associated with higher mortality. TVS was associated with lower mortality (HR: 0.44; 95% CI 0.27 to 0.71). Conclusion Although corrective TVS is associated with better outcomes in patients with severe TR and CHF, a substantial number of them continue to be medically managed. However, since the reasons for patients not being referred to surgery could not be ascertained, further randomised studies are needed to validate our findings before clinicians can consider surgical referral for these patients.
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Nagpal, Seema. "Factors Influencing Outcomes of Heart Failure: A Population Health Approach." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/20242.

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Background: Symptomatic heart failure is a chronic and disabling condition that affects over 350 000 Canadians and is characterized by inevitable progression. Historically, research on the ways to increase survival has focused on biomedical factors. However, the continued poor prognosis of heart failure has prompted the search for other ways to improve the lives of these patients. Research in other chronic conditions demonstrates that social circumstances, described collectively as individual social interactions (e.g. social support, social participation) and community social factors (e.g. social capital, social norms), can influence health outcomes. Purpose: The purpose of this research was to describe and assess the impact of selected social circumstances potentially related to heart failure outcomes. Methods: Two literature reviews and one empirical study were performed. Conceptual models were proposed to describe the hypothesized pathways between selected social circumstances and heart failure outcomes. The first review was a systematic review of quantitative studies evaluating the relationship between social support and both rehospitalization and death. The review included a critical analysis of the methods employed by previous studies. The second review integrated the qualitative and quantitative literature describing the relationship between individual social interactions (including support, roles and participation) and the quality of life of patients or experience of living with heart failure. A narrative summary was provided and an integration of findings from both qualitative and quantitative study designs was performed. In the empirical study, patients‘ demographic and clinical information was examined simultaneously with selected community factors in a multilevel analysis. Outcomes of interest included rehospitalization or death of heart failure patients. Results: The systematic review shows that previous quantitative research has linked social support to reduced rehospitalization, but there is little evidence to link it with prolonged survival. The critique of the methods describes an inadequate conceptualization and inconsistent measurement of social support. A conceptual model showing how social support can influence rehospitalization is proposed. The integrative review presents qualitative research that identified the following social interactions as important components of the heart failure experience: social support, social participation and role fulfillment. However, no quantitative relationship between social support and quality of life was found. The potential reasons for the discrepant findings between the qualitative and quantitative studies include: the focus on social support as the only component of social interactions assessed in the quantitative literature; and the inconsistent measurement of social support. A conceptual model is presented to describe the multiple components of social interactions and the theoretical basis for their effects. The multilevel analysis demonstrates that individual factors exerted the strongest effect on heart failure outcomes in most models. Community characteristics had little influence on rehospitalization or death. Study design and analysis issues are proposed to explain these findings. Conclusion: The literature reviews and the empirical study provide a contribution to the population health literature, offering a broad approach to assessing the determinants of disease progression in heart failure patients. This thesis research advances the discussion about which social circumstances may influence heart failure outcomes and their pathways. The use of the proposed conceptual models in future research will help clarify the role of social circumstances in the prognosis of heart failure.

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Dobre, Daniela. "Treatment of heart failure and patient outcomes in real life." [S.l. : [Groningen : s.n.] ; University Library Groningen] [Host], 2006. http://irs.ub.rug.nl/ppn/298098539.

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O'Malley, Patricia Anne. "Hemodynamic outcomes of weaning intraaortic balloon counterpulsation in heart failure." The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1363169617.

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Takabayashi, Kensuke. "Clinical Characteristics and Outcomes of Heart Failure Patients With Long-Term Care Insurance -Insights From the Kitakawachi Clinical Background and Outcome of Heart Failure Registry-." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/265165.

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Sani, Mahmoud Umar. "Characteristics and outcomes of acute heart failure in sub Saharan Africa." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23778.

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The main objective of this thesis was to study the clinical characteristics and short-term (6 months) outcome of acute heart failure as well as determine the role of conventional biomarker BNP and the novel biomarker Gal3 in the prognostication of acute heart failure patients. To achieve this, we investigated in the first cohort; 1) the demographic and clinical characteristic of patients with AHF, 2) their echocardiographic parameters and how they predict outcome, 3) the predictors of readmission and mortality, 4) the prevalence and impact of renal dysfunction on AHF and 5) the electrocardiographic pattern in AHF. The outcome measures were worsening renal function (WRF), length of hospital stay, HF readmissions and cardiovascular death within 60 days and all cause, cardiovascular or HF death through 180 days. In the second cohort, we investigated the demographics, clinical characteristics as well as the relationship between plasma levels of BNP and galectin 3 and outcomes (cardiovascular (CV) death or HF hospitalization through week 24) as well as the relationship between the plasma levels of BNP and Gal3 and both left ventricular (LV) and right ventricular (RV) remodeling in patients with AHF.

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Lee, Kyoung Suk. "SYMPTOM ASSESSMENT AND MANAGEMENT IN PATIENTS WITH HEART FAILURE." UKnowledge, 2012. http://uknowledge.uky.edu/nursing_etds/2.

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Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF.

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You, Cindy. "Impact of Left Ventricular Heart Failure With Preserved Ejection Fraction and Right Ventricular Systolic Heart Failure on Outcomes in the Intensive Care Unit." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295904.

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Heart failure is a common diagnosis in the intensive care unit (ICU) with many studies regarding left ventricular systolic dysfunction and ICU outcomes. Less commonly explored are heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure, and right ventricular heart failure in ICU outcomes. We sought to study the impact of both diastolic heart failure and right ventricular heart failure on general ICU outcomes. This retrospective cohort study includes 919 patients admitted to an ICU of a major tertiary care medical center with HFpEF, and 298 patients from the same medical center with right ventricular heart failure, comparing outcomes to 6955 control patients without left ventricular systolic or right ventricular heart failure in this general intensive care setting. Primary endpoint was 28-day mortality, with secondary endpoints of 1-year mortality, hospital and intensive care length of stay, length of use of vasopressors, and days on mechanical ventilation. Multivariable regression demonstrated a significant association between HFpEF and improved mortality as compared to controls, but this association is lost at 1-year follow-up. Right ventricular heart failure does not demonstrate any association with 28-day mortality, which was corroborated on sensitivity analysis excluding cardiac or cardiac surgery intensive care patients.

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Blackledge, Hanna Maria. "Outcomes in heart failure : study of contemporary trends in a multi-ethnic population." Thesis, University of Leicester, 2010. http://hdl.handle.net/2381/8276.

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Heart failure is a growing cause of morbidity in an ageing population. Despite increasing use of clinically proven therapies its overall prognosis remains poor, and our knowledge of outcomes in some patient groups is still very limited. Most of existing evidence is based on clinical trial populations, which often exclude ethnic minorities, women or sicker elderly patients. UK’s South Asian population has been shown to suffer from particularly high rates of cardiovascular disease but data on their clinical outcomes have been lacking. This study aimed to evaluate heart failure outcomes in an unselected population and to test a hypothesis of poorer prognosis among South Asians. Using population-based historical cohort design, this thesis evaluates the longterm survival in a large unselected cohort of 5,789 patients with an initial heart failure admission between 1998 and 2001, on a background of the overall trends in heart failure hospitalisation and fatality between 1993 and 2001. The relative risks linked to main patient groups are estimated using logistic regression and survival modelling and a prognostic model is proposed. The results show a plateau in the rates of hospitalisation in the late 1990s. Despite a 50% improvement in survival between 1993 and 2001, outcomes remain poor with a 40% one year fatality. South Asian patients tend to be younger at first admission (by 8 years) and with higher rates of comorbidity, however, their survival appears to be similar to other groups. The developed models indicate high prognostic value of concomitant conditions, such as stroke and renal failure, but only a moderate effect of diabetes. This is the first large study to describe heart failure outcomes in a multi-ethnic contemporary population with an almost complete follow-up of patients. On a background of higher cardiovascular risk, younger age at first admission and higher rate of hospitalisation among South Asians, their clinical outcomes appear to be similar to white patients. Despite the clear limitations inherent in routine data sources, this study shows clear benefits in developing routine risk assessment models for public health research and health care evaluation.

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Al-Rawashdeh, Sami. "Sleep Disturbance and Outcomes in Patients with Heart Failure and their Family Caregivers." UKnowledge, 2014. http://uknowledge.uky.edu/nursing_etds/11.

