Diary of self-monitoring of the patient as a way to increase adherence to the treatment of patients with chronic heart failure

2019 ◽  
Vol 23 (2) ◽  
pp. 21-26
Author(s):  
Elena V. Frolova ◽  
Alena I. Ogorelysheva ◽  
Ekaterina S. Spasenova ◽  
Tamara R. Khalilova

Chronic heart failure (CHF) is the most frequent and severe complication of cardiovascular disease (CVD). One of the most important aspects of management of patients with CHF remains to ensure adherence to treatment. The purpose of the study was to assess the effectiveness of therapy of patients with CHF with the use of a diary of self-control as a way of enhancing adherence to therapy. Materials and methods. A continuous sequential sample was used to select 40 patients with diagnosed Heart Failure II-IV FC (NYHA), who were then randomized into two groups: the follow-up group (n = 20) and the control group (n = 20). The study duration was 8 weeks. Patients of the observation group received materials on self-control (“Diary of a patient with heart failure”). For them, 3 control visits and 8 phone calls were organized once a week. The participants of the control group were observed in the usual conditions of practical health care; 3 control visits to the doctor were provided for them. The results obtained at week 8 of the study showed that the number of complaints of foot and Shin edema decreased by 2 times compared to the initial data; in the control group, the frequency of complaints did not have a positive dynamic. Conclusion. Use of a diary of self-control is the easiest method of improving adherence of patients with CHF to treatment.

2020 ◽  
Vol 12 (3) ◽  
pp. 201-207
Author(s):  
Mahnaz Modanloo ◽  
Ameneh Tazikeh-Lemeski ◽  
Shohreh Kolagari

ABSTRACTObjetive: Determine the effect of teaching palliative care on the self-efficacy of elderly with Chronic Heart Failure. Material and Methods: This single-blind randomized clinical trial was done on patients with Chronic Heart Failure attending to the heart clinics of Golestan University of Medical Sciences in 2018. 48 eligible patients with class-III were selected via convenience sampling. Patients allocated into control and intervention group randomly (n=32). Palliative care training was done for intervention group for six weeks. Data was gathered through the Cardiac Self-Efficacy Scale (CSES) on three time points (before, immediately, and one month after intervention). Data were analyzed in SPSS-18 using independent t-test, chi-squared, Fisher's exact, and repeated-measures ANOVA with corrected Bonferroni post-hoc test. Results: Finding showed that before intervention the mean scores of self-efficacy in intervention and control group was 23.95±8.34 and 24.11±9.41, respectively. Immediate and one month after intervention it was 26.30±8.30 vs. 28.95±8.53 in intervention group and 24.68±9.32 vs. 25.53±10.39 in control group. In intervention group there was no significant difference between the mean scores of before with immediate and one month after intervention. However, there was a significant difference between the two time follow up in both intervention (p<0.0001) and control (p<0.003) groups. Conclusion: Although the education of palliative care has increased the ability to care in elderly, it seems that self-managing in complex conditions is required follow-up over time.


2016 ◽  
Vol 88 (9) ◽  
pp. 10-16 ◽  
Author(s):  
A T Teplyakov ◽  
E N Berezikova ◽  
S N Shilov ◽  
E V Grakova ◽  
Yu Yu Torim ◽  
...  

Aim. To reveal the specific features of Fas ligand-mediated ischemic myocardial remodeling and those of chronic heart failure (CHF) development during a 12-month prospective follow-up. Subjects and methods. A total of 94 patients with ischemic CHF were examined and divided into 3 groups according to NYHA Functional Class (FC): 1) FC II CHF in 35 patients; 2) FC III CHF in 31; 3) FC IV CHF in 28. According to the results of the 12-month follow-up, the patients were randomized into 2 groups: A) 49 patients with a favorable course of cardiovascular disease and B) 45 patients with its poor course. Serum soluble Fas ligand (sFas-L) levels were measured by enzyme immunoassay. Results. In the patients with CHF, the baseline sFas-L levels substantially exceeded that in the control group by 3—6 times (p


