Hjärtsvikt är ett allvarligt tillstånd som är förknippat med hög dödlighet. Tillståndet medför ett frekvent behov av sjukvård och utgör en stor del av den svenska hälso- och sjukvården. Hjärtsviktsvården har även påverkan på ett samhällsekonomiskt plan, då en betydande del av den svenska sjukvårdsbudgeten går till denna vård. Personer med hjärtsvikt lever under oförutsägbara förhållanden och kan behöva genomgå stora livsstilsförändringar. Tillståndet är både fysiskt samt psykiskt påfrestande och påverkar såväl patienter som deras närstående. Syftet var att genom en allmän litteraturstudie belysa sjuksköterskors omvårdnad av patienter med hjärtsvikt. Litteraturstudiens resultat grundades på 10 vetenskapliga artiklar som framkommit genom en systematisk litteratursökning. I resultatartiklarna kunde tre kategorier av omvårdnad identifieras: sjuksköterskors stödjande funktion, sjuksköterskors utbildande funktion samt sjuksköterskors instrumentella funktion. Den stödjande funktionen innebär att omvårdnaden personcentreras samt att sjuksköterskor samarbetar med och agerar som psykosocialt stöd för patienter. Den utbildande funktionen innefattar att sjuksköterskor informerar samt utbildar patienter om hjärtsvikt, dess inverkan på patienters liv samt egenvård. Informationen och utbildningen syftar till att öka patienters medvetenhet samt göra dem kapabla att hantera tillståndet. Den instrumentella funktionen innebär att sjuksköterskor utifrån mätvärden och bedömningar kan utvärdera patienters symtom och tecken på hjärtsvikt samt medicinska och omvårdnadsmässiga behov. / Heart failure is a serious condition associated with high mortality. The condition entails a frequent need for medical care and constitutes a major part of the Swedish health care system. Heart failure care also has an impact on a socioeconomic level, as a significant part of the Swedish health care budget is dedicated to this care. People with heart failure live under unpredictable conditions and may need to undergo major lifestyle changes. The condition is both physically and psychologically stressful and affects both the patients and their relatives. The purpose of the general literature study was to illustrate nurses’ care of patients with heart failure. The results of this literature study are based on 10 scientific articles, which were found through a systematic literature search. Three categories of nursing care were identified in these articles: the nurses’ supporting function, the nurses’ educational function, and the nurses’ instrumental function. The supportive function includes a person-centred nursing approach, and also that nurses cooperate with and act as a psychosocial support for patients. Within the educational function, nurses inform and educate patients about heart failure, its impact on patients’ lives, and self-care. This information and education aim to increase patient awareness and enable them to manage their condition. The instrumental function is comprised of nurses’ evaluation of patients’ symptoms and signs of heart failure, as well as the evaluation of medical and nursing needs based on measurements and assessments.

Bakgrund: Hjärtsvikt är en vanlig orsak till sjukhusinläggning i Sverige. Patienter behöver stöd från vården, aktuell forskning visar på att detta stöd brister. Sjuksköterskan behöver mer förståelse för patientens livsvärld för att kunna lindra dennes lidande. Syfte: Syftet är att belysa patienters upplevelser av att leva med hjärtsvikt Metod: Uppsatsen är en kvalitativ litteraturöversikt där 15 kvalitativa artiklar med ett patientperspektiv analyserats. Resultat: Patienter upplever känslomässigt lidande härledande från deras symtom, deras möten med vården och deras sociala sammanhang. De finner hopp och mening hos sin tro, hos sina närstående och hos en god vård. Patienter upplever att en acceptans av deras begränsningar och en anpassning därefter leder till hälsa. Slutsats: Hela patientens livsvärld påverkas vid hjärtsvikt, detta behöver sjuksköterskan bemöta och ha i åtanke vid vårdande möten. Hjärtsviktspatienter behöver uppleva kontinuitet och förståelse från vården. Förståelsen ska inte enbart beröra patientens symtom utan även behovet av spiritualitet. Denna kan bemötas genom att sjuksköterskan är öppen för att ha existentiella samtal med patienten, eller genom hänvisning till sjukhuspräst eller liknande profession. / Background: Heart failure is a common cause of hospitalization in Sweden. Patients need support from health care, current research shows that this support is lacking. The nurse needs more understanding of the patient's world of living in order to relieve his suffering. Purpose: The purpose is to illuminate patients' experiences of living with heart failure Method: The essay is a literature review where 15 qualitative articles with a patient perspective were analyzed Result: Patients experience emotional disorder derived from their symptoms, their meetings with care and their social context. They find hope and meaning in their faith, with their close relatives and in good care. Patients experience that acceptance of their limitations and an adjustment subsequently leads to health. Conclusion: The entire life of the patient is affected by heart failure, this requires the nurse to keep in mind and respond to when treating the patients. Heart failure patients need to experience continuity and understanding from the healthcare. Understanding should not only be limited to the patient's symptoms but also the patients need for spirituality. This can be addressed by the nurse being open to having existential conversations with the patient, or by referring to a hospital or similar profession.