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Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of depressive symptoms on the association between sleep disturbance and QoL in patients and family caregivers; and 3) provide evidence of the psychometric priorities of the Zarit Burden Interview (ZBI) as a measure of caregiving burden in caregivers of patients with HF. The three specific aims were addressed using secondary analyses of cross-sectional data available from 143 patients with HF and their primary family caregivers. To accomplish Specific Aim One, multilevel dyadic analysis, actor-partner interdependence model was used for 78 patient- caregiver dyads. Individuals’ sleep disturbance predicted their own poor QoL. Caregivers’ sleep disturbance predicted patients’ mental aspect of QoL. For Specific Aim Two, a series of multiple regressions was used to examine the mediation effect in patients and caregivers separately. Depressive symptoms significantly mediated the relationship between sleep disturbance and mental aspect of QoL in patients. The mediation effect was similar in caregivers. For Specific Aim Three, the internal consistency and convergent and construct validity of the ZBI in 124 family caregivers of patients with HF were examined. The results showed that the ZBI is a reliable and valid measure of caregiving burden in this population. This dissertation has fulfilled important gaps in the evidence base for the QoL outcome in patients with HF and caregivers. The findings from this dissertation provided evidence of the importance of monitoring sleep disturbance for better QoL in both patients and caregivers and the importance of assessing caregivers’ sleep disturbance for improving patients’ QoL. It also provided evidence of the importance of managing depressive symptoms when targeting sleep disturbance to improve QoL in both patients and caregivers.

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Riggs, Jennifer Sue. "The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522.

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SEGAFREDO, GIULIA. "New Heart Failure Hospitalization in the Italian region of Lombardy - Epidemiological and economic impact." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2015. http://hdl.handle.net/10281/76821.

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Le ospedalizzazioni per scompenso cardiaco (hospitalized heart failure, HHF) costituiscono un notevole problema per i sistemi sanitari, sia dal punto di vista clinico che di salute pubblica. Data l’eterogeneità delle manifestazioni e degli esiti della malattia, la letteratura più recente ha suggerito di distinguere i pazienti ambulatoriali con scompenso cardiaco da quelli con un’ospedalizzazione per scompenso cardiaco. La ragione di questa scelta è che la prognosi di questi due gruppi di pazienti sembra essere molto diversa. La prognosi dei pazienti ambulatoriali, infatti, è cambiata radicalmente, in modo positivo, negli ultimi vent’anni, grazie allo sviluppo di nuovi trattamenti, come gli ACE-inibitori, i bloccanti del recettore dell'angiotensina (ARB), i beta-bloccanti, gli antagonisti del recettore dei mineralcorticoidi, l’utilizzo della terapia di risincronizzazione e di defibrillatori impiantabili, mentre quella dei pazienti HHF è rimasta pressoché invariata. Inoltre, sebbene la ricerca clinica ed epidemiologica abbia posto grande attenzione a diversi aspetti della gestione dei pazienti ambulatoriali, portando ad una buona conoscenza delle caratteristiche epidemiologiche, fisiopatologiche e farmacologiche, tali conoscenze non sono completamente applicabili all’ambito del HHF, lasciando aperti alcuni importanti quesiti riguardo l’impatto di tale condizione. L'obiettivo di questo progetto è stato, attraverso l'utilizzo dei database sanitari amministrativi della Regione Lombardia, di meglio caratterizzare l'impatto di HHF cercando di fornire una risposta a queste tre domande: 1. Quanti sono i nuovi pazienti con HHF nella Regione Lombardia? In questo capitolo sono stati descritti i metodi sviluppati per quantificare l'impatto epidemiologico del HHF in questa regione. Più in dettaglio, è descritto il processo che ha portato all’identificazione della fonte di dati appropriata, allo sviluppo di un algoritmo per l'identificazione del paziente, alla selezione dei casi e alla quantificazione del tasso d'incidenza e del tasso di attacco. 2. Determinanti di nuove ospedalizzazioni per scompenso - Fattori di rischio In questo capitolo è stato valutato il ruolo del trattamento antipertensivo nella prevenzione HHF. Più specificamente è stato valutato (i) l'effetto dell’aderenza al trattamento antipertensivo (ii) l'effetto del farmaco all'ingresso (iii) l'effetto dell’aderenza ad una specifica classe antipertensivi, sulla comparsa del primo episodio di HHF in una popolazione di nuovi utilizzatori di antipertensivi. 3. Conseguenze dei nuovi ricoveri per scompenso cardiaco - Esiti, fattori prognostici e impatto economico. In questo capitolo, sono stati descritti (i)frequenza di mortalità e riospdedalizzazioni a breve (trenta giorni) e lungo (un anno) termine dopo la prima ospedalizzazione per HF, (ii) fattori prognostici a breve e lungo termine, (iii) impatto economico di HHF in Regione Lombardia.

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Garin, Boronat Olatz 1979. "Measuring health related quality of life in heart failure." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/123573.

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L’objectiu global d’aquesta tesis doctoral va ser identificar les fortaleses i limitacions de les mesures de Qualitat de Vida Relacionada amb la Salut desenvolupades específicament per pacients amb insuficiència cardíaca. Una revisió sistemàtica va trobar 7 qüestionaris de Qualitat de Vida Relacionada amb la Salut específics per insuficiència cardíaca: Chronic Heart Failure Assessment Tool (CHAT), Cardiac Health Profile congestive heart failure (CHPchf), Kansas City Cardiomyopathy questionnaire (KCCQ), Left Ventricular Disease Questionnaire (LVDQ), Minnesota Living with Heart Failure questionnaire (MLHFQ), i Quality of Life in Severe Heart Failure Questionnaire (QLSHFQ). L’evidència publicada fins 2006 senyalava el MLHFQ com el qüestionari més estès i recomanable. La versió espanyola del MLHFQ va mostrar característiques similars a l’original, així com també l’avaluació conjunta de versions de 20 països. A més, l’avaluació del model de mesura va confirmar la unidimensionalitat de la puntuació total del MLHFQ, i les seves dimensions física, emocional i social. L’actualització al 2011 de la revisió sistemàtica juntament amb l’avaluació estandarditzada per experts, varen destacar les propietats mètriques del KCCQ per sobre de les del MLHFQ.

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Hixson, Eric D. "Ambulatory Heart Failure Treatment: Process and Outcomes Effects of Provider Practice and Patient Adherence." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1232736856.

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Singh, Rajender. "Long term outcomes in patients with heart failure : the Darlington Retrospective Out-Patient Study (DROPSY)." Thesis, Durham University, 2014. http://etheses.dur.ac.uk/9491/.

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The Darlington Retrospective Outpatient Study (DROPSY) was carried out at the Darlington Memorial Hospital Darlington. From Jan 2002 to Dec 2007, 1041 patients were seen in the heart failure (HF) clinic. Of these 270 (26%) were diagnosed as having left ventricular systolic dysfunction (LVSD). Of the 771 patients who did not have systolic dysfunction, we identified 243 patients who fulfilled the study criteria for heart failure with preserved ejection fraction (HFpEF). The remaining 528 patients formed the non heart failure (Other) group. Patients with HFpEF were older and more likely to have hypertension and diabetes than the other two groups. The LVSD group had more men plus ischemic heart disease patients while the third group of non HF also had more females and a high number with COPD. Over the mean follow up of 7 years, the number of admissions to hospital per patient was similar in both the LVSD and HFpEF groups, but HFpEF patients had a significantly longer length of stay. In the HFpEF group, the use of beta blockers, ACE inhibitors, and a lower median resting HR of < 78 / min predicted better survival. All cause mortality was high in both LVSD and HFpEF groups, with strikingly different cause of death. Patients with LVSD had more cardiovascular deaths whereas HFpEF patients were more likely to die of non cardiovascular causes. Patients in the third group diagnosed as not having HF (Other group) also had high five year mortality. Conclusion Patients with LVSD and HFpEF have high mortality but different causes of death. The use of beta blockers, ACE inhibitors, and a lower resting heart rate in the HFpEF group was associated with better survival. Patients who were reassured as not having HF do badly as well.

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Loftus, Liliana. "The influence of illness and psychological factors on patient and caregiver outcomes in heart failure." Thesis, University of Liverpool, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408537.

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Akalu, Masresha. "Adherence to Evidence-Based Pharmacological Guidelines and Outcomes for Heart Failure in Primary Care Providers." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/347052.

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Background: Heart failure (HF) is a major public health problem in the United States and accounts for a large burden in rising health care expenditures. Appropriate use of evidence-based pharmacological treatment, including the use of renin-angiotensin-aldosterone inhibitors and beta-blockers can slow progression of the disease and reduce the need for hospitalization. Objectives: In a sample of individuals with HF in a primary care setting, the objectives of this study were to determine the level of providers' adherence to evidence-based pharmacological guidelines and the rate of cardiovascular-related emergency department or hospital visits. Methods: A convenience sample of patients 18 years of age and older with a diagnosis of HF was included. A retrospective chart review of 54 HF subjects was done between April and September 2014, using the American College of Cardiology Foundation and American Heart Association outpatient performance measurement set for HF. Results: Adherence to guideline recommendations for beta-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker ARB), anticoagulation for atrial fibrillation, statin, and aldosterone receptor antagonist therapy was present in 81%, 77.8%, 78%, 80.7% and 23.1% of eligible subjects, respectively. The use of ACEIs/ARBs (OR=8.853, CI 1.212-64.66, p= 0.032) and beta-blockers (OR= 9.24, CI 1.212-70.438, p =0.031) was significantly associated with reduced number of (<1) cardiovascular-related emergency department or hospital visits after adjusted for confounders including age, sex, body mass index, and comorbidities. Conclusion: The use of ACEIs/ARBs and beta-blockers among primary care providers was comparable or higher than similar studies conducted in the primary care settings. However, despite the available evidence and recommendations, the use of aldosterone receptor antagonists in HF patients with myocardial infarction and diabetes mellitus was still low in the absence of any contraindications. These findings can be used by primary care providers to assess the existing gap in the use of HF guideline-recommended therapy and develop interventions to improve the utilization of evidence-based guidelines.

