scholarly journals The development and pilot study of a nurse-led HOMe-based HEart failure self-Management Programme (the HOM-HEMP) for patients with chronic heart failure, following Medical Research Council guidelines

2019 ◽  
Vol 19 (3) ◽  
pp. 212-222 ◽  
Author(s):  
Ying Jiang ◽  
Shefaly Shorey ◽  
Hoang D Nguyen ◽  
Vivien Xi Wu ◽  
Choy Yee Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Self Care ◽  
Self Management ◽  
Intervention Package ◽  
Pilot Testing ◽  
Study Intervention

Background: Chronic heart failure (CHF) is one of the most common causes of hospital admissions and readmissions. Managing CHF requires a comprehensive treatment plan that consists of medication treatment and behavioural change. However, patients often feel unprepared for their self-management role in the community, especially during the period of transition after discharge from hospital. Therefore, an effective intervention to promote CHF self-management is needed. Aims: This paper describes the development and pilot testing of a multicomponent nursing intervention (i.e. the HOM-HEMP) for a randomised controlled trial to assess its effectiveness in improving self-care behaviour among CHF patients in Singapore. A description of the study intervention is also delineated in detail. Methods: The HOM-HEMP was developed based on the UK Medical Research Council framework for developing and evaluating complex interventions. After the development of the study intervention, a single group pre- and post-repeated measure pilot test was conducted to evaluate the study intervention package for its acceptability and the feasibility of the data collection procedure. Ten participants were recruited through consecutive sampling. All of the participants received the full intervention package with the supplementary mobile application. The data were collected at baseline and immediately after the study intervention (i.e. 6 weeks from baseline). The outcome measures included the Self-Care Heart Failure Index, Cardiac Self-Efficacy Scale, Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale and Short Form of the Social Support Questionnaire. Results: The results from the pilot testing showed that the programme was feasible and potentially effective in improving patient’s self-care management, psychological outcomes and health-related quality of life. Conclusion: A self-management psychosocial education approach is the preferred choice for many patients with chronic diseases. The effectiveness of the HOM-HEMP will next be tested in a full scale randomised control trial.

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

scholarly journals Health Promotion and Self-Management Among Patients with Chronic Heart Failure

2021 ◽  
pp. 269-285
Author(s):  
Ying Jiang ◽  
Wenru Wang
Keyword(s):  
Heart Failure ◽  
Health Promotion ◽  
Chronic Heart Failure ◽  
Physical Function ◽  
Self Care ◽  
Clinical Syndrome ◽  
Self Management ◽  
Older Population ◽  
Common Causes ◽  
The Common

AbstractHeart failure is a chronic and complex clinical syndrome. It is one of the common causes of hospitalization and readmission among the older population. Patient self-management is essential to maintaining health and avoiding disruption of life caused by frequent hospitalizations. However, many patients lack self-care skills. This chapter provides a review on evidence for the importance of self-management and strategies to educate patients and promote self-care while living with the limitations on physical function.

Correlação entre a frequência respiratória e escalas de avaliação de dispneia

2016 ◽  
Vol 13 (6) ◽  
Author(s):  
Ivete Alonso Bredda Saad ◽  
Mariana De Moraes ◽  
Vinicius Minatel ◽  
Bruna Alonso Saad
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council

A avaliação da dispneia tem sido feita por meio de instrumentos como escala de Borg modificada, a escala de cores e a escala do Medical Research Council modificada (mMRC). O objetivo deste estudo foi correlacionar a frequência respiratória com a sensação de dispneia, através das escalas citadas, correlacioná-las entre si e verificar se o grau de alfabetização influenciou na resposta do paciente sobre a sensação de dispneia. Para avaliar o esforço físico utilizou-se o teste de caminhada de seis minutos. Este foi um estudo prospectivo, transversal e analítico-descritivo composto por 124 voluntários com diagnóstico de doença pulmonar. Para comparar as variáveis categóricas entre os grupos foram utilizados os testes Qui-Quadrado e exato de Fisher. Para comparar as variáveis contínuas foi utilizado o teste Kruskal-Wallis e para análise de correlação foi utilizado o coeficiente de correlação de Spearman. A idade média foi de 55,9 (± 13,08 anos), 14% eram analfabetos. Nos tempos de análise houve correlação positiva entre as escalas mMRC e Borg, r = 0,43, r = 0,61 e r = 0,55. Entre as escalas mMRC e Cores, observou-se correlação negativa. Concluiu-se que a frequência respiratória correlacionou-se com as três escalas. O grau de alfabetização não modificou a resposta do paciente em relação à sensação de dispneia.Palavras-chave: dispneia, fisioterapia, avaliação.

A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

2020 ◽  
Author(s):  
Michael P. Dorsch ◽  
Karen B. Farris ◽  
Brigid E. Rowell ◽  
Scott L. Hummel ◽  
Todd M. Koelling
Keyword(s):  
Heart Failure ◽  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Self Management ◽  
Control Group ◽  
Patient Centered ◽  
Self Monitoring ◽  
Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

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

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