Introdução: Níveis de fator de necrose tumoral–alfa (TNF-α), N-peptídeo do pró-colágeno III (PIIINP) e metaloproteinase de matriz –1 (MMP-1), marcadores biológicos de remodelamento ventricular, estão elevados em pacientes com insuficiência cardíaca (IC), talvez refletindo elevadas pressões de enchimento. A correlação destes marcadores com variáveis clínicas e hemodinâmicas permanece pouco compreendida, particularmente no contexto ambulatorial da IC. Objetivo: Avaliar níveis séricos de marcadores biológicos de remodelamento ventricular em pacientes com IC, comparando tratamento guiado por ecocardiografia (ECO), buscando redução de pressões de enchimento, versus tratamento convencional (CLÍNICO), baseado em sinais e sintomas. Métodos: Ensaio clínico randomizado. Pacientes estáveis com IC e fração de ejeção menor do que 40% foram alocados entre os grupos de tratamento e submetidos a ecocardiograma e coletas de sangue no início do estudo e em 180 dias. TNF-α e MMP- 1 foram medidos por ELISA, e PIIINP, por radioimunoensaio. Resultados: Incluiu-se 80 pacientes, com 59 ± 15 anos e fração de ejeção de 26 ± 7%; 25% isquêmicos e 52% masculinos. Houve redução dos marcadores biológicos intragrupos, não havendo diferença entre os tratamentos. No grupo CLÍNICO, os níveis de TNF-α, MMP-1 e PIIINP apresentaram diferenças estatisticamente significativas entre os momentos basal e final (respectivamente, 3,11 ± 2,90 versus 1,24 ± 0,60 pg/mL p < 0,0003; 2,66 ± 1,00 versus 1,16 ± 0,40 ng/mL p < 0,0001; 6,12 ± 2,60 versus 3,89 ± 1,60 μg/L p < 0,0001). De maneira semelhante, tal diferença também foi observada no grupo ECO para os três marcadores (respectivamente, 3,90 ± 4,90 versus 1,40 ± 1,30 pg/mL p < 0,0001; 2,50 ± 0,90 versus 1,09 ± 0,40 ng/mL p < 0,0001; 6,09 ± 2,60 versus 3,50 ± 1,30 μg/L p<0,0001). Ao final da intervenção, no entanto, não foi observada diferença significativa dos valores de TNF-α , MMP-1 e PIIINP entre os dois grupos de tratamento (p = 0,7; p = 0,8; e p = 0,2; respectivamente). A combinação dos valores basais das variáveis biológicas gerou um escore que se associou significativamente com o comportamento final das pressões atrial direita e sistólica da artéria pulmonar. Pacientes com marcadores biológicos basais no quartil 75% mantiveram níveis superiores de pressões atrial direita (13 mmHg; p = 0,034) e sistólica de artéria pulmonar (60 mmHg; p = 0,007) ao final do seguimento. Conclusão: Independente do tratamento alocado, houve redução dos níveis de marcadores biológicos ao final do seguimento; no entanto, níveis basais mais elevados destes marcadores foram preditores de menor redução das pressões em átrio direito e sistólica da artéria pulmonar. Os dados sugerem que indicativos de intenso processo de remodelamento ventricular se associam à progressão da IC e a pressões de enchimento elevadas. / Introduction: Levels of tumor necrosis factor-alpha (TNF-α), N-terminal propeptide of type III collagen (PIIINP) and type 1 matrix metalloproteinase (MMP-1), biological markers of ventricular remodeling, are elevated in heart failure (HF) patients, perhaps reflecting elevated filling pressures. The correlation of these markers with clinical and hemodynamic variables remains poorly understood, particularly in the outpatient setting. Objective: To evaluate serum levels of ventricular remodeling biological markers in patients with HF, comparing a conventional clinically-oriented treatment (Conventional Therapy), based on clinical signs and symptoms, to an echocardiography-guided treatment (Echo-guided Therapy), aiming at a reduction in filling pressure levels. Methods: Randomized trial. Stable patients with HF and ejection fraction lower than 40% were allocated to the treatment groups and submitted to echocardiography and blood sampling at the beginning of the study and after 180 days. TNF-α