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Alsaid, Nimer, and Nimer Alsaid. "Ex Ante Economic Evaluations of Arg389 Genetic Testing and Bucindolol Treatment Decisions in Heart Failure Stage III/IV." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626340.

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Introduction: Beta-Blocker Evaluation Survival Trial (BEST) sub-analyses indicated a likely interaction between bucindolol and race disadvantaging black heart failure (HF) patients (Domanski J Cardiac Fail 2003); Arg389 homozygotes having adjusted reductions of 38% in mortality and 34% in mortality/hospitalization over other genotypes (Liggett PNAS 2006). Bucindolol is being evaluated in Arg389 genotype patients in the GENETIC-AF trial (NCT01970501). Objective: To conduct parallel (using Domanski et al and Liggett et al) ex ante economic evaluations of Arg389 genetic testing in stage III/IV HF to support bucindolol treatment decisions (if Arg389-positive) and carvedilol (if Arg389-negative) treatment versus no such testing and empirical bucindolol; using Domanski et al and Liggett et al BEST sub-analyses. Methods: In both Domanski et al and Liggett et al analyses, we used a decision tree model with time horizon of 18 months divided into 3 six-month cycles to estimate the cost-effectiveness and cost-utility of Arg389 genetic testing, considering overall survival (OS) from Domanski et al and Liggett et al BEST sub-analyses. Costs and utilities were retrieved from literature except for assumed cost for bucindolol treatment (1.5x cost of carvedilol) and genetic testing ($250). Discount rate was set at 3%/yr. Weibull distributions were fitted to OS data. Life-years (LY) and quality-adjusted life-years (QALY) were used to estimate incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR), and results were validated using probabilistic sensitivity analyses (PSA). Results: In the Domanski et-based analysis, Arg389 genetic testing versus no testing was associated with incremental gains of 0.29LYs and 0.27QALYs at incremental cost of $726; yielding ICER of US$2,503/LY and ICUR of US$2,688/QALY gained. In the Liggett et al-based analysis, Arg-389 genetic testing versus no testing was associated with incremental gains of 0.35LYs and 0.32QALYs at savings of -$1.081; for ICER of -US$3,089/LY and ICUR of -US$3,378/QALY gained. Both analyses were confirmed in PSAs. Conclusion: Arg389 genetic testing to support bucindolol treatment in stage III/IV HF patients prevails economically over bucindolol treatment without genetic testing due to superior OS. If bucindolol is priced at 1.5x the cost of carvedilol. this economic benefit is likely to disappear if bucindolol and/ or genetic testing are priced higher. The clinical and economic benefits of bucindolol treatment with versus without Arg389 genetic testing versus empiric carvedilol remains to be assessed.

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Karlström, Patric. "Heart failure : biomarker effect and influence on quality of life." Doctoral thesis, Linköpings universitet, Avdelningen för kardiovaskulär medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-124560.

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Background and aims: Heart failure (HF) is a life threatening condition and optimal handling is necessary to reduce risk of therapy failure. The aims of this thesis were: (Paper I) to examine whether BNP (B-type natriuretic peptide)-guided HF treatment improves morbidity and mortality when compared with HF therapy implemented by a treating physician at sites experienced in managing patients with HF according to guidelines; (Paper II) to investigate how to define a responder regarding optimal cut-off level of BNP to predict death, need for hospitalisation, and worsening HF and to determine the optimal time to apply the chosen cut-off value; (Paper III) to evaluate how Health-Related Quality of Life (HR-QoL) is influenced by natriuretic peptide guiding and to study how HR-QoL is affected in responders compared to non-responders; (Paper IV) to evaluate the impact of patient age on clinical outcomes, and to evaluate the impact of duration of the HF disease on outcomes and the impact of age and HF duration on BNP concentration. Methods: A randomized, parallel group, multi-centre study was undertaken on 279 patients with HF and who had experienced an episode of worsening HF with increased BNP concentration. The control group (n=132) was treated according to HF guidelines and in the BNP-guided group (n=147) the HF treatment algorithm goal was to reduce BNP concentration to < 150 ng/L in patients < 75 years and <300 ng/L in patients > 75 years (Paper I), and to define the optimal percentage decrease in BNP and at what point during the follow-up to apply the definition (Paper II). To compare the BNP-guided group with the conventional HF treated group (Paper I), and responders and non-responders (Paper II) regarding HR-QoL measured with Short Form 36 (SF-36) at study start and at study end (Paper III) and to evaluate if age or HF duration influenced the HF outcomes and the influence of BNP on age and HF duration (Paper IV). Results: The primary outcome (mortality, hospitalisation and worsening HF) was not improved by BNP-guided HF treatment compared to conventional HF treatment or in any of the secondary outcome variables (Paper I). Applying a BNP decrease of at least 40 percent in week 16 (compared to study start) and/or a BNP<300 ng/L demonstrated the best risk reduction for cardiovascular mortality, by 78 percent and 89 percent respectively for HF mortality (Paper II). The HR-QoL improved in four domains in the BNP-guided group and in the control group in six of eight domains; however there were no significant differences between the groups (Paper III). For responders the within group analysis showed improvement in four domains compared to the non-responders that improved in one domain; however there were no significant differences between the two groups. There were improvements in HR-QoL in all four groups (Paper III). Age did not influence outcome but HF duration did. HF duration was divided into three groups: HF duration less than 1 year (group 1), 1-5 years (group 2) and >5 years (group 3). A 1.65-fold increased risk could be demonstrated in those with HF duration of more than five years compared to patients with short HF duration. The BNP concentration was increased with increased age, and there was a better response regarding BNP decrease in NP-guiding in patients with short HF duration, independent of age (Paper IV). Conclusions: There were no significant differences between BNP-guided HF treatment group and the group with conventional HF treatment as regards mortality, hospitalisation or HR-QoL. The responders to HF treatment showed a significantly better outcome in mortality and hospitalisation compared to non-responders but no significant differences in HR-QoL. The duration of HF might be an important factor to consider in HF treatment by BNP-guiding in the future.

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Bielecka-Dabrowa, Agata, Ibadete Bytyçi, Haehling Stephan Von, Stefan Anker, Jacek Jozwiak, Jacek Rysz, Adrian V. Hernandez, Gani Bajraktari, Dimitri P. Mikhalidis, and Maciej Banach. "Association of statin use and clinical outcomes in heart failure patients: A systematic review and meta-analysis." BioMed Central Ltd, 2019. http://hdl.handle.net/10757/655521.

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Background The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. Results Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. Conclusions In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.
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Vallina, Helen. "Using OASIS Data to Assess Moderator Effects of Patient Characteristics on Telemonitoring Outcomes in Heart Failure Patients." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/195023.

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This study had two purposes: 1) to compare the difference between home health care only and home health care plus telemonitoring on heart failure patients' symptom burden, self-care of heart failure and re-hospitalization; and 2) to explore which patient characteristics might moderate telemonitoring's impact.Heart failure has emerged as a major public health burden. Like other chronic conditions, heart failure patients have an important role to play in the day-to-day management of their condition. One of the principal reasons for introducing telemonitoring in home health care was to increase heart failure patients' capacity to self-manage their conditions at home.This study used a prospective, non-experimental, comparative, descriptive design. A total of 68 participants were recruited with 34 in each group. Symptom burden and self-care of heart failure were measured on enrollment and 40 days later. Hospitalization was measured as an event that either occurred or did not occur.Although no between-group differences in symptom burden were found, both groups showed significant decreased symptom burden over the 40-day period. Of the three self-care measures, only self-care maintenance differed significantly between the two groups at the 40-day follow-up (p<.05). Only the participant's functional status had significant moderator effect on the relation between type of service received and self-care maintenance (p<.05).The addition of telemonitoring produced similar outcomes to regular home health care, except for self-care maintenance. Like most prior study, this study focused on evaluating the overall relationship between telemonitoring and outcomes without concern for the transformation process. Although these evaluation were able to provide an overall assessment of whether or not the telemonitoring program worked, they cannnot identify the underlying mechanisms that generate the effects. Without knowing what make the program work or not work, it is difficult to pinpoint what needs to be done for future improvement. A theory-oriented evaluation will be needed in future research. Theory-oriented evaluation not only allow reseachers to clarify the connection between a program's operation and its effect, but also to specify intermediate effects of a program that might become evident and measurable.

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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/20702/1/Jung-Hua_Shao_Thesis.pdf.

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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.

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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Queensland University of Technology, 2008. http://eprints.qut.edu.au/20702/.

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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.

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Nauser, Julie Ann. "Heart failure family caregivers psychometrics of a new quality of life scale and variables associated with caregiver outcomes /." Connect to resource online, 2007. http://hdl.handle.net/1805/1139.

