scholarly journals Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047060
Author(s):  
Rosalynn C Austin ◽  
Lisette Schoonhoven ◽  
Mike Clancy ◽  
Alison Richardson ◽  
Paul R Kalra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Lived Experience ◽  
Self Care ◽  
Eligibility Criteria ◽  
External Resources ◽  
Burden Of Treatment ◽  
Registration Number ◽  
Patients Experience ◽  
Experience Of Illness

ObjectiveExplore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients’ experience of illness.DesignReview of qualitative research studies.Data sourcesCINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020.Eligibility CriteriaJournal articles in English, reporting qualitative studies on lived experience of CHF.Results35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms’ interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient’s capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients’ lives.ConclusionsSymptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients’ efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients’ capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient’s agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population.PROSPERO registration numberCRD42017077487.

Patients’ experience with heart failure treatment and self‐care—A qualitative study exploring the burden of treatment

2019 ◽  
Vol 28 (9-10) ◽  
pp. 1782-1793 ◽  
Author(s):  
Oda Karin Nordfonn ◽  
Ingvild Margreta Morken ◽  
Lars Edvin Bru ◽  
Anne Marie Lunde Husebø
Keyword(s):  
Heart Failure ◽  
Qualitative Study ◽  
Self Care ◽  
Heart Failure Treatment ◽  
Burden Of Treatment ◽  
Failure Treatment ◽  
Patients Experience

scholarly journals A qualitative, grounded theory exploration of the determinants of self-care behavior among Indian patients with a lived experience of chronic heart failure

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245659
Author(s):  
Deepak Y. Kamath ◽  
K. B. Bhuvana ◽  
Luke Joshua Salazar ◽  
Kiron Varghese ◽  
Anant Kamath ◽  
...  
Keyword(s):  
Heart Failure ◽  
Grounded Theory ◽  
Chronic Heart Failure ◽  
Lived Experience ◽  
Treatment Adherence ◽  
South Asian ◽  
Self Care ◽  
The Self ◽  
Care Process ◽  
Asian Patients

Background Prior reports have documented extremely poor adherence to evidence-based medications among South Asian patients with established chronic cardiovascular diseases. Treatment adherence is now considered a part of the ‘self-care’ process, the determinants of which have not been adequately explored or explained among South Asian patients with chronic heart failure (CHF). Our objective was to qualitatively ascertain the determinants of the self-care process among Indian patients with a lived experience of heart failure. Methods We conducted in-depth interviews (audio-recorded) among 22 purposively sampled patients living with chronic heart failure, diagnosed at least 4 weeks prior to the interview and 17 caregivers (n = 39) in a tertiary care teaching hospital in Southern India. We employed an inductive analytical approach using Charmaz’s constructivist grounded theory. Initial line-by-line coding and categorization was followed by memo writing, reflexive analysis after interviewing and analyzing four, eight and twelve patients, and at each stage further theoretical sampling was carried out until we reached thematic saturation. We used NVivo ver. 12 to analyze and organize data. Results The mean age of our patients was 61 years and they represented 5 Indian states and spoke seven languages, distributed across socio-economic strata and literacy levels. We classified self-care determinants into 3 broad, simple categories and defined underlying themes namely, negative determinants (passivity, entrenched beliefs, negative affect, lack of knowledge, financial difficulties, and fatalism), intermediate factors (patient expectations, provider/hospital hopping) and facilitators or positive self-care determinants (intrinsic and extrinsic facilitators). Gender and the cultural background of patients’ upbringing appear to shape these determinants, thereby affecting self-care decision making in chronic heart failure. Conclusion We have empirically described a unique set of self-care determinants among Indian chronic heart failure patients, which in turn are shaped by economic and socio-cultural factors. Assessing for and addressing these determinants during clinical interactions through multi-factorial approaches may help improve self-care among Indian CHF patients, thus improving treatment adherence and clinical outcomes.

