scholarly journals Integrating patients with chronic respiratory disease and heart failure into a combined breathlessness rehabilitation programme: a service redesign and pilot evaluation

2021 ◽  
Vol 8 (1) ◽  
pp. e000978
Author(s):  
Emma Chaplin ◽  
Sarah Ward ◽  
Enya Daynes ◽  
Claire LA Bourne ◽  
Amy Stenson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Focus Groups ◽  
Respiratory Disease ◽  
Depression Scale ◽  
Education Programme ◽  
Chronic Respiratory Disease ◽  
Anxiety And Depression ◽  
Comorbid Disease ◽  
Walking Test ◽  
Service Redesign

IntroductionThe successful integration of patients with chronic heart failure (CHF) into a traditional pulmonary rehabilitation (PR) programme has previously been reported. Our aim was to reconfigure both our cardiac rehabilitation (CR) and PR services to enable us to deliver a symptom-based programme—breathlessness rehabilitation (BR), for patients with a primary symptom of breathlessness irrespective of the index diagnosis, or comorbid disease.MethodsAfter a service redesign process, patients attended a two times per week, group-based, tailored exercise and education programme for 6 weeks, delivered by CR and PR staff. The classes included both aerobic and resistance exercises and an overarching generic education programme alongside disease-specific components. Home programmes were reviewed at each session to facilitate progress and influence changes in exercise behaviour beyond the supervised programme. Generic clinical outcome measures were performed pre and post BR.Staff focus groups were conducted to identify barriers and facilitators and explore staff perceptions.Results272 patients (n=193 chronic respiratory disease (CRD) and n=79 CHF) were assessed and enrolled into BR (153 men, mean (SD) age 68.8 (12.7) years, body mass index 28.8 (7.3), Medical Research Council 3 (IQR 2–4), New York Heart Association 2 (IQR 2–3)). 164 patients completed the programme. Statistically significant improvements were seen in both exercise capacity (incremental shuttle walking test: mean change 47.4 m; endurance shuttle walking test: mean change 310.7 s) and quadriceps strength (quadriceps maximal voluntary contraction: mean change 3.7 kg) (p≤0.0001) alongside a statistically significant reduction in dyspnoea (chronic respiratory questionnaire/chronic heart questionnaire - self reported - dyspnoea: mean change 0.4) and anxiety and depression scores (Hospital Anxiety and Depression Scale (HADS) - anxiety: −1.6; HADS - depression: −1.3) (p≤0.0001).Qualitative staff focus groups identified three subthemes: collaboration and integration, service quality and future challenges.DiscussionOverall the service redesign indicates the feasibility for staff and individuals with CRD and CHF to integrate into a breathlessness programme. Early data suggests clinical effectiveness. Given the significance of comorbid disease it is an approach that warrants further consideration.

scholarly journals THE DETERMINATION OF DEPRESSION AND ANXIETY LEVEL IN INDIVIDUALS WITH CHRONIC HEART FAILURE

2021 ◽  
Vol 54 (1) ◽  
pp. 51-57
Author(s):  
Pelin İlhan ◽  
Sıdıka Oğuz
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Depression Scale ◽  
Anxiety Level ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Significant Difference ◽  
Anxiety Levels

Objective: This study was planned to assess the depression and anxiety level in individuals with Chronic Heart Failure (CHF). Methodology: A cross sectional study was conducted in a training and research hospital in Istanbul. The population of the study consisted of patients with CHF who stayed in the cardiology and internal medicine clinics between the months of March and June 2017. One hundred consecutive patients of CHF were included in the study. The "Hospital Anxiety and Depression Scale" (HAD) was used to assess the anxiety and depression level of the patients and other demographic and exploratory variables data was collected on a questionnaire. Results: The anxiety and depression was found in 62% and 84%, CHF patients respectively. The anxiety levels were found to be high in the individuals with no social insurance, females, primary school graduates and housewives. Also, the depression levels of the cases whose duration of disease was longer were found to be high. The anxiety levels were found to be high in the individuals with DM, with NYHA class 3-4, using diuretic and performing salt restrictions. There was no statistically significant difference between both subscales in patients with hypertension, using beta blockers or anticoagulants, and exercising. Conclusion: In our study both anxiety and depression are found to be common in patients with CHF.

scholarly journals Agreement of the mMRC and NYHA scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease