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Thesis (Ph.D.)--Indiana University, 2007.
Title from screen (viewed on September 21, 2007). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Tamilyn Bakas, Sharon Sims, Mary L. Fisher, Janet Welch. Includes vitae. Includes bibliographical references (leaves 228-244).

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Kim, Kitae. "Outcomes and predictors of cardiac events in medically treated patients with atrial functional mitral regurgitation." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264636.

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Alhurani, Abdullah S. "CO-MORBID SYMPTOMS OF DEPRESSION AND ANXIETY AND BIO-BEHAVIORAL RESPONSE TO STRESS IN PATIENTS WITH HEART FAILURE." UKnowledge, 2016. http://uknowledge.uky.edu/nursing_etds/21.

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Heart failure (HF) is a major public health problem throughout the world. It accounts for one death certificate among nine in the United States. Heart failure and sudden death combined are responsible for the largest number of deaths in America. The total costs of HF in the United States are estimated to be $37 billion each year. Despite substantial medical and surgical advances related to treatment of HF, it remains a very costly condition with high mortality and morbidity rates. Although biological factors contribute to high morbidity and mortality in HF, there are many unexplored psychosocial factors that also likely contribute to these rates. Thus, the purpose of this dissertation was to examine the association between some of the psychosocial factors (i.e. depression, anxiety, comorbid depression and anxiety, stress, cognitive appraisal, and coping) and health outcomes as defined by rehospitalisation and mortality among HF patients. The first paper is a report of longitudinal study of 1,260 patients with HF. The purpose of the study was to determine whether co-morbid symptoms of depression and anxiety are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF. Anxiety and depression were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients were then divided into four groups based on the presence of symptoms of anxiety and depression. When depression and anxiety were treated as continuous level variables, both comorbid depression and anxiety, and depression alone were significant predictors of all-cause mortality. However, when depression and anxiety were treated as categorical variables, comorbid depression and anxiety was a predictor of all-cause mortality, while anxiety and depressive symptoms considered alone were not independent predictors of the same outcome. None of those variables were significant predictors of cardiac rehospitalization outcome, regardless of whether entered as continuous or categorical level variables. The second paper is a report of a study that was conducted to (1) examine the association of stress with 6-month cardiac event-free survival; (2) examine the relationship of stress with salivary cortisol; and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. The study sample was 81 HF patients. A prospective design was used in which patients were followed for 6 months to determine occurrence of 6-month cardiac event-free survival, defined as time to the combined endpoint of cardiac rehospitalization or all-cause death. Stress was not a significant predictor of event-free survival in HF, salivary cortisol was a significant predictor of event-free survival in the unadjusted model, but not in the adjusted model, and stress was not a significant predictor of salivary cortisol level. The final paper is a report of prospective design study that aimed to describe self-reported stress level, cognitive appraisal and coping among patients with HF, and to examine the association of cognitive appraisal and coping strategies with event-free survival based on a proposed model of HF patients’ response to stressors that been suggested according to literature to date. The study sample consisted of 88 HF patients who been followed for 6 months to determine occurrence of the combined endpoint of rehospitalization for cardiac causes or all-cause death. The study showed that stress level was associated with harm and loss cognitive appraisal. Harm/loss and threat cognitive appraisals were associated with avoidant emotional coping. Furthermore, harm/loss cognitive appraisal was a significant predictor of avoidant emotional coping and event free survival. Finally avoidant emotional coping was a significant predictor of event free survival among HF patients in the unadjusted model, but not in the adjusted model. The findings from this dissertation provided further evidence of the importance of psychosocial factors to health outcomes in HF patients. It also filled important gaps in the body of knowledge related to health outcomes among those with HF by demonstrating the need for cognitive and behavioral therapy among HF patients who negatively appraise their health condition.

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Easton, Katherine Anne. "An investigation into the nature, prevalence and severity of anxiety in heart failure patients : the association between anxiety and patient health outcomes." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/an-investigation-into-the-nature-prevalence-and-severity-of-anxiety-in-heart-failure-patients-the-association-between-anxiety-and-patient-health-outcomes(3c2ebad9-0418-4cec-b4a6-d17784043c85).html.

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Long Term Conditions (LTCs) with co-morbid common mental health conditions of anxiety and depression present a significant challenge for UK health and social care services. Depression and anxiety are common in heart failure (HF) patient populations and research suggests depression has a detrimental effect on a range of health outcomes, including Health related Quality of Life (HRQoL). The impact of anxiety is relatively under-researched in this patient group. In this doctoral study a systematic review was conducted to consolidate the evidence base for the prevalence and variance of rates of anxiety in HF patients. Importantly, the relative contribution of anxiety symptoms, measured using the Hospital Anxiety and Depression Scale (HADS), to reported HRQoL , measured using the Kansas City Cardiomyopathy Questionnarie (KCCQ) was examined in a cross-sectional survey of 158 HF patients attending specialist HF outpatient clinics. The systematic review identified 72 studies, with reported rates of anxiety varying dramatically, ranging from 6.2% to 72.3%. The random effects pooled prevalence estimate for anxiety disorders was 13.01% (95% CI 9.3% - 16.9%), for probable clinically significant anxiety was 28.8% (95% CI 23.3% - 34.3%) and the random effects pooled prevalence estimate for elevated symptoms of anxiety was 55.5% (95% CI 48.1% - 62.8%). Not all tools used to assess anxiety were population appropriate. In the survey multivariate analysis found that anxiety symptoms, did not account for a significant proportion of unique variance in HRQoL scores. Higher levels of physical symptom burden, depression and an increased number of physical co-morbidities predominantly account for 69% of the variance in HRQoL (F13,125 = p <0.0005). The findings highlight the need for accurate and valid measurement of anxiety and depression within the context of a physical LTC. Anxiety and depression are common in HF patients and the evidence suggests depression in particular predicts reported HRQoL. Further research is required to understand more about the role of anxiety in influencing patient’s health outcomes.

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Pokras, Stan. "Outcomes and Opportunities for Reducing Heart Failure 30-Day Readmissions and Mortality for Acute Care Inter-Hospital Transfers at a Multi-Site Hospital System." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1585222151873158.

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Oriowo, Oluremi Omolara. "Improving Patient and Caregiver Engagement During the Transition of Care to Improve Health Outcomes in Patients 65 Years and Older with Heart Failure." Xavier University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1512646682649032.

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Jonsson, Åsa. "How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life." Doctoral thesis, Linköpings universitet, Avdelningen för kardiovaskulär medicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-137351.

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Background and aims Heart failure (HF) is a major cause of serious morbidity and death in the population and one of the leading medical causes of hospitalization among people older than 60 years. The aim of this thesis was to describe how to create and how to analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life. (Paper I) We described the creation of the Swedish Heart Failure Registry (SwedeHF) as an instrument, which may help to optimize the handling of HF patients and show how the registry can be used to improve the management of patients with HF. (Paper II) In order to show how to analyze a HF registry we investigated the prevalence of anemia, its predictors, and its association with mortality and morbidity in a large cohort of unselected patients with HFrEF included in the SwedeHF, and to explore if there are subgroups of HF patients identifying high--‐risk patients in need of treatment. (Paper III) In order to show another way of analyzing a HF registry we assessed the prevalence of, associations with, and prognostic impact of anemia in patients with HFmrEF and HFpEF. (Paper IV) Finally we examined the usefulness of EQ--‐ 5D as a measure of patient--‐reported outcomes among HF patients using different analytical models and data from the SwedeHF, and comparing results about HRQoL for patients with HFpEF and HFrEF. Methods An observational study based on the SwedeHF database, consisting of about 70 variables, was undertaken to describe how a registry is created and can be used (Paper I). One comorbidity (anemia) was applied to different types of HF patients, HFrEF (EF <40%) (II) and HFmrEF (EF 40--‐49% ) or HFpEF (> 50%) (III) analyzing the data with different statistical methods. The usefulness of EQ--‐5D as measure of patient--‐ reported outcomes was studied and the results about HRQoL were compared for patients with HFpEF and HFrEF (IV). Results In the first paper (Paper I) we showed how to create a HF registry and presented some characteristics of the patients included, however not adjusted since this was not the purpose of the study. In the second paper (Paper II) we studied anemia in patients with HFrEF and found that the prevalence of anemia in HFrEF were 34 % and the most important independent predictors were higher age, male gender and renal dysfunction. One--‐year survival was 75 % with anemia vs. 81 % without (p<0,001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all--‐cause death 1.34. Anemia was associated with greater risk with lower age, male gender, EF 30--‐39%, and NYHA--‐class I--‐II. In the third paper (Paper III) we studied anemia in other types of HF patients and found that the prevalence in the overall cohort in patients with EF > 40% was 42 %, in HFmrEF 38 % and in HFpEF (45%). Independent associations with anemia were HFpEF, male sex, higher age, worse New York Heart Association class and renal function, systolic blood pressure <100 mmHg, heart rate ≥70 bpm, diabetes, and absence of atrial fibrillation. One--‐year survival with vs. without anemia was 74% vs. 89% in HFmrEF and 71% vs. 84% in HFpEF (p<0.001 for all). Thus very similar results in paper II and III but in different types of HF patients. In the fourth paper (Paper IV) we studied the usefulness of EQ--‐5D in two groups of patients with HF (HFpEF and HFrEF)) and found that the mean EQ--‐5D index showed small reductions in both groups at follow--‐up. The patients in the HFpEF group reported worsening in all five dimensions, while those in the HFrEF group reported worsening in only three. The Paretian classification showed that 24% of the patients in the HFpEF group and 34% of those in the HFrEF group reported overall improvement while 43% and 39% reported overall worsening. Multiple logistic regressions showed that treatment in a cardiology clinic affected outcome in the HFrEF group but not in the HFpEF group (Paper IV). Conclusions The SwedeHF is a valuable tool for improving the management of patients with HF, since it enables participating centers to focus on their own potential for improving diagnoses and medical treatment, through the online reports (Paper I). Anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity (II, III). The influence of anemia on mortality was significantly greater in younger patients in men and in those with more stable HF (Paper II, III). The usefulness of EQ--‐5D is dependent on the analytical method used. While the index showed minor differences between groups, analyses of specific dimensions showed different patterns of change in the two groups of patients (HFpEF and HFrEF). The Paretian classification identified subgroups that improved or worsened, and can therefore help to identify needs for improvement in health services (Paper IV).