Association between self-care and prognosis in 1123 patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Calero ◽  
E Hidalgo ◽  
R Marin ◽  
L Rosenfeld ◽  
I Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
Nyha Class ◽  
Self Care ◽  
P Value ◽  
Funding Source ◽  
Class Iii ◽  
Cox Models ◽  
Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

scholarly journals Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021966 ◽  
Author(s):  
Federica Dellafiore ◽  
Cristina Arrigoni ◽  
Francesco Pittella ◽  
Gianluca Conte ◽  
Arianna Magon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Chronic Heart Failure ◽  
Real World ◽  
Self Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Caregiver Relationship

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort’s demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients’ discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients’ self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

scholarly journals Self-care behaviors and related factors in chronic heart failure patients

2018 ◽  
Vol 1 (1) ◽  
pp. 42-47
Author(s):  
Mohammad Iraj Bagheri –Saweh ◽  
Asrin Lotfi ◽  
Shahnaz Salawati Ghasemi
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Self Care ◽  
Related Factors ◽  
Heart Failure Patients

Self Care Behaviors among Elderly with Chronic Heart Failure and Related Factors

2014 ◽  
Vol 17 (11) ◽  
pp. 1161-1169 ◽  
Author(s):  
Ahmad-Ali Akbari Kamrani ◽  
Mahshid Foroughan ◽  
Zohreh Taraghi ◽  
Jamshid Yazdani ◽  
Ali-reza Kaldi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Self Care ◽  
Related Factors

P4396Patients explanations of self-care in chronic heart failure: a grounded theory analysis of qualitative data from PANACEA-HF Phase 1

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Kamath ◽  
K B Bhuvana ◽  
L Salazar ◽  
K Varghese ◽  
S Umesh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Rural Areas ◽  
Belief Systems ◽  
Self Care ◽  
Task Sharing ◽  
Intervention Package ◽  
Heart Failure Patients ◽  
Socioeconomic Strata

Abstract Background Sub-optimal self-care and non-adherence to treatments are important predictors of poor clinical outcomes in patients with heart failure. Task-sharing and technology have each contributed modest improvements, but the combined effect on outcomes is unknown. We aim to develop a complex intervention package to improve self-care predicated on task sharing and smartphone based remote monitoring among heart failure patients. Purpose As a formative step, we conducted a qualitative study among heart failure patients and their caregivers to explore self-care and to inform the development of a contextualized intervention package. Methods We conducted in-depth interviews among 22 patients admitted to in-patient wards with a clinical diagnosis of chronic heart failure (diagnosis made at least 1 month prior to index hospitalization) and 18 caregivers (n=40), sampled from 4 states in southern India. Patients were purposively sampled based on sex, socioeconomic status, health literacy and past one month's history of adherence to heart failure medications. The middle range theory of self-care informed the drafting of the interview guide. We recorded and transcribed interviews translated from 5 regional languages. We inductively coded the data from a social constructionist viewpoint, created categories, prepared memos, compared extreme cases, identified key emergent themes and their inter-relationships. Results Patients' mean age was 60.5 (±13.4), with representation from socioeconomic strata, urban and rural areas. Patients had a high pill burden [median 10; IQR (6, 31)] and 8 (44%) reported irregular adherence to prescribed medications in the last month. Key categories associated with sub-optimal self-care included “Passivity”, “Entrenched Belief systems”, “Negative Emotions/Affect”, “Ageing causes disease”, and “inability to control situations” across all socioeconomic strata. These themes appear to impair self-actualization that negatively impacts self efficacy/confidence and in turn self-care reciprocally (Refer Figure). Key facilitators of self-care were: Intrinsic patient distinctive facilitators (situational awareness, resilience) and extraneous facilitators (insurance/financial protection, positive caregiver relationships and ease of healthcare access). Patients and caregivers generally expressed their readiness to use mobile technology for remote monitoring and to be counseled by trained lay workers to address beliefs and be trained on self-care. Framework explaining self-care in HF Conclusions Findings from this formative study show opportunities for providers and community-based care workers to address task-sharing of beliefs by educating patients on self-care, including through the use of technology-based solutions. These findings regarding a self-care framework identify opportunities to improve self-care among heart failure patients using task-sharing and technology to support the patient-caregiver-provider triad. Acknowledgement/Funding India Alliance - Wellcome Trust and Department of Biotechnology

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