Heart failure (HF) is a debilitating chronic illness that afflicts millions of Americans and carries a poor prognosis, likely due to insufficient medication and low-salt diet adherence, which exacerbates HF symptoms and leads to frequent rehospitalizations. Specific reasons underlying non-adherence among HF patients are unclear. Studies investigating reasons for adherence among HF patients have shown that correlates of poor adherence include demographic (i.e., age, income), functional (i.e., NYHA), and psychosocial (i.e., social support, depression) variables. Research studies among individuals with chronic diseases suggest that an individual’s beliefs about medicines may explain adherence, but this research is limited among HF patients. The purpose of this study was to examine how psychosocial variables and beliefs about medicines are related to self-reported medication and low-salt diet adherence among individuals with HF, while controlling for demographic and physical functioning variables. This study had three aims: 1) To examine the relationships between psychosocial variables (e.g., depression, hostility, social support) and adherence; 2) To examine the relationship between beliefs about medicines and adherence; and 3) To investigate whether beliefs about medicines moderate the relationship between psychosocial variables and adherence. An ethnically-diverse sample of 105 HF patients completed several measures assessing depressive symptoms, level of hostility, perceived social support, beliefs about medicines, and medication and low-salt diet adherence. Structural equation modeling revealed that higher depression, higher hostility, and a stronger belief that medications are harmful and/or overused by doctors were significantly related to worse medication adherence. Further, participants who believed that medicines are necessary and had few concerns about them were more likely to adhere to a low-salt diet. Age, income, and number of co-morbid illness also were significantly related to low-salt diet adherence beyond contributions of beliefs about medicines scales and psychosocial variables. Thus, overall it appears that different beliefs about medicines differentially influence medication versus low-salt diet adherence, and psychological disposition may not underlie low-salt diet adherence. These results can inform interventions of health care practitioners in addressing adherence issues with HF patients.

Postoperative heart failure (PHF) remains a major determinant of the outcome after cardiac surgery. However, characteristics of and risk factors for PHF after valve surgery have received little attention. Post-ischaemic disturbances of myocardial metabolism that may contribute to PHF and are amenable to metabolic treatment have been identified early after coronary surgery (CABG). Knowledge derived from these studies may not be applicable to other patient groups. We therefore studied myocardial energy metabolism in 20 elective patients undergoing aortic valve replacement (AVR) for isolated aortic stenosis (AS). The metabolic studies indicated that myocardial oxidative metabolism had not fully recovered when the procedure was completed. Free fatty acids were the only major substrates taken up by the heart. Signs of preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously demonstrated in patients with coronary artery disease, were found. Postoperative infusion of glutamate, (2 mL/kg body weight and hour of 0.125 M solution) based on assessment of myocardial glutamate requirements in CABG patients, resulted in a two-fold increase in myocardial glutamate uptake and a seven-fold increase in AV differences across the leg. This was associated with a significant myocardial uptake of lactate and metabolic changes in the leg suggesting mitigation of net amino acid loss and peripheral tissue lipolysis. Characteristics of and risk factors for PHF were evaluated in 398 patients undergoing isolated AVR for AS from 1 January 1995 to 31 December 2000. These were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients fulfilled criteria for PHF and these were studied in detail. PHF usually presented at weaning from cardiopulmonary bypass. After CABG it was closely associated with preoperative ischaemic events and intraoperatively acquired myocardial infarction. Potential causes and eliciting events of PHF after AVR for AS were obvious only in one-third of the patients. Risk factors for PHF after AVR for AS indicated either pre-existing myocardial dysfunction, increased right or left ventricular after-load, or intraoperatively acquired myocardial injury. PHF was associated with high early mortality after CABG, whereas the consequences of PHF after AVR for AS became evident only with time, resulting in a 42% five-year mortality. Although PHF had a different temporal impact on late mortality after CABG and AVR for AS, it emerged as the statistically most significant risk factor for mortality occurring within 5 years from surgery both after AVR for AS and after CABG. Potential implications of our findings include needs for greater focus on preoperative surveillance of patients with AS for optimal timing of surgery, mitigation of intraoperatively acquired myocardial injury and tailoring of treatment for PHF. Furthermore, the findings have implications for long-term follow up of AS patients after surgery.