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Galil, Arise Garcia de Siqueira. "Prevalência de anemia e doença renal crônica em portadores de insuficiência cardíaca sistólica num ambulatório de hipertensos e diabéticos." Universidade Federal de Juiz de Fora (UFJF), 2008. https://repositorio.ufjf.br/jspui/handle/ufjf/2837.

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Introdução: A insuficiência cardíaca (IC) tem alta morbimortalidade que decorre de fatores causais e refratariedade ao tratamento. A doença renal crônica (DRC) e a anemia têm se associado a pior prognóstico em pacientes com IC grave, especialmente os hospitalizados. Há, porém, poucos estudos que avaliem a prevalência e as conseqüências da DRC e da anemia em pacientes com IC acompanhados ambulatorialmente. Objetivos: Avaliar a prevalência da DRC e anemia e o impacto de desfechos cardiovasculares em portadores de IC sistólica estágios B e C. Pacientes e Métodos: Foram estudados pacientes adultos, com idade >18 anos e diagnóstico de IC sistólica e com fração de ejeção (EF) ≤45%, selecionados do ambulatório do Serviço de Hipertensão, Diabetes e Obesidade do SUS de Juiz de Fora e acompanhados por 12 meses. A anemia foi definida como hemoglobina <12,0g/dl nas mulheres e <13,0g/dl nos homens. A reserva de ferro foi considerada adequada quando índice de saturação da transferrina encontrava-se ≥20% e a ferritina ≥100ηg/dl. A filtração glomerular foi estimada pela fórmula do estudo MDRD e a DRC foi definida como proposto pelo K/DOQI da National Kidney Foundation americana. Considerou-se com desfechos cardiovasculares (CV) a ocorrência de hospitalização e/ou morte decorrente da IC. Os dados demográficos, de exame físico e laboratorial foram obtidos do prontuário dos pacientes. Resultados: Foram avaliados 83 pacientes, com idade média de 62,7±12 anos, sendo 56,6% do sexo feminino. A média da fração de ejeção (FE) foi de 37,8+7,9% e a maioria dos indivíduos (60,2%) estava no estágio C. A prevalência de anemia foi de 24,09%; 30,30% no estágio B e 20% no estágio C. A prevalência de DRC foi elevada, presente em 49,4% da amostra, 42,4% no estágio B da IC e 54% no estágio C. Todos os pacientes com anemia tinham reserva de ferro normal e 68,6% apresentavam DRC concomitante. Os desfechos CV ocorreram em 26,5% da amostra. Na estratificação dos pacientes nos estágios B e C da IC e presença ou não de DRC, evidenciou que 100% e 64,7% apresentaram desfechos, respectivamente. Na análise multivariada, após ajustes para fatores prognósticos no período basal, o diagnóstico de DRC aumentou em 3,6 vezes a possibilidade de desfechos (IC 95%1,04-12,67, p=0,04), enquanto os níveis mais elevados de sódio sérico (R 0,807, IC95%0,862-0,992, p=0,03) e da fração de ejeção (R 0,925, IC95% 0,862-0,942, p= 0,03) se mostraram protetores. Conclusão: Na coorte de pacientes estudada, composta de pacientes com IC estágios B e C, a ocorrência de anemia foi compatível com a observada em outros estudos e com tendência de se associar com menor filtração glomerular. A DRC foi prevalente e independentemente se associou a maior risco de hospitalizações e mortes secundárias à descompensação cardíaca, especialmente nos pacientes assintomáticos.
Introduction: Chronic heart failure (CHF) has a high morbidity and mortality which are consequent to etiologic factors and no response to treatment. Anemia and chronic kidney disease (CKD) have been associated to worse outcome in patients with severe hospitalized CHF. So far, there is few studies that assessed the prevalence and the consequences of anemia and CKD in outpatients with CHF. Aim: To study the prevalence of CKD and anemia and the impact of CV end points in patients with systolic CHF followed in an outpatient clinic. Methods: This is prospective cohort study, dealing with adult patients older than 18 years of age and diagnosis of systolic CHF and ejection fraction (EF) ≤45%, selected from the Hypertension, Diabetes and Obesity Outpatient Clinic of SUS of Juiz de Fora. Anemia was defined as hemoglobin <12,0g/dL in women and <13g/dL in men and women after the menopause. Normal iron store was defined when transferring saturation index was >20% and/or ferritin >100ηg/dL. The glomerular filtration rate was estimated from serum creatinine usinf the MDRD study formula, and CKD was defined as suggested by the K/DOQI of National Kidney Foundation. CV endpoints were defined as death or hospitalization due to CHF, in 12 months follow up. Demographic and clinical date were obtained from the patients’ charts. Results: Eight three patients were studied, the mean age was 62.7±12 years, and 56.6% were female. The EF was 37,8+7,9%, and the majority of the patients had stage C CHF (60,2%). The prevalence of anemia was 24,1%; 30,3% in stage B and 50% in stage C. CKD was diagnosed in 49.4% of the patients, 42,4% of the stage B and 54% in the stage C. All patients with anemia had normal iron storage, and 68,6% had concomitant CKD. Cardiovascular endpoints were observed in 26.5% of the patients. When the sample was stratified in stages B and C of CHF and presence or absence of CKD, it was found that 100% and 64.7% had CV endpoints, respectively. After adjustments for all other prognostic factors at baseline, it was observed that the diagnosis of CKD increased in 3.6 folds the hazard of CV endpoints (CI 95% 1,04-12,67, p=0,04), whereas higher ejection fraction (R 0,925, IC 95% 0,862-0,942, p= 0,03) and serum sodium (R 0,807, IC 95% 0,862-0,992, p=0,03) were protectors. Conclusion: In this cohort of outpatients with CHF stages B and C, the occurrence of anemia was low and frequently associated with concomitant CKD. On the other hand, CKD was prevalent and independently associated with heightened risk for hospitalization and death secondary of cardiovascular causes, mainly in asymptomatic patients.

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Thong, Cao Huy. "The plasma proteome and outcome in patients with heart failure." Thesis, University of Leicester, 2015. http://hdl.handle.net/2381/32453.

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Heart failure is a complex clinical syndrome that occurs at the end stage of heart disease with high costs and poor outcomes. Despite advances in therapy, improving clinical outcomes remains a challenge for physicians with 50% of patients dying within 5 years. The main aim of this study was to discover novel biomarkers in plasma that could predict treatment response in patients with heart failure using plasma proteomics. The use of two dimensional liquid chromatography coupled to electrospray ionisation tandem mass spectrometry in high definition ion mobility combined with a multiple affinity removal system column and immunoluminometric assay discovered CD180 antigen, Heat shock 70 kDa protein 4L, Leukemia inhibitory factor receptor and Neurotrimin as novel biomarkers which are able to predict treatment response in patients with heart failure. Moreover, Thyroid receptor interacting protein 11, Patatin like phospholipase domain containing protein 2 and Mannan binding lectin serine protease 2 were identified as novel biomarkers for prediction of death in patients with heart failure. Furthermore, two multiple biomarker models were developed from the findings obtained of using matrix assisted laser desorption ionisation mass spectrometry combined with C18 solid phase extraction which are able to predict treatment response in patients with heart failure. The model with seven peptide peaks showed an excellent area under the receiver operating characteristic curve (AUC) of 0.907. In particular, the model with seventeen peptide peaks achieved the maximum AUC of 1.000 (100% sensitivity and 100% specificity). The discovery of novel biomarkers in this study not only adds information to understand the pathophysiological mechanisms of heart failure better, but also may provide a more accurate prediction of treatment response to guide medical therapy. This may enable the practice of stratified medicine in the future. Moreover, novel therapeutic targets could be identified for design of new drugs to improve outcomes.