Author(s):  
Adizova D.R. ◽  

To study the effectiveness of teaching "self-care" and "self-control" in elderly and senile patients with chronic heart failure. The study included 107 patients with chronic heart failure. The training program was attended by 54 patients who made up the study group. 53 untrained patients made up the control group. These sessions were conducted with patients for 7 days, 1 hour per day. To assess the effectiveness of the training program, adherence to treatment was assessed using the Morisky-Green scale and the quality of life was assessed using the Minnesota questionnaire on the quality of life of patients. Results. During 1 year of follow-up, feedback was interrupted with 17 patients (15,8%) due to various reasons. Out of 90 subjects of observation, only 6 patients (6,7%) died due to the deterioration of their condition and the development of associated conditions. The assessment of the number of visits by patients to family polyclinics showed a generally satisfactory level of clinical examination in the study group - the average rate of planned visits was 3,2. In the control group, the average number of visits was 2,5 per year. There was a statistically significantly lower number of unplanned visits to the study group compared to patients from the control group. As a result, there was a significant decrease in the number of unplanned visits in the intervention group as a whole. Conclusion. The program of training elderly and senile patients on the aspects of self-medication and self-control in chronic heart failure is effective in improving the control of their adherence to therapy and the prognosis of the disease.


2018 ◽  
Author(s):  
Joanna Banach ◽  
Łukasz Wołowiec ◽  
Daniel Rogowicz ◽  
Wojciech Gilewski ◽  
Katarzyna Buszko ◽  
...  

BackgroundDefensins play an important role in the processes associated with innate immunity. Their growth is observed in sites of intense inflammation, but also in less severe inflammation. Evaluation of alpha-defensin levels in patients with chronic heart failure (CHF) and its possible association with a long-term prognosis may be an interesting supplement to knowledge about the state of the immune system in heart failure.The aim of the study was to compare the plasma concentration of alpha-defensin between the patients with chronic heart failure with impaired ventricular ejection fraction (LVEF) &lt;45% and the control group, as well as to evaluate the prognostic value of alpha-defensin as a possible predictor of death during a 24-month observation period.Methods The study included 52 hospitalized patients with a primary diagnosis of CHF and LVEF &lt;45%. 20 patients exhibited features of CHF exacerbation, the remaining 32 were hospitalized on schedule. The control group consisted of 28 healthy volunteers. The observation was conducted by telephone for 2 years. The end point of the study was death for all reasons.Results Patients with CHF had significantly higher levels of alpha-defensin than control subjects. Similarly, plasma hs-CRP levels were significantly higher in the study group than in the control group, although in both groups the median hs-CRP did not exceed 5 mg / L. It has not been shown that exacerbation has an effect on alpha-defensin concentration. During the two-year follow-up, statistically significant effects on the endpoint of the following parameters were observed: EF (p = 0.035, HR = 0.917), hs-CRP (p = 0.036; HR = 1.046) and NT-proBNP (p &lt; 0.001, HR = 1.000078). ROC analysis showed that during both a 12-month (AUC = 0.333, p = 0.116) as well as a 24 month (AUC = 0.447, p = 0.616) observation period plasma concentration of alpha-defensin was not a good predictor of death in CHF patients.ConclusionsHigher levels of alpha-defensin in patients with CHF confirm subclinical inflammatory activation in this population. However, this marker does not have predictive value for predicting death in the medium-term observation.


Author(s):  
Cristina Silva Arruda ◽  
Juliana de Melo Vellozo Pereira ◽  
Lyvia da Silva Figueiredo ◽  
Bruna dos Santos Scofano ◽  
Paula Vanessa Peclat Flores ◽  
...  

