1. Introducción y Objetivos: Existe un gran número de modelos predictivos de desenlaces en Insuficiencia Cardíaca Aguda; sin embargo, no se conoce la utilidad clínica. Se evaluará el desempeño de los modelos incluidos en el artículo. 2. Metodología: Se realizó una revisión sistemática de los modelos predictivos de desenlaces adversos. Por lo que se realizó una búsqueda en 6 bases bibliográficas, incluyéndose todo artículo original que reporte modelos de predicción. Se utilizó la herramienta PROBAST para valorar el riesgo de sesgo en los artículos. 3. Resultados: De 2498 artículos seleccionados, 39 fueron incluidos. La mayoría provienen de Europa (46.1%), 20 de ellos evalúan mortalidad, mientras que 21 demostraron bajo riesgo de sesgo y buena aplicabilidad utilizando la herramienta de evaluación PROBAST. El sexo masculino fue el mayoritario en el 69% de artículos. La morbilidad más común es hipertensión arterial. Todos los modelos fueron validados, y más del 50% cuentan con validación externa. Borovac JA et al. presenta el AUC más alto, con 0.907. Catorce modelos utilizaron el modelo de calibración de Hosmer-Lemeshow. Ningún artículo contó con beneficio neto. 4. Conclusión: : Los estudios no muestran una adecuada evaluación de desempeño, al no presentar todas las estadísticas de medición que existen; es necesario el desarrollo de nuevos modelos con la descripción completa de estadísticas de desempeño, para llevar a cabo una adecuada comparación. / 1. Introduction and Objectives: There are currently a number of predictive models of outcomes in Acute Heart Failure (AHF); the clinical usefulness and the possible implementation of these are unknown. In this study, we propose to evaluate the performance of the predictive models for AHF. 2. Methodology: A systematic review of the predictive models of adverse outcomes was performed. Therefore, a search was made in 6 bibliographic databases, including all original articles that report prediction models. The PROBAST tool was used to assess the risk of bias in the articles.3. Results: From 2498 initial articles, we took 39 from them. The majority came from Europe (46.1%), 20 of them assess mortality, while 21 demonstrated low risk of bias and good applicability using the PROBAST assessment tool. The male sex was the majority in 69% of articles. The most common morbidity is high blood pressure. All the models were validated, and more than 50% have external validation. Borovac JA et al. it has the highest AUC with 0.907. Fourteen models used the Hosmer Lemeshow calibration model. No article had a net benefit. 4. Conclusion: The studies don’t show an adequate evaluation of performance, since they do not present all the existing measurement statistics; The development of new models with the complete description of performance statistics is necessary to carry out an adequate comparison. / Tesis

Bakgrund: Hjärtsvikt är en global folkhälsosjukdom som berör både fysiska och psykiska aspekter. Symtomen skapar begräsningar i vardagen och påverkar livskvalitén. Hjärtsvikt är en oförutsägbar sjukdom som inte kan botas men symtomen kan lindras med hjälp av medicinering, behandling och underhåll av egenvård. Syfte: Att beskriva personers erfarenhet av egenvård vid hjärtsvikt. Metod: En kvalitativ metod användes med induktiv ansats där tolv kvalitativa artiklar granskades och analyserades i fem steg enligt Friberg. Resultat: Litteraturöversiktens resultat påvisade att egenvård vid hjärtsvikt var komplext och krävde stora förändringar i vardagen. Information upplevdes som bristfällig och påverkade resultatet av egenvården. Olika former av drivkraft identifierades för att utföra egenvård där rädsla var en huvudsaklig motivationsfaktor. Resultatet presenterades i två teman: Utföra egenvård för att kvarhålla hälsa och utföra egenvård för att bibehålla sin självständighet. Slutsats: Det visade sig att personerna upplevde svårigheter i att utföra egenvård på grund av brist på information och kunskap. Komplexiteten i egenvårdsåtgärderna skapade individuell tolkning av instruktionerna. Det orsakade instabilitet i den balans som, enligt Orem, krävs för att upprätthålla egenvård. / Background: Heart failure is a disease prevalent throughout the world's population and affect both physiological and psychological aspects. Symptoms of heart failure limit the person’s quality of life and lead to a negative effect on the person’s general well-being. Heart failure is an unpredictable disease that can not be cured. The symptoms can be alleviated through medication, treatment and self-care maintenance. Aim: To describe people’s experiences of performing self-care when living with heart failure. Method: A qualitative method was used with an inductive approach where twelve articles were reviewed and analysed using the five steps approach according Friberg. Findings: Self-care was complex and required a lot of adjustments to their daily lives. A lack of information was experienced among people living with heart failure. Different aspects of motivation to perform self-care were identified with fear being a major contributing factor. The result was presented in two main themes: Perform self-care to maintain health and perform self-care to maintain autonomy. Conclusion: People were found to experience difficulties in performing self-care due to a lack of information and knowledge. The complexity of self-care actions and the room for individual interpretation caused incomplete self-care maintenance strategies. It caused disruption to the balance that is required to maintain self-care according to Orem.

