People living with heart failure (PLHF) should be screened for symptoms at every healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires were compared and assessed with the gold standard laboratory test for HF (NT-proBNP) for sensitivity and specificity. For HF, the SHEFS was the most sensitive (83%) compared to the NT-proBNP, but the MLHFQ was most specific (89%). When compared to the MLHFQ as the standard, SHEFS was 71% sensitive, and 73% specific for HF. Similarly, when compared to the KCCQ, the SHEFS was both, 75% specific and sensitive in identifying HF. However, the rate of correlation to a positive or negative NT-proBNP test results was the highest for the SHEFS (87%). All 3 questionnaires were statistically significant in predicting admission to hospital for HF in the past 6 months (p = 0.02 to 0.03). Finally, given the shortest length and simplicity of use, the SHEFS was selected by the stakeholders to be the standard screening tool for the clinic. This project contributes to positive social change by providing the first reported comparison in the literature to implement questionnaires in a clinic to assess symptoms for PLHF attending an arrhythmia devices clinic.

Information from anecdotal interviews at a practicum site indicated a lack of training for advanced practice providers (APPs) in core competencies critical for effective practice in a heart failure (HF) unit. The goal of this project was to assess the APPs' verbal reports and develop HF unit-specific training for APPs. The practice-focused question examined whether unit-specific training for HF APPs improved knowledge and skills in HF management. The Johns Hopkins nursing evidence-based practice model and Knowles's adult learning theory were used to create a survey, a focus group, and a pre/posttest assessment of knowledge and skills gap. Descriptive and inferential statistics could be used to analyze pre/post survey data, and thematic analysis could be used to analyze focus group data. Assessment data could be used to develop a targeted HF program based on identified skill deficiencies. The implications of this project related to social change are the potential to increase APPs' knowledge, job engagement, and retention. The program could affect length of stay and 30-day readmission of patients in the HF unit.

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and interpretation of this research. The purpose of this project was to design a CHF protocol using evidence-based research for clinicians making home visits to homebound patients with a primary diagnosis of CHF with an individualized protocol focusing on disease management, in home support system, knowledge base and financial factors for homebound patients. The protocol was released through a snowballing campaign to clinicians who work with CHF, transitional care, or homecare who then evaluated the protocol on its perceived efficacy if integrated into practice. Findings were analyzed using simple descriptive statistics by 32 nurses and other health care professionals who responded work in home care, cardiology, medical surgical nursing hospitalists, or skilled nursing facilities. Thirty-one of the 32 respondents deemed the protocol useful and stated a clinical need of protocol as evidenced by completed the AGREE II Questionnaire. The findings demonstrate that the CHF Practice Protocol provides clinicians with an evidence-based guidance to manage homebound patients with CHF on a small scale.

African Americans suffer disproportionately higher incidence of congestive heart failure (CHF) at an earlier age of onset and with more rapid progression compared to other races. Due to this escalating prevalence of CHF within the African American population and the lack of culturally responsive support for the caregiving role, African American family caregivers of adult CHF patients face greater challenges and suffer increased caregiver burden, stress, depression, and financial strain compared to European American caregivers. The purpose of this project was to conduct a systematic literature review to find the recommendations that target African American family caregivers of adult CHF patients. The Joanna Briggs Institute model for systematic review (JBIM-SR), and the caregiver stress theory proposed by Tsai, guided this project. A review of multiple databases yielded 118,078 articles. After removal of duplicates and exclusion of articles not consistent with the purpose of the review, 1 article was selected. A second reviewer completed an independent search of the databases using the same exclusion/inclusion criteria and identified the same review. The selected article was analyzed and graded using the JBIM-SR grading tools. Family Heart Failure Home Care, a telephone coaching intervention adapted to the cultural preferences of the African American family caregivers of adult CHF patients, was suggested as an effective culturally sensitive intervention. Results of this project can promote positive social change by improving the care and well-being of the African American community. Nurses at the project site can use the findings to provide evidence-based care to the African American family caregivers of adult CHF patients.