ABSTRACT Objective: To evaluate the effect of the orientation group on therapeutic adherence and self-care among patients with chronic heart failure. Method: Randomized controlled trial with 27 patients with chronic heart failure. The intervention group received nursing consultations and participated in group meetings with the multi-professional team. The control group only received nursing consultations in a period of four months. Questionnaires validated for use in Brazil were applied in the beginning and in the end of the study to assess self-care outcomes and adherence to treatment. Categorical variables were expressed through frequency and percentage distributions and the continuous variables through mean and standard deviation. The comparison between the initial and final scores of the intervention and control groups was done through the Student’s t-test. Results: The mean adherence in the intervention group was 13.9 ± 3.6 before the study and 4.8 ± 2.3 after the study. In the control group it was 14.2 ± 3.4 before the study and 14.7 ± 3.5 after the study. The self-care confidence score was lower after the intervention (p=0.01). Conclusion: The orientation group does not improve adherence to treatment and self-care management and maintenance and it may reduce confidence in self-care. Registry REBEC RBR-7r9f2m.


2011 ◽  
Vol 6 (1) ◽  
pp. 240
Author(s):  
Maria Fernanda de Oliveira Carvalho ◽  
João Carlos Alchieri

ABSTRACTObjective: to check which instruments have been used in psychological assessment of treatment adherence, the indicators have shown the results from these instruments for research and evaluation of this aspect, as well as reflect on the applicability of the practice of the psychologist. Method: this integrative review is performed in the Portal Periodicos Capes, using the keywords adherence, instruments and chronic heart failure and correlates in English. Results: poor adherence to treatment may be associated with several factors, from socioeconomic, psychological disorders and cognitive impairment until the disease characteristics and complexity of treatment, the relationship between health professional and patient, however, is one of the factors contributing to treatment adherence. Conclusion: some authors have sought to present methods to assess adherence to treatment, including psychological tests and inventories, but there are a limited number of investigations in this direction. It is known that the compliance behavior involves many different factors, which requires thorough investigation by means of psychological assessment, to identify those which favor or hinder the appropriate follow-up treatment, and promote greater understanding of both the healthcare staff as to patient, allowing for intervention strategies. Descriptors: heart failure; patient adherence; treatment.RESUMOObjetivo: verificar quais instrumentos psicológicos vêm sendo utilizados na avaliação da aderência terapêutica, apresentar os indicadores evidenciados nos resultados provenientes de tais instrumentos para investigação e avaliação deste aspecto, bem como refletir acerca da aplicabilidade destes na prática de atuação do psicólogo. Método: trata-se de revisão integrativa realizada no portal Periódicos Capes, utilizando-se os descritores aderência, instrumentos e insuficiência cardíaca crônica, bem como os correlatos em língua inglesa. Resultados: a baixa adesão ao tratamento pode estar associada a diversos fatores, desde problemas socioeconômicos, distúrbios psicológicos, e prejuizos cognitivos, até as características da doença e a complexidade do tratamento; o relacionamento entre o profissional de saude e o paciente, em contrapartida, é um dos fatores que contribui à adesão ao tratamento. Conclusão: alguns autores vêm buscando apresentar métodos que avaliem a adesão ao tratamento incluindo testes e inventários psicológicos, porém há um número limitado de investigação nesse sentido. Sabe-se que o comportamento aderente envolve muitos e diferentes fatores, o que requer investigação aprofundada por meio da avaliação psicológica, no sentido de identificar quais destes favorecem ou dificultam o seguimento adequado do tratamento, e promover maior conhecimento tanto à equipe de saude quanto ao paciente, possibilitando estratégias de intervenção. Descritores: insuficiência cardíaca; adesão do paciente; tratamento.RESUMENObjetivo: comprobar que instrumentos psicológicos han sido utilizados en la evaluación de la adherencia al tratamiento, presente los indicadores que se evidencia en los resultados de estos instrumentos para la investigación y la evaluación de este aspecto, así como reflexionar sobre la aplicabilidad destas en la práctica del psicólogo. Método: se trata de un revisión integradora celebrada en el Portal Periodicos Capes, utilizando los descriptores la adhesión, los instrumentos y la insuficiencia cardiaca crónica y se correlaciona en inglés. Resultados: la mala adherencia al tratamiento puede estar asociado con varios factores, desde socioeconómica, trastornos psicológicos y deterioro cognitivo hasta la características de la enfermedad y la complejidad del tratamento; la relación entre el profesional de la salud y el paciente, sin embargo, es uno de los factores que contribuyen a la adherencia al tratamiento. Conclusión: algunos autores han tratado de presentar los métodos para evaluar la adherencia al tratamiento, incluyendo las pruebas psicológicas y los inventarios, pero hay un número limitado de investigaciones en esta dirección. Se sabe que el comportamiento de cumplimiento implica muchos factores diferentes, lo que requiere una investigación a fondo por medio de la evaluación psicológica, para identificar los que favorecen o dificultan la comprensión de un seguimiento adecuado del tratamiento, y promover una mayor conocimiento tanto del personal médico en cuanto a paciente, teniendo en cuenta las estrategias de intervención. Descriptores: insuficiencia cardíaca; adhesión del paciente; el tratamiento.