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Subramanyan, Nandhini, and Ranjani Subramanyan. "Patient data representation for outcome prediction of congestive heart failure patients." Thesis, Högskolan i Halmstad, CAISR Centrum för tillämpade intelligenta system (IS-lab), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-40818.

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Artificial Intelligence (AI) has its roots in every field in present scenario. Healthcare is one of the sectors where AI is reaching considerable growth in recent years. Tremendous increase in healthcare data availability and considerable growth in big data analytic methods has paved way for success of AI in healthcare and research is being driven towards improvement in quality of service. Healthcare data is stored in the form of Electronic Health Records (EHR) which consists of temporally ordered patient information. There are many challenges with EHR data like heterogeneity, missing values, biases, noise, temporality etc. This master thesis focuses on addressing the problem of visit level irregularity which refers to irregular timing between events (patient’s visits).

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Bhatt, Digant V. "Race/Ethnicity: Is it an Outcome Predictor in Patients with Heart Failure?" Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/118.

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Objective: The aim of this study was to determine the role of race as a significant risk factor for prediction of outcomes in heart failure (HF). Methods: The data was collected on demographics, detailed history of HF, family history, vital signs, medication and laboratory profile for 585 patients from Heart failure Treatment Center of Emory University after year of 2000. Outcome of HF was defined as combination of death, placement of left ventricular assisted devise, heart transplant or emergency transplant. The independent relationship between race and outcomes of HF was evaluated by univariate and multivariate logistic regression analyses. The survival analysis was done by Cox regression modeling. Results: Among 585 HF patients, 58.1% were whites and 41.9% were blacks and 28.2% HF patients had positive outcomes. Although Whites tended to have a more positive outcome (34.6%) than blacks (28.9%), the difference was not statistically significant. Factors predicting the outcome in whites were male gender (OR 5.02), history of hypertension (OR 2.3), ventricular arrhythmias (OR 2.4), placement of AICD(OR 0.09), low EF% (OR 0.95), high NYHA class (OR 3.25), use of beta blockers (OR 0.12), aldosterone blockers (OR 2.19), furosemide (2.18); while in blacks they were age in years (OR 0.96), history of PTCA (OR 7.04), dislipidemia (OR 3.90), depression (OR 0.01), placement of AICD (OR 0.14), low EF% (OR 0.92), systolic blood pressure (OR 0.96), high NYHA class (OR 4.01), use of beta blockers (OR 0.14), torsemide (OR 2.86), and digoxin (OR 4.91) etc. Blacks had higher survival than whites (p < 0.001). Conclusion: There is no significant difference in combined outcome (death, transplant, emergency transplant, and Left Ventricular Assisted Devise placement) of HF between whites and blacks. There are differences regarding the risk factors, which are more prominent in each race. Further exploration is required to evaluate the race as significant risk factor for predicting the outcome in HF.

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Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

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Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2007. http://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

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Conic, Rosalynn Ruzica Zoran. "USING PSORIASIS AS A MODEL TO IDENTIFY UNIQUE BIOMARKERS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1554485554569272.

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Azzolin, Karina de Oliveira. "Efetividade da implementação das intervenções de enfermagem nos resultados esperados de pacientes com insuficiência cardíaca em cuidado domiciliar." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/34808.

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A estabilidade clínica de pacientes com insuficiência cardíaca (IC) ainda é um desafio para equipe de saúde, pois as elevadas taxas de descompensação da doença são frequentes e, assim, requerem maiores investimentos no avanço de protocolos de cuidados. Na área da enfermagem, verifica-se que intervenções específicas ainda não foram adequadamente estudadas, principalmente dentro de um referencial teórico próprio, como as classificações NANDA-I-NIC-NOC. O objetivo deste estudo é avaliar a efetividade da implementação de intervenções e atividades, por meio dos resultados, a pacientes com insuficiência cardíaca sob cuidado domiciliar, acompanhados por quatro visitas no período de seis meses. O estudo foi conduzido em duas etapas metodológicas distintas. A primeira teve como método a validação por consenso entre especialistas, para formulação de um protocolo de pesquisa, com os diagnósticos, as intervenções e os resultados de enfermagem, utilizados na segunda etapa do estudo. Nessa etapa, desenvolveu-se um estudo de coorte prospectivo, aninhado a um Ensaio Clínico Randomizado (ECR). A amostra constituiu-se de pacientes com insuficiência cardíaca descompensada, com fração de ejeção ≤ 45%, participantes do grupo intervenção do ECR, procedentes de duas instituições de Porto Alegre, no período de abril de 2010 a março de 2011. Os pacientes foram acompanhados durante seis meses e receberam quatro visitas domiciliares. Durante a avaliação clínica, estabeleceram-se os diagnósticos, mensuraram-se os resultados e implementaram-se as intervenções de enfermagem. O consenso entre as especialistas selecionou seis diagnósticos, 11 intervenções, com 89 atividades, e oito resultados com 44 indicadores. A coorte de 23 pacientes teve a maioria do sexo masculino 15(65%), com idade média de 63 ± 11 anos; 30,4% já haviam tido pelo menos uma internação no último ano. Dentre os diagnósticos selecionados, Autocontrole Ineficaz da Saúde, Volume de Líquidos Excessivo e Risco de Desequilíbrio do Volume de Líquidos foram os mais prevalentes na primeira visita domiciliar. Disposição para Controle Aumentado do Regime Terapêutico e Risco para Desequilíbrio de Líquidos foram mais frequentes na quarta visita. A maioria das intervenções selecionadas foi no domínio Comportamental: Ensino: Processo de Doença; Ensino: Medicamentos Prescritos; Modificação de Comportamento; Educação para Saúde; Assistência na Automodificação; Aconselhamento Nutricional; Promoção do Envolvimento Familiar; Mobilização Familiar; Controle de Energia; Monitoração Hídrica; e Consulta por Telefone. Dentre os resultados avaliados, Conhecimento: Regime de Tratamento; Comportamento de Aceitação; Conhecimento: Medicação; Controle dos Sintomas; Tolerância à Atividade; e Conservação de Energia apresentaram aumento significativo nos escores, quando comparadas as médias dos resultados da VD1 e VD4. Os resultados Equilíbrio Hídrico e Participação Familiar no Cuidado Profissional não demonstraram diferenças estatisticamente significativas. As médias dos resultados Equilíbrio Hídrico e Conservação de Energia, na VD1, foram associadas significativamente aos desfechos de reinternações e atendimentos de emergência (P = 0,041 e P = 0,020). Conclui-se que, dentre as 11 intervenções de enfermagem implementadas aos pacientes, oito foram consideradas efetivas, tendo-se como base a avaliação dos seis resultados que apontaram melhora significativa na comparação entre as médias da VD1 e VD4.
Clinical stability in heart failure (HF) patients is a challenge for health care team, because increased rates of decompensation are frequent, thus requiring more investments for the advancement of care protocols. In Nursing, specific interventions have not been properly studied, especially considering a proper theoretical framework, such as NANDA-I-NIC-NOC classifications. The objective of this study is to evaluate, through outcomes, the effectiveness of the implementation of interventions and activities in patients with heart failure under home based interventions, accompanied by four visits in a six-month period. The study was conducted through two distinct methodological steps. The first step was consisted of the validation through a consensus of experts for the formulation of a research protocol, with nursing diagnoses, interventions and outcomes used in the second step of this study. In this phase, a prospective cohort study, nested in a randomized clinical trial (RCT). The sample was composed of patients with decompensated heart failure, with ejection fraction of ≤45%, participants of the intervention group in the RCT, from two institutions in Porto Alegre, from April 2010 to March 2011. The patients were followed for six months and received four home based interventions. During clinical evaluation, diagnoses were established, results were measured and nursing interventions were implemented. The experts’ consensus selected six diagnoses, 11 interventions, with 89 activities, and eight results with 44 indicators. The cohort of 23 patients, received a total of 87 visits, had the majority of male 15 (65%), with mean age 63 ± 11; 30.4% was hospitalized at least once during the last year. Amongst the selected diagnoses, Ineffective Self health Management, Excess Fluid Volume and Risk for Imbalance Fluid Volume were the most prevalent in the first home based intervention. Readiness for Enhanced Self health Management and Risk for Imbalance Fluid Volume were the most frequent in the fourth home based intervention. The majority of interventions selected were from the behavior domain: Teaching: Disease Process; Teaching: Prescribed Medication; Behavior Modification; Health Education; Self-Modification Assistance; Nutrition Counseling; Family Involvement Promotion; Family Coping; Energy Management; Hydric Balances; and Telephone Triage. Amongst the results evaluated, Knowledge: Treatment Regimen; Behavior of Acceptance; Knowledge: Medication; Symptoms Management; Activity Tolerance; and Energy Conservation were the ones to present a significant increase in scores when compared to the average found for outcomes of VD1 and VD4. The outcomes HydricBalance and Family Coping with Professional Care did not demonstrate statistically significant differences. The average for the outcomes for Hydric Balance and Energy Conservation in VD 1 were significantly associated with the endings of readmissions and emergency care (P = 0.041 and P = 0.020). It was possible to conclude that, amongst the 11 nursing interventions implemented, eight were considered effective, having as basis the evaluation of six outcomes that pointed to a significant improvement when comparing the averages of VD 1 and VD 4.
La estabilidad clínica de los pacientes con insuficiencia cardíaca (IC) sigue siendo un reto para el personal de salud, debido las altas tasas de descompensación de la enfermedad son frecuentes e por lo tanto requieren más inversión en el avance de los protocolos de atención. En el área de enfermería, hay intervenciones específicas que no fueron adecuadamente estudiadas, sobre todo dentro de un marco teórico propio, como las clasificaciones NANDAI- NIC-NOC. El objetivo de este estudio es evaluar la eficacia de implementación de intervenciones y actividades, por los resultados, en pacientes con insuficiencia cardíaca en atención domiciliaria, acompañada de cuatro visitas en seis meses. El estudio fue realizado en dos pasos metodológicos distintos. El primero fue la validación por consenso entre los expertos, para formulación de un protocolo de investigación, con los diagnósticos, las intervenciones y los resultados de enfermería, utilizados en la segunda etapa del estudio. En esta etapa, se desarrolló un estudio prospectivo de cohorte, anidado en un ensayo clínico aleatorizado (ECA). La muestra consistió de pacientes con insuficiencia cardíaca descompensada, con fracción de eyección ≤45%, participantes del grupo intervención del ECA, provenientes de dos instituciones de Porto Alegre, en el período abril 2010 - marzo 2011. Los pacientes fueron seguidos durante seis meses y recibieron cuatro visitas domiciliarias. En la evaluación clínica se establecieron los diagnósticos, se mensuró los resultados e implementó las intervenciones de enfermería. El consenso entre los expertos seleccionó seis diagnósticos, 11 intervenciones con 89 actividades y ocho resultados con 44 indicadores. La cohorte de 23 pacientes, recibió um total de 87 visitas, tenía la mayoría hombres 15(65%), con edad media de 63 ±11 años; 30,4% ya habían tenido al menos una hospitalización en el último año. Entre los diagnósticos seleccionados, Auto Controle Ineficaz de la Salud, Volumen de Líquidos Excesivo y Riesco de Desequilibrio del Volumen de Líquidos fueron los más frecuentes en la primera visita domiciliaria. Disposición para Controle del Régimen Terapéutico y Riesco de Desequilibrio del Volumen de Líquidos fueron más frecuentes en la cuarta visita. La mayoría de intervenciones seleccionadas fue en el dominio de la conducta; Enseñanza: Proceso de Enfermedad; Enseñanza: Medicamentos recetados, Modificación de Comportamiento, Educación para Salud y Asistencia en Auto Modificación. Además, Asesoramiento Nutricional, Promoción de la Participación Familiar, Movilización Familiar, Control de Energía, Supervisión del agua y Consulta por Teléfono. Entre los resultados evaluados: Conocimiento del Régimen del Tratamiento, Comportamiento de Aceptación, Conocimiento: Medicación; Controle del Síntomas; Tolerancia a Actividad y Conservación de Energía, presentaron aumento significativo en las puntuaciones, al comparar las medias de los resultados de VD1 e VD4. Los resultados del Balance Hídrico y Participación Familiar en el Cuidado Profesional no mostraron diferencias estadísticamente significativas. Las medias de resultados del Balance Hídrico y Conservación de Energía, en VD1, fueron asociadas significativamente a los resultados de readmisiones y atendimientos de emergencia (P=0,041 e P=0,020). Concluye que entre las 11 intervenciones de enfermaría aplicados a los pacientes, ocho se consideró efectivas, tomando como base la evaluación de seis resultados que mostraron mejoría significativa en la comparación entre las medias da VD1 e VD4.