Bakgrund: Hjärtsvikt är en vanlig och allvarlig sjukdom som kan få stora konsekvenser för personers hälsa. För att kunna ge personcentrerad vård, lindra lidande och underlätta vardagen för patienter med hjärtsvikt behöver sjuksköterskor få kunskap om hur det är att leva med sjukdomen. Hänsyn behöver tas till hela människan och till olika typer av lidande. Syfte: Att beskriva patienters upplevelser av att leva med hjärtsvikt i vardagen. Metod: Litteraturstudie av vetenskapliga studier med kvalitativ design. Analysen av studierna baserades på Fribergs femstegsmodell och gjordes med en induktiv ansats. Resultat: Tre övergripande teman identifierades: Begränsningar i vardagen, Social inverkan och Förändrade känslor. Slutsats: Upplevelsen av att leva med hjärtsvikt medför lidande i olika dimensioner. Förståelse för detta är värdefullt i sjuksköterskors utformning av omvårdnad vid hjärtsvikt. Omvårdnaden bör fokusera på att hjälpa patienter hantera de upplevelser som sjukdomen ger upphov till. / Background: Chronic heart failure is a common and severe illness which can have major consequences to a person's health. To be able to give patients a person centered care, ease suffering and facilitate everyday life for patients with chronic heart failure, nurses need knowledge of what it is like to live with heart failure. Nurses need to take regard to the whole person and different aspects of suffering. Aim: To describe patients' experiences of living with chronic heart failure in everyday life. Method: A literature review of scientific papers with a qualitative design. The analysis was based on Friberg’s five step model and was carried out with an inductive approach. Results: Three general themes were identified: Limitations in everyday life, Social impact and Changed emotions. Conclusion: The experience of living with heart failure involves suffering in various dimensions. These understandings are valuable in the design of nursing interventions in heart failure. Nurses should focus on helping patients to handle the experiences caused by heart failure.

L'insuffisance cardiaque (IC) est l'évolution terminale de nombreuses pathologies cardiaques, notamment de l'infarctus du myocarde (IDM). Elle se caractérise par la mort des cellules contractiles du cœur, les cardiomyocytes (CMs), et par l'incapacité des CMs survivants à régénérer le tissu lésé. Les thérapeutiques disponibles ralentissent sans toutefois stopper la progression de l'IC, expliquant l'émergence du concept de régénération tissulaire pour restaurer la fonction du cœur. Dans ce domaine, la thérapie cellulaire par injection de cellules exogènes (souches/progénitrices) dans le myocarde représente l'approche la plus conventionnelle. Malgré des résultats expérimentaux prometteurs, l'efficacité de cette stratégie reste encore mal établie en clinique. Ainsi, identifier de nouvelles voies thérapeutiques s'avère essentiel en médecine régénérative cardiaque. Jusqu'à récemment, les CMs survivant à l'IDM ont été ignorés en régénération cardiaque car considérés comme bloqués dans un état post-mitotique. Or, des études récentes ont montré que ces CMs adultes différenciés résidents sont dotés d'un potentiel naturel faible de prolifération qu'il est possible de stimuler afin de régénérer le tissu lésé. L'enjeu est maintenant d'identifier les mécanismes moléculaires naturels bloquant la prolifération du CM en vue d'une modulation en thérapeutique et a constitué le contexte de mon travail de thèse. Dans ce contexte, l'équipe a récemment identifié Ephrine-B1 comme nouvelle protéine spécifique de la membrane latérale (ML) du CM stabilisant la morphologie en brique du CM adulte et la cohésion du tissu cardiaque. De façon inattendue, au cours de mon travail de doctorat, nous avons montré, grâce à de multiples approches in vitro et in vivo, que la délétion d'Ephrine-B1 (souris KO ou thérapie génique avec interférence à l'ARN) confère au CM adulte un potentiel de prolifération important (~ 15%), mobilisé uniquement en situation de stress cardiaque (vieillissement, apectomie adulte ou IDM) et permettant la régénération cardiaque. Ephrine-B1 apparaît donc comme une cible prometteuse en médecine régénératrice cardiaque. [...] / Heart failure (HF) is the convergent evolution of many cardiac diseases, particularly myocardial infarction (MI). At the tissue level, HF is characterized by the death of cardiac contractile cells, the cardiomyocytes (CMs), and by the incapability of survivor CMs to regenerate the damaged tissue. Various pharmacological therapies have proven to slow HF progression but not to block it. Thus, major efforts have been developed in regenerative cardiac medicine to repair the scar tissue of failing heart to restore the function. In this context, cardiac cell therapy (injection of exogenous stem/progenitor cells) has been one of the more promising approaches. Besides its encouraging results in laboratories, its clinical