2021 ◽  
pp. 00460-2021
Author(s):  
Zainab Ahmadi ◽  
Helena Igelström ◽  
Jacob Sandberg ◽  
Josefin Sundh ◽  
Magnus Sköld ◽  
...  
Keyword(s):  
Heart Failure ◽  
Respiratory Disease ◽  
Concurrent Validity ◽  
Patient Reported Outcomes ◽  
Chronic Respiratory Disease ◽  
Chronic Obstructive ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Patient Reported ◽  
The Impact

BackgroundFunctional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale in chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale in heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.MethodsOutpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between mMRC and NYHA was analysed using Cramer's V and Kendall's Tau B. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression and health-related quality of life. Analyses were conducted in all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.ResultsIn a total of 182 participants with cardiorespiratory disease, agreement between mMRC and NYHA was moderate (Cramer's V: 0.46; Kendall's Tau B: 0.57,) with similar results in COPD (Cramer's V: 0.46; Kendall's Tau B: 0.66) and in heart failure (Cramer's V: 0.46; Kendall's Tau B: 0.67). In the total population, the scales correlated in similar ways to the other patient-reported outcomes.ConclusionIn outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

scholarly journals Associations between understanding of current treatment intent, communication with healthcare providers, preferences for invasive life-sustaining interventions and decisional conflict: results from a survey of patients with advanced heart failure in Singapore

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021688 ◽  
Author(s):  
Chetna Malhotra ◽  
David Sim ◽  
Fazlur Jaufeerally ◽  
Eric A Finkelstein
Keyword(s):  
Heart Failure ◽  
Healthcare Providers ◽  
Depression Scale ◽  
Heart Association ◽  
Current Treatment ◽  
Anxiety And Depression ◽  
Class Iii ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Intent

ObjectivesTo make informed choices about use of future invasive life-sustaining interventions (ILSI), patients with congestive heart failure (CHF) need to correctly understand the intent of their current treatments. However, healthcare providers may be wary of having these discussions due to fear of distressing patients. In this study, we assessed whether patients who understand their treatment intent are less willing to undergo ILSI and are indeed more psychologically distressed.Design, participants and outcomesAs part of a cross-sectional survey conducted prior to randomising patients for a trial, we asked 282 patients with advanced CHF (New York Heart Association Class III and IV) whether they believe their existing treatments would cure their heart condition, their willingness to undergo ILSI and assessed their anxiety and depression using the Hospital Anxiety and Depression Scale.ResultsApproximately half of patients reported a willingness to undergo ILSI if needed. Only 22% knew that their current treatments were not curative. These patients were far less willing to undergo ILSI (OR 0.28, 95% CI 0.15 to 0.56) and were not at a greater risk of having clinically significant anxiety (OR 0.72, 0.34 to 1.54) and depression (OR 0.70, 0.33 to 1.47) compared with those who did not understand their current treatment intent.ConclusionsImproving patients’ understanding of the intent of their current treatments can help patients make informed choices about ILSI.Trial registration numberNCT02299180; Pre-results.

Prognostic impact of self-reported health on clinical outcomes in patients with heart failure

2020 ◽  
Author(s):  
Anne Ankerstjerne Rasmussen ◽  
Signe Holm Larsen ◽  
Martin Jensen ◽  
Selina Kikkenborg Berg ◽  
Trine Bernholdt Rasmussen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Prognostic Impact ◽  
Depression Subscale ◽  
Continuous Scale ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

Abstract Aims An in-depth understanding of the prognostic value of patient-reported outcomes (PRO) is essential to facilitate person-centred care in heart failure (HF). This study aimed to clarify the prognostic role of subjective mental and physical health status in patients with HF. Methods and results Patients with HF were identified from the DenHeart Survey (n = 1499) and PRO data were obtained at hospital discharge, including the EuroQol five-dimensional questionnaire (EQ-5D), the HeartQoL, and the Hospital Anxiety and Depression Scale (HADS). Clinical baseline data were obtained from medical records and linked to nationwide registries with patient-level data on sociodemographics and healthcare contacts. Outcomes were all-cause and cardiovascular (CV) mortality, CV events, and HF hospitalization with 1- and 3-year follow-up. Analysing the PRO data on a continuous scale, a worse score in the following were associated with risk of all-cause and CV mortality after 1 year: the HeartQoL (adjusted hazard ratios (HRs) 1.91, 95% confidence interval (CI) 1.42–2.57 and 2.17, 95% CI 1.50–3.15, respectively), the EQ-5D (adjusted HRs 1.26, 95% CI 1.15–1.38 and 1.27, 95% CI 1.13–1.42, respectively), the HADS depression subscale (adjusted HRs 1.12, 95% CI 1.07–1.17 and 1.11, 95% CI 1.05–1.17, respectively), and the HADS anxiety subscale (adjusted HRs 1.08, 95% CI 1.03–1.13 and 1.09, 95% CI 1.04–1.15, respectively). Three-year results were overall in concordance with the 1-year results. A similar pattern was also observed for non-fatal outcomes. Conclusion Health-related quality of life and symptoms of anxiety and depression at discharge were associated with all-cause and CV mortality at 1- and 3-year follow-up.