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. / 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.

Background and objective: Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role. Methods: In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years. Results: In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis. Conclusions: Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure.

Bakgrund: Risken för hjärtsvikt ökar med stigande ålder. Upplevelser av att leva med hjärtsvikt varierar vilket kan påverka det dagliga livet och leda till individuella vårdbehov. Patienter med hjärtsvikt ska vid behov erbjudas vård i hemmet och den är idag mer avancerad än tidigare. Syfte: Syftet med studien var att belysa patienters upplevelser av att få vård i hemmet för sin hjärtsvikt. Metod: En induktiv intervjustudie med semistrukturerade frågor har använts. Genom ett strategiskt urval framkom sex informanter. Intervjumaterialet analyserades med kvalitativ manifest innehållsanalys. Resultat: Vården i hemmet utformades individuellt och informanterna upplevde att de fick all vård de var i behov av. Olika yrkeskategorier samverkade och möjliggjorde vården i hemmet. En relation till vårdpersonalen var viktig och hembesöken medförde ett socialt sällskap. Det innebar en trygghet att vara med och planera sin vård och kontinuitet i vården var viktig. Möjligheten att ta kontakt med vårdpersonal var viktig vid olika vårdbehov samt att få vara kvar i hemmet för vård. Känslorna inför framtiden och vården i hemmet varierade. Slutsats: Samverkan mellan olika yrkeskategorier möjliggör vård i hemmet för patienter med hjärtsvikt. För patienten skapas möjlighet att vara i sin hemmiljö, även vid progression av hjärtsvikten. Vården i hemmet påverkar upplevelsen av trygghet och skapar förutsättningar för en god hälsa. / Background: The risk of heart failure increases with age, and experiences of living with heart failure varies. This condition can affect the daily life and lead to individual care needs. If necessary, patients with heart failure should be offered attendence at home. The home health care is more advanced now than before. Aim: The aim of the study was to illuminate the experiences of heart failure patients whom received care at home. Method: An inductive interview study with semi-structured questions were used. Six informants emerged from a strategic sampling. During the study of the interview material, a qualitative content analysis was used. Results: The results showed that attendance at home was designed individually, and the informants received the care they needed. Interaction between different professions made this possible. The relationship between the resident and the caregiver was important, and it also led to social company. It meant security to be involved in the creating of the care plan, and the continuity of care was important. The possibility to contact the caregiver at different care needs, and to stay at home were important. Feelings about the future and the home health care varied. Conclusion: Home health care for patients with heart failure is enabled by collaboration between different professions. Even during the progression of heart failure, the patient may still be given the opportunity to stay at home. The attendence at home affects the perception of being safe and enables conditions for good health.

With the recent advent of gene therapy, anti-apoptotic therapy has been receiving spotlight as a potential modality to inhibit the deterioration of pump function in the failing heart. We hypothesized that anti-apoptotic therapy using survivin gene delivery will 1) salvage H9c2 cells exposed to doxorubicin toxicity, and 2) ameliorate the progressive decline in left ventricular function in a rat model of doxorubicin-induced cardiomyopathy. The in vitro data suggested that survivin successfully prevented cell death under doxorubicin stress by both direct and indirect/paracrine mechanisms. Doxorubicin-treated animals developed progressive left ventricular dysfunction as evident by echocardiography and invasive pressure-volume loop analysis, which was prevented by ultrasound-mediated survivin plasmid delivery, but not empty plasmid delivery. Post-mortem analysis of myocardial tissue indicated a lowered apoptotic index in survivin-treated hearts, with evidence of decrease in interstitial fibrosis. In conclusion, survivin gene therapy was shown to ameliorate doxorubicin-induced cardiomyopathy, by decreasing apoptosis and preventing adverse remodeling.