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, and Wagner's chronic care model guided the development and implementation of this project. The practice-focused question for this project asked whether evidence informs a CPG intended to assess health literacy and numeracy assessment and promote an enhanced individualized education intervention in an outpatient HF population. A literature review using 20 articles from 2006-2018 was completed. Five articles were selected to review levels of evidence, and three articles were chosen to support the development of the CPG. The CPG was reviewed, refined, and validated by an expert panel of HF nurses and physicians. The CPG might support a positive social change in the practice setting by improving the tools for nurses to assess health literacy in the HF patient population and provide individualized education to influence self-care interventions.

Natriuretic peptides are a family of hormones released by several different tissues and exert various physiological functions by coupling with cell surface receptors and increasing intracellular cyclic gyanylyl monophosphate (cGMP). Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP) are released in response to mechanical stretch of the atrial or ventricular myocardium, respectively and their plasma level is markedly elevated during myocardial infarction and heart failure. Heart failure in turn is associated with symptoms suggestive of perturbed gastrointestinal function such as nausea, indigestion and malabsorption. Intragastric pressure was monitored using a balloon catheter in anesthetized mice. The pressure before and after treatment with a 10 ng/g intravenous dose of ANP, BNP, CNP or vehicle was compared and analyzed. All the natriuretic peptides significantly decreased intragastric pressure compared to vehicle. These effects were attenuated or absent in natriuretic peptide receptor type-A (NPR-A) knockout mice. Furthermore, the effect of BNP on gastric emptying and intestinal absorption was examined using a meal consisting of fluorescence labeled dextran gavage fed to awake mice. BNP significantly decreased gastric emptying and absorption as compared to vehicle control. Using a cryoinfarction acute myocardial injury model, our investigation showed that mice with acute cryoinfarction had a significantly lower gastric emptying and absorption of a gavage fed meal compared to sham. Circulating BNP levels were significantly higher in the infarcted mice compared to controls. Immunostaining showed amplified distribution of the non-muscle myosin type-II (MCH-II) in BNP treated mice. MCH-II is involved in movement of intestinal villi. In summary, natriuretic peptides in general and BNP in particular, have gastrointestinal effects including reduced gastric contractility, emptying and absorption. In addition to their effect on smooth muscle relaxation mediated by cGMP, natriuretic peptides appear to have an effect on distribution of MHC-II in cells of the intestinal villi. We postulate that these effects are aimed at mediating a 'communication' between the cardiovascular and gastrointestinal systems. Further characterization of such a link will not only add a dimension to the understanding of the pathophysiology of heart failure but also enhances the search for further therapeutic targets.

Chronic and complex conditions are a significant concern within contemporary health care systems. The ageing population and improvements in survival from acute cardiac illness have seen an increasing incidence of heart failure (HF). Heart failure represents a significant burden on both the individual and the wider community. Despite effective pharmacotherapy and established evidence-based management guidelines, the overall prognosis from HR is poor. The complexity of the disease process and the highly developed evidence-base makes HR an excellent exemplar for the management of a range of chronic conditions. Studies undertaken as part of the ‘Carving a niche for Australian practice nurses’ project have led to the development of a model of care that integrates the role of the practice nurse with those of other health care providers to improve outcomes for people with chronic and complex conditions. Whilst the model of care developed from these studies requires empirical testing to validate its utility, it is currently being incorporated in clinical planning and ongoing pragmatic research. The systematic, sequential derivation of data from this ‘Carving a niche for Australian practice nurses’ project will inform the development of primary care and provide a conceptual framework for future intervention studies in Australian general practice. / Doctor of Philosophy (PhD)

<p>Heart failure is a common disease which is difficult to diagnose. To aid physicians in diagnosing heart failure, a decision support system has been proposed. Parameters useful to the system are suggested. Some of these, such as age and gender, should be provided by the physician, and some should be derived from electro- and phonocardiographic signals.</p><p>Various methods of signal processing, such as wavelet theory and principal components analysis, are described. Heart failure should be diagnosed based on the parameters, and so various forms of decision support systems, such as neural networks and support vector machines, are described. The methods of signal processing and classification are discussed and suggestions on how to develop the system are made.</p>