scholarly journals Relationship between Cognitive Function, Depression/Anxiety and Functional Parameters in Patients Admitted for Congestive Heart Failure

2013 ◽  
Vol 7 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Mauro Feola ◽  
Sonia Garnero ◽  
Paola Vallauri ◽  
Luigi Salvatico ◽  
Antonello Vado ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Output ◽  
Cognitive Impairment ◽  
Plasma Level ◽  
Nyha Class ◽  
Depression Scale ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anxiety And Depression

Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters. Methods: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). Results: Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). Conclusions: in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness.

scholarly journals Kecemasan dan status gizi berhubungan dengan lama rawat inap pada pasien jantung di RSUD Jenderal Ahmad Yani, Metro, Lampung

2016 ◽  
Vol 3 (2) ◽  
pp. 98
Author(s):  
Eva Nurlindayanti ◽  
Susetyowati Susetyowati ◽  
Probosuseno Probosuseno ◽  
Retno Pangastuti
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Length Of Stay ◽  
Nutritional Status ◽  
Depression Scale ◽  
Exposed Group ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Chi Square ◽  
Heart Failure Patients

<p><strong>ABSTRACT</strong></p><p><em><strong>Background</strong>: Anxiety is one of the most common psychological problem occured in hospitality patient. The prevalence of anxiety in chronic heart failure patients was 11-45%. Anxiety in heart failure patients could worsening patient’s condition that lead to increased ischemic event, morbidity, negative effects on</em><br /><em>quality of life, and mortality. Despite anxiety, nutritional status is also one of the most important thing in mantaining patient’s health. Malnutrition has association with increased morbidity, complication, length of stay (LOS), medical therapy, and hospital fees.</em></p><p><em><strong>Objectives</strong>: To know the impact of nutritional status and anxiety on LOS in chronic heart failure patients at Jenderal Ahmad Yani General Hospital, Metro, Lampung.</em></p><p><em><strong>Methods</strong>: This was an observational quantitative study with cohort prospective design. The research was conducted on July 2014. Subjects were 70 patients who full fi lled the inclusive requirement, patients with anxiety as exposed group and patients without anxiety as non-exposed group. Anxiety was assessed</em><br /><em>with Hospital Anxiety and Depression Scale (HADS), while nutritional status was assessed by upper-arm circumference. Data were analyzed with chi-square and logistic regression test.</em></p><p><em><strong>Results</strong>: Bivariate test showed that there was significant association between anxiety with LOS (p&lt;0.05). Subjects without anxiety tended to have shorter LOS than that of with anxiety (RR=5.5). There was significant association between nutritional status and LOS (p&lt;0.05). Subjects with normal nutritional</em><br /><em>status tended to have shorter LOS than that of with undernutrition (RR=2.28). Multivariate test showed that there was an association between anxiety and LOS (p&lt;0.05) with OR=11.22.</em></p><p><em><strong>Conclusions</strong>: There was an association between anxiety and LOS. Patients without anxiety had shorter LOS than that of with anxiety. There was association between nutritional status and LOS. Patients with normal nutritional status had shorter LOS than undernutrition patients.</em></p><p><strong>KEYWORDS</strong><em>: anxiety, heart failure patients, length of stay, nutritional status</em></p><p><strong>ABSTRAK</strong></p><p><em><strong>Latar belakang</strong>: Kecemasan merupakan salah satu masalah psikologi yang banyak dialami oleh pasien di rumah sakit. Prevalensi kecemasan pada pasien gagal jantung sekitar 11-45%. Kecemasan pada penyakit jantung yang tidak teratasi dapat berakibat pada penurunan kualitas hidup pasien, peningkatan</em><br /><em>iskemik, dan kejadian masuk rumah sakit berulang yang pada akhirnya akan meningkatkan mortalitas. Selain kecemasan, status gizi juga menjadi salah satu faktor penting dalam menunjang kesehatan pasien. Malnutrisi berhubungan dengan peningkatan kesakitan, komplikasi, lama rawat inap, terapi medis, dan</em><br /><em>biaya perawatan rumah sakit. </em></p><p><em><strong>Tujuan</strong>: Mengetahui pengaruh status kecemasan dan status gizi saat masuk terhadap lama rawat inap pada pasien jantung di RSUD Jenderal Ahmad Yani, Metro, Lampung.</em></p><p><em><strong>Metode</strong>: Penelitian ini merupakan penelitian observasional kuantitatif dengan rancangan cohort prospective. Penelitian dilakukan pada bulan Juli 2014. Subjek penelitian adalah 70 pasien jantung di RSUD Jenderal Ahmad Yani Metro yang memenuhi kriteria inklusi, dengan kelompok terpapar adalah pasien jantung dengan kecemasan dan pasien jantung tanpa kecemasan sebagai kelompok tidak terpapar. Status kecemasan diukur dengan kuesioner Hospital Anxiety and Depression Scale (HADS), sedangkan status gizi diukur dengan lingkar lengan atas. Data dianalisis dengan uji chi-square dan uji regresi logistik.</em></p><p><em><strong>Hasil</strong>: Hasil uji bivariat menunjukkan adanya hubungan bermakna antara status kecemasan dengan lama rawat inap (p&lt;0,05). Subjek tanpa kecemasan cenderung memiliki lama rawat yang lebih pendek (RR=5,5). Ada hubungan yang bermakna antara status gizi dengan lama rawat inap (p&lt;0,05). Subjek</em><br /><em>dengan status gizi baik cenderung memiliki lama rawat yang lebih pendek daripada subjek dengan status gizi kurang (RR=2,28). Hasil uji multivariat menunjukkan adanya hubungan bermakna antara status kecemasan dengan lama rawat inap (p&lt;0,05) dengan nilai OR=11,22.</em></p><p><em><strong>Kesimpulan</strong>: Ada hubungan bermakna antara tingkat kecemasan dengan lama rawat inap. Pasien tanpa kecemasan memiliki lama rawat yang lebih pendek dari pada pasien jantung dengan kecemasan. Ada hubungan bermakna antara status gizi dengan lama rawat inap. Pasien jantung berstatus gizi baik memiliki lama rawat yang lebih pendek daripada pasien jantung berstatus gizi kurang.</em></p><p><strong>KATA KUNCI</strong><em>: kecemasan, pasien jantung, lama rawat, status gizi</em></p>