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Champ-Rigot, Laure. "Nouvelles perspectives diagnostiques et thérapeutiques dans la prise en charge rythmologique des patients en situation d'insuffisance cardiaque Rationale and Design for a Monocentric Prospective Study: Sleep Apnea Diagnosis Using a Novel Pacemaker Algorithm and Link With Aldosterone Plasma Level in Patients Presenting With Diastolic Dysfunction (SAPAAD Study) Usefulness of sleep apnea monitoring by pacemaker sensor in elderly patients with diastolic dysfunction : the SAPAAD Study Clinical outcomes after primary prevention defibrillator implantation are better predicted when the left ventricular ejection fraction is assessed by magnetic resonance imaging Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study Comparison between novel and standard high-density 3D electro-anatomical mapping systems for ablation of atrial tachycardia Safety and acute results of ultra-high density mapping to guide catheter ablation of atrial arrhythmias in heart failure patients Long-term clinical outcomes after catheter ablation of atrial arrhythmias guided by ultra-high density mapping system in heart failure patients." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC430.

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L’insuffisance cardiaque est un problème de santé publique dans les pays développés, touchant 1 à 2% de la population générale, mais dont la prévalence atteint 10% après 70 ans. Les progrès thérapeutiques ont permis d’améliorer le pronostic des patients, notamment ceux ayant une altération de la fonction systolique ventriculaire gauche. Les troubles du rythme sont fréquents et nécessitent une pris en charge particulière au cours des situations d’insuffisance cardiaque. Cependant, il reste des questions non résolues : comment améliorer l’efficacité du traitement de l’insuffisance cardiaque à fonction systolique préservée, comment mieux sélectionner les patients pouvant bénéficier de la prévention primaire de la mort subite par un défibrillateur implantable, les patients âgés peuvent-ils bénéficier de la même prise en charge que les patients plus jeunes, et pour finir comment améliorer les résultats de l’ablation de fibrillation auriculaire dans les situations d’insuffisance cardiaque. Nous avons mis en place une étude prospective chez des patients présentant une dysfonction diastolique pour évaluer l’intérêt de l’algorithme de surveillance de l’apnée du sommeil disponible dans des stimulateurs cardiaques. En parallèle, nous avons analysé l’impact de l’évaluation par résonance magnétique des patients candidats à un défibrillateur sur la prédiction des évènements rythmiques, mais aussi le devenir des patients de plus de 75 ans appareillés avec un système de resynchronisation cardiaque. Enfin, nous nous sommes intéressés aux résultats d’un nouveau système de cartographie électroanatomique ultra-haute densité pour guider les procédures d’ablation de troubles du rythme supraventriculaires complexes chez des patients insuffisants cardiaques comparés à des patients contrôles
Heart failure is a major public health issue in developed countries, with a prevalence of 1-2% of global population, rising to 10% after 70 years of age. Therapeutic progresses have succeeded in improving patients’ prognosis, particularly in case of reduced left ventricular ejection fraction. Rhythm abnormalities are frequent, and need special consideration in case of heart failure. Meanwhile, there are still some gaps in the evidence: heart failure with preserved systolic function is complex and difficult to treat, primary prevention of sudden cardiac death is effective but there is a need to better select candidates, whether elderly patients should be treated as younger individuals, and finally how to improve outcomes of atrial fibrillation catheter ablation. Firstly, we have conducted a prospective study to evaluate the Sleep Apnea Monitoring algorithm provided in a novel pacemaker in patients with diastolic dysfunction. Besides, we analyzed whether magnetic resonance imaging could predict cardiac outcomes in patients with an implantable cardioverter defibrillator better than echocardiography. We also reported the outcomes of the cardiac resynchronization therapy in patients ≥75 years old compared to younger patients. Finally, we studied the results of a novel ultra-high density mapping system to guide ablation procedures of complex atrial arrhythmias in heart failure patients compared to controls

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Souza, Rosana Oliveira de. "Definições operacionais para o resultado de enfermagem "eficácia da bomba cardíaca" - subsídios para a construção de um instrumento." Universidade Federal Fluminense, 2012. https://app.uff.br/riuff/handle/1/1230.