benefit still remains elusive. Thus, there is an urgent need for identifying new therapeutic strategies for cardiac regenerative medicine. Until now, surviving resident CMs to MI have been ignored in cardiac regeneration since considered in a post-mitotic state, unable to proliferate. However, recent studies demonstrated that adult differentiated CMs can naturally proliferate but at low rate and that it is possible to stimulate this potential to regenerate the damaged tissue. The issue remains now to identify the natural molecular mechanisms involved in the post-mitotic blockage of adult CMs and has constituted my main thesis project. In this context, the team has recently identified Ephrin-B1 as a new specific protein of the CM lateral membrane (LM),stabilizing the adult CM rod-shape and the overall cardiac tissue cohesion. Surprisingly, during my thesis, we demonstrated, based on multiple in vitro and in vivo approaches, that Ephrin-B1 deletion (KO mice or RNA-interference based-gene therapy) confers an important proliferative potential to the adult CM. Interestingly, this potential is only mobilized under cardiac stress (aging, adult apectomy or MI). Thus, Ephrin-B1 deletion in CMs leads to substantial cardiac regeneration through their proliferation. Ephrin-B1 appears as a promising target for cardiac regenerative medicine. [...]

Contexte : Le lien entre insuffisance cardiaque et obésité n’est pas clairement établi, et les mécanismes mis en jeu le sont encore moins.Objectif : Confirmer l’existence de la cardiopathie métabolique et explorer ses mécanismes physiopathologiques par mise au point de modèles de souris associés à des techniques de modulations.Méthode : Etablissement d’un modèle de souris sauvages (WT, C57/BL6J, mâle) soumises à un régime riche en graisse (60% de graisse, HFD), associé à des techniques de modulation comme l’exercice (natation) et l’ablation de la graisse viscérale. Utilisation de souris déficientes pour le gène de l’ostéopontine (voie de la sénescence). Analyse des effets du régime HFD sur le tissu adipeux et ses fonctions métaboliques, et sur le myocarde et sa contractilité. Analyse en parallèle des effets du vieillissement physiologique chez les souris WT et déficientes sur ces mêmes paramètres. Recherche d’un lien entre dysfonction du tissu adipeux et dysfonction cardiaque au travers de l’exploration des voies de la sénescence, notamment celle de l’ostéopontine.Résultats : Nous avons tout d’abord confirmé l’existence d’une cardiopathie métabolique induite par le régime HFD. Cette cardiopathie se manifestait par un remodelage avec fibrose myocardique associé à une dysfonction systolique visible uniquement en strain rate (FEVG normale) et en hémodynamique invasive. Chez ces souris obèses, nous avons retrouvé une augmentation du taux plasmatique de marqueurs pro-fibrotiques (TGF, leptine) et une baisse des marqueurs protecteurs (adiponectine), le tout secondaire à une dysfonction du tissu adipeux qui prédominait au niveau viscéral. En parallèle, nous avons observé une fibrose myocardique avec dysfonction systolique au cours du vieillissement physiologique, elle-même associée à une augmentation de la production d’ostéopontine par le tissu adipeux viscéral. D’ailleurs, les souris déficientes pour le gène de l’ostéopontine étaient protégées de la sénescence cardiaque. L’ablation de la graisse viscérale et l’utilisation de drogues inhibant l’ostéopontine chez les souris WT protégeaient également de la sénescence cardiaque ce qui confirmait le rôle du tissu adipeux dans ce processus via la production d’ostéopontine. Enfin, des résultats préliminaires chez les souris HFD montraient également un effet protecteur de l’ablation de la graisse viscérale vis-à-vis de la dysfonction cardiaque.Conclusion : La cardiopathie métabolique secondaire à l’obésité est donc une entité bien réelle. Nous avons établi la preuve de concept du rôle de la sénescence du tissu adipeux viscéral dans les altérations cardiaques qui sont assimilables à un vieillissement cardiaque prématuré. L’ostéopontine est une cible thérapeutique potentielle à explorer. / Background: The link between heart failure and obesity is not clear, and the mechanisms are unknown.Objectives: To validate the existence of metabolic cardiomyopathy and to explore the underlying mechanisms using mice models and rescue technics.Method: Establish a wild type mice model (WT, C57/BL6J, male) fed with a high fat diet (60% of fat, HFD), associated with rescue technics such as exercise (swimming) or visceral fat ablation. Use of a transgenic mice model with a deletion for the Osteopontin gene (OPN, senescence pathway). Analysis of HFD consequences on the adipose tissue histology and function, on the myocardial histology and function. In addition, analysis of the effects of physiological aging on the same parameters in WT and OPN mice. Finally, explore the link between adipose tissue dysfunction and cardiac