and MMP-1 were measured by ELISA, and PIIINP, by radioimmunoassay. Results: Eighty patients at 59 ± 15 years and a mean ejection fraction of 26 ± 7% were included; 25% were ischemic and 52%, males. There was a reduction in intragroup biological markers, without difference between treatments. TNF-α, MMP-1 and PIIINP levels were statistically different between baseline and final in patients allocated to Conventional Therapy (respectively, 3.11 ± 2.90 versus 1.24 ± 0.60 pg/mL p < 0.0003; 2.66 ± 1.00 versus 1.16 ± 0.40 ng/mL p < 0.0001; 6.12 ± 2.60 versus 3.89 ± 1.60 μg/L, p < 0.0001). Similarly, such a difference was also observed in the Echo-guided Therapy for the 3 markers (respectively, 3.90 ± 4.90 versus 1.40 ± 1.30 pg/mL p < 0.0001; 2.50 ± 0.90 versus 1.09 ± 0.40 ng/mL p < 0.0001; 6.09 ± 2.60 versus 3.50 ± 1.30 mg/L p<0.0001). By the completion of the intervention, however, no significant difference was observed in the values of TNF-α, MMP- 1 and PIIINP between the 2 treatment groups (p = 0.7; p = 0.8; and p = 0.2; respectively). A composite score incorporating baseline biological marker levels was statistically associated to final right-sided pressure levels (right atrial pressure and pulmonary artery systolic pressure). Patients with baseline biological marker levels over percentile 75 maintained higher right atrial (13 mmHg; p = 0.034) and pulmonary artery systolic pressures (60 mmHg; p = 0.007) at the end of protocol. Conclusion: Regardless of allocated treatment group, biological marker levels were lower at the end of the follow-up; however, higher baseline levels of these markers were predictive of lower reductions in right atrial pressure and pulmonary artery systolic pressure. The data obtained suggest that indicators of an intense remodeling process are associated with elevated filling pressures and progression of HF.

Master of Science / Department of Kinesiology / Timothy I. Musch / Chronic heart failure (CHF) reduces nitric oxide (NO) bioavailability and impairs skeletal muscle vascular control during exercise. Reduction of nitrite (NO[subscript]2-) to NO may impact exercise-induced hyperemia particularly in muscles with pathologically-reduced O[subscript]2 delivery. We tested the hypothesis that NO[subscript]2- infusion would increase exercising skeletal muscle blood flow (BF) and vascular conductance (VC) in CHF rats with a preferential effect in muscles composed primarily of type IIb+IId/x fibers. CHF (coronary artery ligation) was induced in adult male, Sprague-Dawley rats. Following a >21 day recovery, mean arterial pressure (MAP, carotid artery catheter) and skeletal muscle BF (radiolabelled microspheres) were measured during treadmill exercise (20 m•min[superscript]-1, 5% incline) with and without NO[subscript]2- infusion. The myocardial infarct size (35 ± 3%) indicated moderate CHF. NO[subscript]2- infusion increased total hindlimb skeletal muscle VC (CHF: 0.85 ± 0.09, CHF+NO[subscript]2-: 0.93 ± 0.09 ml•min[superscript]-1•100g[superscript]-1•mmHg[superscript]-1, p<0.05) without changing MAP (CHF: 123 ± 4 mmHg, CHF+NO[subscript]2-: 120 ± 4 mmHg, p=0.17). Total hindlimb skeletal muscle BF was not significantly different (CHF: 102 ± 7, CHF+NO[subscript]2-: 109 ± 7 ml•min[superscript]-1•100g[superscript]-1, p>0.05). BF increased in 6 (~21%) and VC in 8 (~29%) of the 28 individual muscles and muscle parts. Muscles and muscle portions exhibiting greater BF and VC following NO[subscript]2- infusion were comprised of ≥63% type IIb+IId/x muscle fibers. These data demonstrate that NO[subscript]2- infusion can augment skeletal muscle vascular control during exercise in CHF rats. Given the targeted effects shown herein, a NO[subscript]2[superscript]--based therapy may provide an attractive “needs-based” approach for treatment of the vascular dysfunction in CHF.