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Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-21T15:54:58Z No. of bitstreams: 1 Rosana Oliveira de Souza.pdf: 2044355 bytes, checksum: ccc3df1943bafae792327e6deea939e4 (MD5)
Made available in DSpace on 2015-12-21T15:54:58Z (GMT). No. of bitstreams: 1 Rosana Oliveira de Souza.pdf: 2044355 bytes, checksum: ccc3df1943bafae792327e6deea939e4 (MD5) Previous issue date: 2012
Mestrado Profissional em Enfermagem Assistencial
O avanço da ciência e da tecnologia proporcionou um aumento na longevidade da população e, conseqüentemente, um aumento da prevalência das doenças crônicas. Dentre estas doenças, a insuficiência cardíaca é a que acarreta um dos maiores gastos para o Sistema Único de Saúde. Desta forma, faz-se necessário o monitoramento destes pacientes para que se evitem os quadros de descompensação e possíveis internações hospitalares. Na área da enfermagem verifica-se que intervenções adequadas devem ser implementadas à busca de resultados para estes pacientes. Este estudo teve como objetivo construir um instrumento de monitoramento e avaliação para pacientes com insuficiência cardíaca a partir dos indicadores do resultado de enfermagem Eficácia da Bomba Cardíaca e elaborar definições operacionais para estes indicadores. Foi utilizado o método de revisão integrativa com metassumarização. Para o desenvolvimento das definições operacionais utilizou-se como referencial teórico as estratégias propostas pela Análise de Conceito. A amostra foi constituída por produções científicas que abordaram sobre a temática em estudo em um recorte temporal dos últimos cinco anos, nas línguas portuguesa, inglesa e espanhola. Os indicadores propostos pelo resultado de enfermagem Eficácia da Bomba Cardíaca que puderam ser confirmados pela presente pesquisa foram os seguintes: Pressão arterial sistólica, Pressão arterial diastólica, Frequência cardíaca apical, Índice cardíaco, Fração de ejeção cardíaca, Pulsos periféricos, Tamanho do coração, Débito de urina, Pressão venosa central, Equilíbrio entre ingestão e eliminação nas 24 horas, Estase de jugular, Disritmia, Sons cardíacos anormais, Angina, Edema periférico, Edema pulmonar, Náusea, Fadiga, Dispneia em repouso, Dispneia com esforço leve e Aumento de peso. Novos indicadores foram observados como Ansiedade, depressão, Autocuidado, apoio Familiar e Adesão ao Tratamento. É de suma importância destacar que os indicadores Rubor, Cianose e Diaforese não foram citados na literatura, e por este motivo, não foram inclusos no instrumento de monitoramento destes pacientes. Espera-se que o resultado deste estudo contribua para a produção de novos conhecimentos sobre a Sistematização da Assistência da Enfermagem direcionada ao paciente com insuficiência cardíaca à medida que traz à tona melhores evidencias acerca do resultado de Enfermagem Eficácia de Bomba Cardíaca, possibilitando com isso, a utilização de uma linguagem padronizada que valoriza o contexto de saúde e a práxis da enfermagem, além de nortear a tomada de decisão clínica pelo enfermeiro.
The advancement of science and technology has brought an increase in longevity and, consequently, an increased prevalence of chronic diseases. Among these diseases, heart failure causes one of the higher expenses for the Unified Health System. Thus, it’s necessary to monitor these patients to avoid decompensation and possible hospitalizations. In the nursing area, it appears that proper interventions should be implemented to the search of results for these patients. This study aims to build a tool for monitoring and evaluation for the patients with heart failure from the outcome indicators of Nursing Outcomes Effectiveness of Cardiac Pump Classifications found in nursing literature and develop operational definitions of the indicators of the outcome of nursing Effectiveness of Cardiac Pump. It is an exploratory, descriptive, quantitative and qualitative approach. The sample consists of scientific productions that addresses on the topic under study in a time frame of five years. It was used as a theoretical and methodological referential the concept analysis and the analysis of lexical co-occurrences. It’s hoped that the results of this study contributes to the production of new knowledge about the Nursing Care System targeted to patients with heart failure as it brings out the best evidence about the outcome Nursing Effectiveness of Cardiac Pump, allowing thus, the use of a standardized language that enhances the health context and practice of nursing and guides clinical decision making by nurses.

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Vánky, Farkas. "Surgery for aortic stenosis : with special reference to myocardial metabolism, postoperative heart failure and long-term outcome." Doctoral thesis, Linköpings universitet, Thoraxkirurgi, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7471.

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Postoperative heart failure (PHF) remains a major determinant of the outcome after cardiac surgery. However, characteristics of and risk factors for PHF after valve surgery have received little attention. Post-ischaemic disturbances of myocardial metabolism that may contribute to PHF and are amenable to metabolic treatment have been identified early after coronary surgery (CABG). Knowledge derived from these studies may not be applicable to other patient groups. We therefore studied myocardial energy metabolism in 20 elective patients undergoing aortic valve replacement (AVR) for isolated aortic stenosis (AS). The metabolic studies indicated that myocardial oxidative metabolism had not fully recovered when the procedure was completed. Free fatty acids were the only major substrates taken up by the heart. Signs of preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously demonstrated in patients with coronary artery disease, were found. Postoperative infusion of glutamate, (2 mL/kg body weight and hour of 0.125 M solution) based on assessment of myocardial glutamate requirements in CABG patients, resulted in a two-fold increase in myocardial glutamate uptake and a seven-fold increase in AV differences across the leg. This was associated with a significant myocardial uptake of lactate and metabolic changes in the leg suggesting mitigation of net amino acid loss and peripheral tissue lipolysis. Characteristics of and risk factors for PHF were evaluated in 398 patients undergoing isolated AVR for AS from 1 January 1995 to 31 December 2000. These were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients fulfilled criteria for PHF and these were studied in detail. PHF usually presented at weaning from cardiopulmonary bypass. After CABG it was closely associated with preoperative ischaemic events and intraoperatively acquired myocardial infarction. Potential causes and eliciting events of PHF after AVR for AS were obvious only in one-third of the patients. Risk factors for PHF after AVR for AS indicated either pre-existing myocardial dysfunction, increased right or left ventricular after-load, or intraoperatively acquired myocardial injury. PHF was associated with high early mortality after CABG, whereas the consequences of PHF after AVR for AS became evident only with time, resulting in a 42% five-year mortality. Although PHF had a different temporal impact on late mortality after CABG and AVR for AS, it emerged as the statistically most significant risk factor for mortality occurring within 5 years from surgery both after AVR for AS and after CABG. Potential implications of our findings include needs for greater focus on preoperative surveillance of patients with AS for optimal timing of surgery, mitigation of intraoperatively acquired myocardial injury and tailoring of treatment for PHF. Furthermore, the findings have implications for long-term follow up of AS patients after surgery.

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Vánky, Farkas. "Surgery for aortic stenosis : with special reference to myocardial metabolism, postoperative heart failure and long-term outcome /." Linköping : Linköpings universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7471.

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Jones, Susan Kathleen Blackburn. "Thermal balance in patients undergoing continuous veno-venous hemodialysis (CVVHD)." Oklahoma City : [s.n.], 2002. http://library.ouhsc.edu/epub/theses/Jones-Susan-Kathleen-Blackburn.pdf.

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Babb, Ellen Burkhardt. "Oral Nutritional Supplement Use in Relation to Length of Stay in Heart Failure Patients at a Regional Medical Center." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2082.

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Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.

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Kane, Pauline. "Improving the assessment and management of symptoms and concerns in heart failure : a longitudinal study of the feasibility of a patient-reported outcome measure in clinical practice." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/improving-the-assessment-and-management-of-symptoms-and-concerns-in-heart-failure-(a6fddc35-5ed8-46a2-bd22-4f17c170853d).html.

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Background: Patients with advanced heart failure have unmet needs which are poorly identified and addressed. This study (i) explores the feasibility, acceptability and potential mechanisms of action of a palliative-specific patient-reported outcome measure (PROM)–based intervention and (ii) examines the methods to undertake this study to inform a future clinical trial. Methods: This study used a mixed methods approach. Patients with advanced heart failure and their caregivers were recruited to participate in a pre-post uncontrolled longitudinal follow-up study at nurse-led heart failure disease management clinics in two hospital study sites. Patients completed telephone administered quantitative questionnaires at baseline and at three time points post intervention (1-2 days, 1-2 weeks and 4-6 weeks respectively). Caregivers completed postal baseline assessments and a follow-up assessment 4-6 weeks post intervention completion. Descriptive statistics were used to examine both intervention feasibility and the feasibility of the quantitative follow-up assessments used to evaluate the intervention. Intervention compliance and adherence, together with follow-up assessments response rates were examined. Qualitative semi-structured interviews with patients and nurses explored the acceptability and potential mechanisms of action of this intervention. Semi-structured interviews were analysed using framework approach and interpreted in the context of the longitudinal data. Results: Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). Recruitment of patients was challenging due to intra-site subjectivity of the New York Heart Association functional classification system. Twenty five (66%) patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (due to non-response). Over two thirds (65.6%) of these missing items related to just three patients. No single item was consistently missing; appetite was the most frequently missing item (1.4%). Twenty-three (92%) patients who completed the IPOS completed all follow-up assessments with no missing data. The a priori feasibility objectives were achieved. In the semi-structured interviews, patients and nurses reported the intervention and follow-up assessments were feasible and acceptable. The potential mechanism of the intervention involved: the identification of patient participants’ unmet needs; a holistic assessment of their symptoms and concerns; and patient empowerment. Patient participants stated they felt empowered as they described themselves as being more knowledgable and aware of their symptoms and concerns, whilst being better able to articulate these in the clinical consultation. They described these skills as helping them feel more enabled to take a more active role in clinical discussions about their heart failure. Conclusion: This research study tested this intervention and methods among patients with advanced heart failure for the first time. Both the methods used and the intervention were found to be feasible and acceptable. This research provides valuable insights into the challenges in conducting PROM research in this population. This work also gives novel insights into the mechanism of action of PROMs, particularly in palliative care.

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Dissertations / Theses on the topic 'Heart failure outcomes'

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