2021 ◽  
Vol 11 (6) ◽  
pp. 1616-1622
Author(s):  
Chenwei Gao ◽  
Wei Zeng ◽  
Xueyong Li ◽  
Yingjuan Zheng ◽  
Weiliang Liu

Chronic heart failure (CHF) is a group of clinical syndromes caused by changes in myocardial structure and function caused by any reason, leading to ventricular filling and ejection disorders. It is the final stage of the development of various cardiovascular diseases. It is a progressive disease. Once it starts, even if there is no new myocardial damage, the clinic is still in a stable stage, and it can still continue to develop on its own. This article uses the comprehensive parameters of echocardiography to evaluate the overall heart function of patients with chronic heart failure, and evaluates the treatment effect of patients with chronic heart failure. A total of 160 patients with chronic heart failure were studied, including 80 cases in the follow-up group, 40 cases in the non-follow-up group, and 40 cases in the normal control group. The heart failure ultrasound index composed of the comprehensive parameters of echocardiography was used to measure brain natriureric pepride (BNP), and the heart function was graded. The results showed that when the heart failure ultrasound index value >3, the diagnosis of symptomatic chronic heart failure had a sensitivity of 94.7%, a specificity of 94.6%, a positive predictive value of 97.8%, and a negative predictive value of 80.6%. The heart failure ultrasound index was positively correlated with plasma BNP and NYHA heart function (respectively 0.68, 0.73). After 6 months of observation, the ultrasound index of heart failure in the follow-up group decreased significantly before and after treatment. The experimental results show that the heart failure ultrasound index can be used to guide the treatment of patients with chronic heart failure, evaluate the treatment effect, and evaluate the prognosis. Appropriate health education and standardized medication can improve the treatment effect of chronic heart failure and improve the quality of life of patients.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Concetta Pastore ◽  
Giulia Elena Mandoli ◽  
Nicolò Ghionzoli ◽  
Flavio D’Ascenzi ◽  
Luna Cavigli ◽  
...  

Abstract Aims In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient’s quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular (CV) congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. The aim of our study was to determine the association between NT-proBNP and PALS in patients acute and chronic HF. Methods and results Patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. The overall study cohort included 388 patients (172 with chronic HF and 216 with chronic HF). Mean age was 65 ± 12, 37% were female. Most patients had reduced LV systolic function (mean LV ejection fraction = 30 ± 10%; mean LV global longitudinal strain = −8.3 ± 3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF [median (interquartile range) = 6039 (2989–13 535) pg/ml vs. 544 (200–1533) pg/ml] and lower global PALS =10.4 (6.3–16.45)% vs. 15.6 (10.6–21)%. Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (all P &lt; 0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2 = 0.2; P &lt; 0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 CV deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC = 0.87and 0.82, respectively, Figure 1). Conclusions Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. Both global PALS and NT-proBNP confirmed to be accurate prognostic markers in HF.