Doctor of Philosophy / Department of Anatomy and Physiology / Timothy I. Musch / Matching local muscle O[subscript]2-supply to O[subscript]2-demand during the prodigious exercise-induced metabolic challenge is achieved through coordinated mechanisms of vascular control. The unique sensitivity of ATP-sensitive potassium (K[subscript]ATP) channels to cell metabolism indicates the potential to match energetic demand to peripheral O[subscript]2 transport. The aim of this dissertation was to determine the magnitude and kinetics of the K[subscript]ATP channel contribution to vascular control during exercise in health and heart failure. It was hypothesized that K[subscript]ATP channel inhibition via glibenclamide would, in healthy rats, 1) reduce exercising skeletal muscle blood flow and vascular conductance 2) speed the fall of microvascular O[subscript]2 driving pressure (PO[subscript]2mv; set by the O[subscript]2 delivery-O[subscript]2 utilization ratio) during muscle contractions and 3) in heart failure rats, augment the PO[subscript]2mv undershoot and delay the time to reach the contracting steady-state. A total of 55 male Sprague-Dawley rats were used under control and glibenclamide conditions (5 mg kg[superscript]-1). Hindlimb muscle blood flow (radiolabelled microspheres) was determined at rest (n = 6) or during treadmill exercise (n = 6-8; 20, 40 and 60 m min[superscript]-1, 5% incline). Spinotrapezius muscle PO[subscript]2mv (phosphorescence quenching) was measured in 16 heart failure (coronary artery ligation) and 12 healthy rats and during 180 s of 1-Hz twitch contractions (~6 V). The major effects of glibenclamide were, in healthy rats, 1) a reduction in exercising hindlimb skeletal muscle blood flow with the greatest effect in predominantly oxidative muscle fiber types and at higher running speeds 2) an increased prevalence of the undershoot of PO[subscript]2mv steady-state and doubled time to reach the steady-state and 3) in heart failure rats, a reduced baseline PO[subscript]2mv, an augmented undershoot of the steady-state and time to reach steady-state and a reduction in the mean PO[subscript]2mv during contractions. These data suggest that the K[subscript]ATP channel contributes substantially to exercise-induced hyperemia and may contribute to the slowing of VO[subscript]2 kinetics given the spatial and temporal effects of glibenclamide. The K[subscript]ATP channel-mediated protection against a severe O[subscript]2-delivery to O[subscript]2-utilization mismatch at the onset of contractions raises serious concerns for sulphonylurea treatment in diabetes which is likely to cause perturbations of [metabolite] and compromise exercise tolerance.

abstract: ABSTRACT The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2017

目的：本研究以真武湯及其加減方對慢性充血性心力衰竭作用的系統文獻研究，用Meta 分析法評價其臨床療效和安全性。 方法： 以“心力衰竭"或“心衰"或“心悸"或"喘證"或"水腫"或"胸痹"和“真武湯 為中文檢索主題詞 “heart failure" 、"zhenwu"為英文檢索詞，在中國科技期刊資料庫（ V I P ） 、中國期刊全文資料庫（ CNKI) 、萬方資料庫、中國生物醫學文獻資料庫（ CBM ） 、PubMed 、The Cochrane Library 和EMbase 的資料庫檢索近五年文獻。(2011年至2015年12月），並手工檢索相關雜誌，獲取真武湯及其加減方治療慢性充血性心力衰竭的臨床隨機對照試驗的文獻。對文獻的研究質量進行評價，並選取Jadad 評分l分及以上、資料恰當的研究，採用RevMan 5.3 軟件進行Meta 分析，用倒漏斗圖檢測是否存在發表偏倚。 結果：納入的54個研究中（4422名患者），均為單中心的開放對照試驗。