scholarly journals Reflexive thematic analysis exploring stakeholder experiences of virtual pulmonary rehabilitation (VIPAR)

2021 ◽  
Vol 8 (1) ◽  
pp. e000800
Author(s):  
Liam Knox ◽  
Rachel Gemine ◽  
Michelle Dunning ◽  
Keir Lewis
Keyword(s):  
Focus Groups ◽  
Lung Disease ◽  
Respiratory Disease ◽  
Thematic Analysis ◽  
Chronic Lung Disease ◽  
Pulmonary Rehabilitation ◽  
Video Conferencing ◽  
Chronic Respiratory Disease ◽  
Trade Off ◽  
Community Site

IntroductionTo enable greater availability of pulmonary rehabilitation (PR), video-conferencing technology was employed to link a community site to a standard outpatient PR service to deliver the programme closer to those with chronic respiratory disease. The service was called virtual pulmonary rehabilitation (VIPAR). To understand the experiences of those involved in this service, this study aimed to answer the question: How do the different stakeholders that interact with VIPAR experience the programme?MethodsFocus groups were conducted with people with chronic lung disease attending either the community or outpatient PR site, in addition to the staff involved in the running of the PR groups. A total of five focus groups were conducted. Reflexive thematic analysis was used to analyse the transcripts.ResultsParticipants who received VIPAR were positive regarding the programme and described the benefits of the service. Additionally, participants discussed the trade-off between convenience and relatedness. Staff described barriers to the service and solutions that could be employed to mitigate these, including greater training, organisation and understanding of risk.DiscussionUsing technology to increase the availability of PR is acceptable to the stakeholders involved, providing problems and organisational issues are resolved with training.

scholarly journals Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Helle Spindler ◽  
Malene Hollingdal ◽  
Jens Refsgaard ◽  
Birthe Dinesen
Keyword(s):  
Heart Failure ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Depression Scale ◽  
Self Determination Theory ◽  
Anxiety And Depression ◽  
Randomized Controlled ◽  
Rehabilitation Programs ◽  
Multicenter Randomized Controlled Trial ◽  
Patients With Heart Failure

Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.

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