Author(s):  
E. T. Guseinova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
S. N. Tolpygina ◽  
V. P. Voronina ◽  
...  

The review of the literature examines the General problems of treatment of chronic heart failure, among which special attention is paid to the problem of adherence. This problem remains one of the most urgent and difficult to solve in medicine, because it directly affects the effectiveness of treatment and the outcome of the disease. The article considers the commitment of both doctors to comply with clinical recommendations and patients to prescribed therapy. Some of the reasons that explain the lack of adherence to treatment (such as gender, age, institution where the patient is observed, and others) are described. It is also described that comorbidity is an aggravating factor in the treatment of chronic heart failure. It is described that comorbidity is an aggravating factor in the treatment of chronic heart failure. The presence of concomitant diseases increases the number of medications taken, which exacerbates the problem of adherence to medication therapy. It is noted that medical registry is the ideal model for studying adherence in clinical practice. The main Russian registers included of patients with chronic heart failure are considered. It is noted that in none of them a full assessment of patients’ adherence to therapy was carried out. In the largest foreign chronic heart failure registers, the assessment of commitment is also given insufficient attention. Separate clinical trials are described, including randomized trials, specifically studying various aspects of the problem of adherence and its impact on the course of the disease. Special attention is paid to the methods of assessing adherence in these studies. It is noted that there is no “gold standard” for its evaluation, and existing methods (such as Chips, determining the concentration of the drug in the blood, counting prescription forms and others) are unacceptable for real clinical practice. This indicates the need and prospects for further work on assessing adherence to therapy in patients with chronic heart failure.


2020 ◽  
Vol 16 (4) ◽  
pp. 571-578
Author(s):  
S. Yu. Martsevich ◽  
E. T. Guseynova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
S. N. Tolpygina ◽  
...  

Aim. To study the adherence of doctors to the guidelines for the treatment of chronic heart failure (СHF) and the adherence of patients with СHF to the therapy prescribed by doctors.Material and methods. The COMPLIANCE study is an integral part of the PROFILE registry of the specialized cardiology division of the research center. The study includes patients with verified CHF who were previously observed in the PROFILE registry and patients with CHF who have been newly seeking medical care in the period from December 01, 2019 to December 31, 2020. At the first visit, the initial therapy was evaluated, treatment adherence was determined, and treatment was corrected in accordance with current guidelines. The second visit will also assess patient adherence to treatment, assess the factors of non-adherence and complications of diseases during the year of follow-up.Results. The first 30 case-records of patients with CHF included into the study were analyzed. 90% of patients received angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB). Beta-blockers (BB) were prescribed to 96.7% of patients, and mineralocorticoid receptor antagonists (MRAs) – to 76.7% of patients, and some of them received MRAs at ejection fraction >35%. It was found that the overall adherence of patients according to the adherence scale of the Russian National Society of Evidence-Based Pharmacotherapy (NSEPh) was significantly lower than the adherence to specific drugs. The worst was adherence to ACEI (71%) and MRAs (77%), higher – to BB (86%). The most common factors of non-adherence to treatment, according to the first results, are a large number of medications and a complex medication regimen.Conclusion. The first part of the COMPLIANCE study showed a relatively good adherence of doctors to current guidelines. However, the choice of the drug and its doses did not always correspond to evidence-based medicine data, existing guidelines and summary of product characteristics (SmPC) of specific drugs. The patients adherence to the prescribed therapy was not bad (this can be explained by long-term follow-up in specialized centers), but it was different for different drugs. The worst adherence was registered to the ACEI/ARB. This is warning factor, since these drugs make a significant contribution to improving the long-term outcome of CHF.


Sign in / Sign up

Export Citation Format

Share Document