With the recent advent of gene therapy, anti-apoptotic therapy has been receiving spotlight as a potential modality to inhibit the deterioration of pump function in the failing heart. We hypothesized that anti-apoptotic therapy using survivin gene delivery will 1) salvage H9c2 cells exposed to doxorubicin toxicity, and 2) ameliorate the progressive decline in left ventricular function in a rat model of doxorubicin-induced cardiomyopathy. The in vitro data suggested that survivin successfully prevented cell death under doxorubicin stress by both direct and indirect/paracrine mechanisms. Doxorubicin-treated animals developed progressive left ventricular dysfunction as evident by echocardiography and invasive pressure-volume loop analysis, which was prevented by ultrasound-mediated survivin plasmid delivery, but not empty plasmid delivery. Post-mortem analysis of myocardial tissue indicated a lowered apoptotic index in survivin-treated hearts, with evidence of decrease in interstitial fibrosis. In conclusion, survivin gene therapy was shown to ameliorate doxorubicin-induced cardiomyopathy, by decreasing apoptosis and preventing adverse remodeling.

Bakgrund: Hjärtsvikt är den vanligaste orsaken till sjukhusinläggning hos äldre personer. Upp till 50 % av dessa patienter är felnärda. Detta kan delvis orsakas av de gastrointestinala symtom som sjukdomen ger såsom tidig mättnadskänsla, aptitlöshet och illamående. Syfte: Att ur patienters perspektiv belysa problematik med mat och kostråd vid kronisk hjärtsvikt. Metod: En litteraturstudie där tio kvalitativa eller kvantitativa vetenskapliga artiklar ingår. Resultat: Personer med hjärtsvikt förstod inte alltid att de hade en kronisk sjukdom och att detta skulle påverka deras matintag för resten av livet. Att följa en saltfattigkost kunde ge svårigheter i det dagliga livet. Maten kunde väcka både positiva och negativa känslor. De kunde känna sig begränsade i sociala situationer t ex. vid högtider eller restaurangbesök, då maten de blev bjudna på oftast innehöll för mycket salt. De flesta patienterna utvecklade strategier för att lättare följa kostråden. Diskussion: Patienter och anhöriga har ett stort informationsbehov om sjukdomen och dess påverkan i det dagliga livet. De kan behöva stöd och uppmuntran från omgivningen för att genomföra livsstilsförändringarna. Det är viktigt att förstår sambandet mellan saltrik mat och ökade symtom. Personcentrerad vård kan minska vårdtiden och förbättra eller bevara patienternas vardagliga resurser jämfört med traditionell vård samt minska återinläggningarna. / Background: Heart failure is the leading cause of hospitalization of older people. Up to 50% of these patients are malnourished. This may be partly caused by the gastrointestinal symptoms caused by the disease, as early satiety, loss of appetite and nausea. Aim: From patient’s perspective highlight problems with food and dietary advice in chronic heart failure. Method: A literature review where ten qualitative or quantitative scientific papers were included.  Results: People with heart failure did not always understand that they had a chronic illness and that this would affect their food intake for the rest of their lives. To follow a low salt diet could cause difficulties in the daily life. The food could give both positive and negative emotions. They could feel limited at social occasions, feasts or when visiting restaurants, when the food they were invited to often included too much salt. Many patients developed strategies to follow the dietary recommendations more easily. Discussion: Patients and their relatives have a great need for information about the disease and the impact in daily life. They may need support and encouragement from the environment to implement lifestyle changes. It is important to understand the relationship between salty food and increased symtoms. Person-centred care could reduce the length of stay and maintain or improve the patient´s daily resources and reduce re-admission.

No description available.

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. 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.