這些研究對治療後的臨床療效有效率、心功能療效、6分鐘步行試驗等指標進行了評價，選取研究分組及干預措施相近、評價指標一致的研究，按同一評價指標和療效判定標準者嘗試合併, Meta 分析提示治療組改善優於對照組： (1 ) 9 個研究根據2002版的《中藥新藥臨床研究指導原則〉以臨床療效的總有效率為評價指標，其合併效應量0R=4.09, 95%CI(2.66, 6.29), Z=6.42(P<0.00001 ），兩名且比較有統計學意義，提示治療組在臨床療效總有效率上優於對照組。（ 2) 7 個研究參考2002 版的《中藥新藥臨床研究指導原則〉以心功能療效的有效率為評價指標，其合併效應量OR二3 .6 2, 95%CI(2.23, 5.88), Z=5.20(P<0.00001) ，比較有統計學意義，提示治療組在慢性心寰的心功能療效方面優於常規西藥組。（ 3) 5 個研究根據2002 版的〈中藥新藥臨床研究指導原則〉以中醫證候療效為評價指標， 其合併效應量OR=S.24, 95%CI(2.90,9.47), Z二5.4 (P<0.00001) ，兩名且比較有統計學意義，提示治療組的中醫證候療效優於對照組。（ 4 )5 個研究以6 分鐘步行試驗為評價指標，MD=41.66, 95%CI(38.57, 44.74), Z=26.45(P<0.00001) ，兩組比較有統計學意義，提示治療組對慢性心力衰竭患者6 分鐘步行試驗的改善情況優於對照組。有15 個研究提及不良反應，其中1 2 個未出現不良反應，剩餘3 個研究，治療組不良反應的病例數並不多於對照組，對症處理後緩解，或自行緩解。描述隨訪的2個研究中，發生病情惡化和猝死的為其他原因引起。故無足夠證據說明真武湯及其加減方的不良反應，其安全性有待進一步研究。 結論：真武湯及其加減方在短期內有提高CHF 患者臨床療效的總有效率、心功能療效、中醫證候療效， 改善6 分鐘步行試驗等指標的趨勢，但對於遠期復發率、病死率及安全性， 評價證據不足，有待進一步驗證。

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Background: Patients with heart failure are a common patient group in many caring facilities. Previous research shows that the number of heart failure patients may increase in the future and that nurses do not have enough knowledge of how to treat patients with heart failure. Aim: To describe patients’ experiences of living with heart failure. Method: A literature study with descriptive synthesis. Result: Patients with heart failure may experience a change in life. These changes are limitations in performing physical activities which may result in increased stress on relatives and friends. Patients can feel that they are a burden as they become more dependent on others. Heart failure causes patients to experience anxiety and fear in their lives. Despite adverse consequences of heart failure, patients can accept the situation and thereby experience well-being. Conclusion: lack of knowledge, bodily and emotional changes were the root cause of patients experiencing a change in life due to heart failure. Nurses can help patients deal with the new life through support and good information. They should be perceptive to patients' experiences and can therefore promote patient’s well-being. / Bakgrund: Patienter som lever med hjärtsvikt är en patientgrupp som förekommer inom flertalet vårdverksamheter. Tidigare forskning visar att antalet hjärtsviktspatienter kan komma att öka framöver och att sjuksköterskor inte har tillräcklig kunskap om hur de ska vårda patienter som lever med hjärtsvikt. Syfte: Att beskriva patienters upplevelser av att leva med hjärtsvikt. Metod: En litteraturstudie med beskrivande syntes. Resultat: Patienter som lever med hjärtsvikt kan uppleva förändringar i vardagen. Dessa förändringar är begränsningar av att utföra fysiska aktiviteter vilket kan resultera i ökad påfrestning för närstående och vänner. Patienter kan uppleva att de är en börda då de blir mer beroende av andra. Hjärtsvikt leder till att patienter kan uppleva oro och rädsla i vardagen. Trots negativa konsekvenser av hjärtsvikt kan patienter acceptera situationen och genom detta uppleva välbefinnande. Slutsats: Kunskapsbrist, kroppsliga- och emotionella förändringar var grundorsaken till att patienter upplever en förlorad kontroll över vardagen orsakat av hjärtsvikt. Sjuksköterskor kan hjälpa patienter att hantera den nya vardagen genom stöd och god information. De bör vara lyhörda till patienters upplevelser och kan därmed främja patienters välbefinnande.