<p>Syftet med denna litteraturstudie var att enligt vetenskapliga studier, publicerade mellan år 2002 och 2007, beskriva omvårdnad av patienter med kronisk hjärtsvikt. Metoden som användes var en litteraturstudie med beskrivande design. Information hämtades från databaserna Medline, Academic Search Elite och Cochrane Library, samt ur Vård i Nordens webbarkiv. Sökorden som användes var ”chronic heart failure” och ”nursing”. Totalt inkluderades 22 studier i denna litteraturstudie. Ur studierna kunde fem inriktningar inom omvårdnaden av patienter med hjärtsvikt identifieras. Dessa var omvårdnad genom patientutbildning, telefonrådgivning, fysisk träning, hemsjukvård och hjärtsviktsmottagning. Resultatet visade på ett positivt samband mellan fysisk träning och ökad livskvalitet hos patienter med hjärtsvikt i samtliga studier som undersökte dessa två variabler. Majoriteten av studierna som undersökte effekten av telefonrådgivning till patienter med hjärtsvikt fann att antalet inläggningar på sjukhus hade minskat efter att patienterna under en period fått telefonrådgivning. I de studier som granskats låg fokus till stor del på att stärka patienternas egenvård. Två inriktningar inom omvårdnaden av patienter med hjärtsvikt utmärkte sig som de mest effektiva metoderna. Dessa var fysisk träning och telefonrådgivning.</p> / <p> </p><p>The aim of this literature study was to describe the care of patients with chronic heart failure according to scientific studies published between the years 2002 and 2007. A descriptive design was used. Information was gathered from the following databases: Medline, Academic Search Elite and Cochrane Library. Vård i Norden webb archive was also used for collecting articles. Keywords used in the search were "chronic heart failure" and "nursing". A total of 22 articles were included in this study. The articles in this study showed five different themes in the care of patients with heart failure, these were: patient education, telephone care, physical exercise, home-based care and heart failure clinics. The result showed a positive correlation between physical exercise and quality of life, this was found in every article covering these two variables. Most studies concerning telephone care found that the number of hospital readmissions decreased after an intervention based on telephone care. In the included studies a lot of focus was on strengthening patient's ability to self care. In this study physical exercise and telephone care were the most effective methods of care for patients with heart failure.</p>

<p>För många närstående förändras livet radikalt när  en anhörig diagnostiseras med hjärtsvikt. Att leva med hjärtsvikt är som att "knacka på dödens dörr och aldrig veta vad som är att vänta av morgondagen". Att stanna hemma och vårda en en anhörig under palliativ fas innebär stora påfrestningar i närståendes liv. Syfte: Att belysa närståendes upplevelser när anhörig med hjärtsvikt vårdas palliativt i hemmet. Metod: Studien utfördes som en allmän litteraturstudie. Tolv kvalitativa och tre kvantitatva vetenskapliga artiklar ingick. Resultat:  Närstående som vårdade en anhörig palliativt i hemmet upplevde social isolering, stress och ångest och krav på att vara en "stöttepelare". Närstående upplevde också att informationen om tillstånd och prognos var bristfällig. Upplevelsen av att känna stöd från vårdpersonal varierade och närstående ville vara delaktiga i vården. Slutsats: Det är klarlagt att hjärtsvikt har en betydande påverkan på närståendes liv. Närståendes situation behöver studeras vidare och då speciellt när det gäller palliativ hemsjukvård.</p> / <p>For many next of kin important changes took place when heart failure was diagnosed. Meanings of living with heart failure emerged as "knocking on death's door" yet surviving and never knowing what to expect of tomorrow. Staying at home in the palliative phase of life brings multiple complex issues for next of kin who is subject to stress during a along period of time. The aim of the study was: To illuminate next of kin's experiences when a partner with heart failure is taken care of in palliative home care setting. Method: A general litterature review based on twelve qualitative and three quantitative scientific articles. Findings: Next of kin in palliative home care setting described situations of being restricted, they experienced stress and anxiety, and took on the role of being "a pillar of strength". Next of kin also described how they lacked adequate medical information. Som next of kin experienced  that they received support from healthcare personnel but some lacked concrete support. Next of kin also felt it important to have influence on decisions. Conclusion: It is clear that heart failure seriously affects the lives of next of kin. This group need to be further investigated, especially when it comes to palliative care at home.</p>