dysfunction through the senescence pathway analysis, especially the OPN pathway.Results: First, we confirmed the development of a metabolic cardiomyopathy in HFD mice, which was characterized by left ventricular remodeling with myocardial fibrosis associated with a systolic dysfunction detected only by strain rate (normal LVEF) and in-vivo hemodynamic technics. In addition, we observed in the plasma of HFD mice an increase in pro-fibrotic markers (TGF, leptin) and a decrease in protective markers (adiponectine), which was related to a visceral adipose tissue dysfunction. We also observed a myocardial fibrosis with systolic dysfunction during physiological aging associated with an increased release of osteopontin from the visceral adipose tissue. Moreover, OPN ko mice were protected from cardiac senescence. The surgical removal of the visceral adipose tissue and the use of OPN inhibitors in WT mice also protected from cardiac senescence, which corroborated the role of the adipose tissue and its OPN production in the aging process. Finally, preliminary results on HFD mice showed a cardiac protection from visceral adipose tissue removal.Conclusion: The metabolic cardiomyopathy is a real entity, in which our data establish the proof-of –concept that adipose tissue senescence plays a key role in cardiac alteration that may be considered as premature cardiac aging. OPN may constitute a promising therapeutic target.

Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. Local Problem: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear. Methods: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process. Interventions: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record. Results: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%. Conclusion: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.

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Bakgrund: Cirka 200 000 personer i Sverige uppskattas leva med symtom på hjärtsvikt. Risken för hjärtsvikt ökar med åldern och uppskattningsvis 10% av befolkningen över 80 år har hjärtsvikt. Hjärtsviktspatienter rapporterar att de har lägre livskvalitet och lider av psykiska besvär i högre utsträckning än de utan hjärtsvikt. Syfte: Att beskriva hjärtsviktspatienters upplevelse av att leva med kronisk hjärtsvikt. Metod: Allmän litteraturstudie på kvalitativ forskning med Polit och Becks niostegsmodell. 11 artiklar inkluderades och alla bedömdes ha hög eller medelhög kvalitet. Resultat: Sex huvudteman och sex subteman framkom: Uppfattning om livet – förändrad inställning till livet, begränsningar i livet; Förändrade relationer och livssituation – familj och vänner, livsvillkor; Känslomässiga förändringar – positiva känslor, negativa känslor; Upplevelsen av egenvård; Tankar om framtiden och Upplevelser av vården. Slutsats: Hjärtsvikt påverkar alla delar av livet både praktiskt och emotionellt. Deltagarnas sociala och ekonomiska status påverkades av sjukdomen. Många kände ångest och oro över sin sjukdom och upplevde behandlingen som påfrestande. De upplevde också begränsande fysiska symtom. Deltagarna lärde sig leva med sin sjukdom men det krävde god sjukvård. För att kunna genomföra egenvård behövdes ett bra samarbete med vårdpersonal. Ökad förståelse kan leda till effektivare interventioner och därmed förbättrad livssituation hos hjärtsviktspatienter och lägre samhällskostnader.Nyckelord: Kronisk hjärtsvikt, patientupplevelse, livssituation / Background: Approximately 200 000 people in Sweden have symptoms of heart failure. The risk of getting heart failure increases by aging and about 10% of the population over the age of 80 have heart failure. Patients with heart failure report lower quality of life and experience psychological difficulties.  Aim: To describe the experience of living with chronic heart failure. Method: Literature based review of qualitative research following Polit and Beck’s flow of tasks in a literature review. Eleven articles were included, and the quality was deemed as high or moderate.Results:  Six themes and six sub themes were found. Perception of life - adjusted attitude to life, limitations in life; Changes in relationships and situation in life - Family and friends, living conditions; Emotional changes - positive emotions, negative emotions; Experience of self-care; Thoughts regarding the future and Experiences from health care.  Conclusion: Heart failure affects all parts of life, both the practical and the emotional parts. The participant’s social and economic status were affected by the disease. Many experience anxiety and worry about their health and the treatment was stressful. They also experienced physical limitations. They learned how to live with their condition, but good health care was needed. Self-care required a good collaboration with healthcare professionals. Increased understanding for the patient experience can lead to better life situations and less economic burden.