INTRODUÇÃO: A insuficiência cardíaca (IC) constitui hoje um dos maiores problemas de saúde pública em todo o mundo, com números crescentes em qualquer análise epidemiológica. Além de representar grande demanda aos serviços de saúde, é responsável por prejuízo na qualidade de vida das pessoas. Alterações do sono têm sido descritas como freqüentes e comuns entre os pacientes com IC, e também é um dos sintomas de mais incômodo para esta população. OBJETIVO: Descrever o padrão de sono em pacientes com IC e analisar associações do padrão de sono com as seguintes variáveis: sexo, idade, fadiga, fadiga ao esforço, atividade física, classe funcional, terapia medicamentosa, dispnéia e índice de massa corporal. MÉTODO: Estudo transversal descritivo, com uma amostra não probabilística de 400 pacientes ambulatoriais (idade média 57,8 anos, DP=11,6; 64,8% eram homens; escolaridade média de 6,1 anos, DP=3,9; 82,5% em classe funcional II ou III) em tratamento de insuficiência cardíaca em um hospital de ensino. Os dados foram coletados por meio de entrevista em que os participantes responderam a um conjunto de instrumentos contendo: dados de demográficos e da insuficiência cardíaca; e avaliação do padrão de sono (Pittsburg Sleep Quality Index PSQI); de fadiga (Dutch Fatigue Scale DUFS), fadiga ao esforço (Dutch Exertion Fatigue Scale), atividade física (International Physical Activity Questionnaire) e dados sobre dispnéia, tabagismo e terapia medicamentosa. Os instrumentos mostraram boa consistência interna na amostra deste estudo (no PSQI = 0,73; na DUFS = 0,90 e na DEFS = 0,92). Testes não paramétricos foram aplicados para analisar a associação do padrão de sono com variáveis selecionadas e um modelo de regressão logística foi ajustado para investigar os preditores de maus dormidores. RESULTADOS: O escore total médio no PSQI foi 8,70 (DP = 4,39); a prevalência de maus dormidores (PSQI > 5) foi de 68,5%; e 46,5% classificou o sono como ruim ou muito ruim. Escores mais elevados no PSQI ou categoria de mau dormidor foram associados com: sexo feminino (p=0,009); não empregados (p=0,013), fadiga (p=0,000), fadiga ao esforço (p=0,000), dispnéia (p=0,000) e classes funcionais mais elevadas da IC (p=0,000). Dispnéia (OR = 3,23; IC95%1,72 6,07) e fadiga (OR = 3,45; IC95%1,82 6,49) associaram-se independentemente à categoria de mau dormidor. CONCLUSÕES: A proporção de maus dormidores entre os pacientes com IC está entre as mais altas nas doenças crônicas. Dispnéia e fadiga, sintomas comuns nessa enfermidade, aumentam significativamente a chance de ser mau dormidor. Portanto, o padrão do sono dos pacientes com IC deve ser rotineiramente avaliado. / INTRODUCTION: Heart failure (HF) is one of the largest public health problems worldwide, with increasing numbers in any epidemiological analysis. Besides representing a large demand for health services, it is responsible for poor quality of life. Sleep disorders have been described as frequent and common among patients with HF, as well as one of the most troublesome symptoms for this population. OBJECTIVE: To describe sleep patterns in patients with HF and examine associations of sleep pattern with the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, body mass index, and smoking habits. METHODS: A cross sectional study, with a non-probability sample of 400 outpatients (mean age 57.8 years (SD = 11.6), 64.8% men, mean schooling = 6.1 years (SD = 3.9); 82.5% in functional class II or III) under treatment of HF in an academic hospital. Data were collected by interviews in which participants answered a set of tools including: demographic and heart failure data; and assessment of the sleep pattern (PSQI Pittsburgh Sleep Quality Index), fatigue ( Dutch Fatigue Scale - DUFS), fatigue on exertion (Dutch Exertion Fatigue Scale), physical activity (International Physical Activity Questionnaire), and data on dyspnea, smoking habits and drug treatment. Reliability coefficients of the tools in this study were adequate ( PSQI = 0.73; DUFS = 0.90; DEFS = 0.92). Nonparametric tests were applied to analyze the association of sleep patterns with selected variables, and a logistic regression model was adjusted to investigate predictors of poor sleepers. RESULTS: The mean PSQI total score was 8.70 (SD 4.39), the prevalence of poor sleepers (PSQI> 5) was 68.5% and 46.5% rated sleep as poor or very poor. Higher PSQI scores or poor sleeper category was associated with: female gender (p = 0.009), unemployement (p = 0.013), fatigue (p = 0.000), fatigue on exertion (p = 0.000), dyspnea (p = 0.000) and higher HF functional class (p = 0.000). Dyspnea (OR=3.23; CI 95% 1.72 to 6.07) and fatigue (OR= 3.45; CI 95% 1.82 to 6.49) were independently associated with the poor sleeper category. CONCLUSIONS: The proportion of poor sleepers among patients with HF is among the highest rates in chronic diseases. Dyspnea and fatigue, commom symptoms in this illness, increase significantly the likelihood of being a poor sleeper. Therefore, the sleep pattern of HF patients has to be routinely assessed.