Hjärtvikt är en vanligt förekommande kronisk sjukdom i Sverige som ger symtomen trötthet, andfåddhet och ben svullnader. Personers förmåga att utöva en god egenvård är en mycket viktig del, och kan öka livskvalitén och överlevnaden vid hjärtsvikt. Litteraturgenomgången tyder på att det hos vissa personer med hjärtsvikt finns en bristande förmåga att utöva egenvård. Syfte: Att beskriva och identifiera vilka faktorer som påverkar personers egenvård vid hjärtsvikt. Metod: En litteraturöversikt med kvalitativ ansats utfördes. Totalt 10 studier granskades och analyserades med hjälp av Fribergs femstegsmodell. Resultat: Ur granskningen och analysen kom fem subteman fram som sedan delades in i två huvudteman. Huvudteman blev sociala faktorer och hälsofaktorer. Resultatets underteman blev miljöfaktorer, erfarenhet och kunskap, relationer och stöd, emotionella uttryck samt fysiologiska faktorer. Några av de faktorer som redovisades i resultatets olika underteman var ålder, tillgänglighet, nedstämdhet och bristfällig kunskap, de faktorerna påverkade egenvården hos personer. Slutsats: Det är viktigt att som sjuksköterska vara medveten om att olika faktorer kan ha olika betydelse för personens egenvårds hantering, vikten av personcentrerad omvårdnad är tydlig Nyckelord: hjärtsvikt, omvårdnad, egenvård, egenvårdshantering / Heart failure is a common chronic disease occurring in Sweden. Symptom that can arise is fatigue, shortness of breath and edema. The ability to practice a good self-care is a really important part and can increase the quality of life and the survival with heart failure. A review of previous studies suggests that some person’s with heart failure have a lacking ability to practice an adequate self-care. Purpose: The purpose of the study is to describe and identify the factors that influence a person’s self-care in heart failure. Method: A literature review with a qualitative approach was carried out. A total of 10 studies was reviewed and analyzed with the use of the five step-model created by Friberg. Result: Out of the survey and the analysis, five subthemes were found which later were divided into two themes. The themes that were created were social factors, and health factors. The subthemes of the result were factors in the environment, experience and knowledge, relations and support, emotional expression and physiological factors. Some of the factors that will be found in the subthemes are, age, availability, depression and lack of knowledge, which was factors that gave an impact to the self-care of a person. Conclusion: It is important as a nurse to be aware of the fact that different factors could have various meanings for a person’s self-care management, the importance of person-centered-care is very clear. Keywords: heart failure, self-care, nursing, self-care management

Background: Patients older than 75 years with heart failure (HF) are at increased risk for mortality and hospital admissions. Echocardiography and brain natriuretic peptides (BNP, NTproBNP) are important diagnostic tools but sparsely evaluated in elderly PHC patients. Aims: Validate the clinical diagnosis of HF, investigate the types of HF and underlying cardiovascular disorders with focus on sex and age differences. Explore the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of BNP and NT-proBNP in patients with systolic HF. Study the associations of HF or NTproBNP on all-cause and cardiovascular mortality. Study the prognostic value of different biomarkers and HF, on all-cause and cardiovascular hospitalizations. Methods: Patients with suspected HF were recruited from one selected PHC and registered on a prespecified record and referred for an echocardiographic examination and a final cardiologist consultation. Blood samples for natriuretic peptides were stored frozen at – 70° C. Death certificates were used to register all-cause mortality and cardiovascular mortality. To register hospitalisations, medical records were used and classification was defined according to ICD-10. Results The GPs identified 121 women and 49 men with suspected HF of whom 39% (51 women and 16 men) were above 80 years. Myocardial infarction (OR:4,3 CL: 1,8-10,6) hypertension (OR:3,4 CI:1,6-6,9) atrial fibrillation (OR:2,8 CL:1,0-7,9) predicted a confirmed diagnosis of HF. Confirmed HF was verified in 45% of the patients and was significantly more common in men than women (p=0,02). The best NPV was 88 % for NT-proBNP (200 ng/L) and 87 % for BNP (20 pg/ml). Age and male gender were independently associated with higher levels of NT-proBNP. During the 10-year follow up, 71 out of 144 patients died. In univariate Cox regression analysis, significant associations were found for overall HF (hazard ratio [HR]: 1.86; 95% confidence interval [CI]:1.15- 3.01), isolated systolic HF (HR:1.95; 95% CI:1.06-3.61), and combined (systolic and diastolic) HF (HR:3.28; 95% CI:1.74-6.14) with all-cause mortality, but not for isolated diastolic HF. In multivariable analysis, age (HR: 1.11; 95% CI: 1.06-1.17), kidney dysfunction (HR:1.91; 95% CI:1.11- 3.29), smoking (HR:3.70; 95% CI:2.02-6.77), and NTproBNP (HR:1.01; 95% CI:1.00-1.02), but not any type of HF, significantly predicted all-cause mortality. During ten years, 136 (80%) patients were hospitalised with 660 and 207 for all-cause and cardiovascular hospitalisations, respectively. Age (OR:1.1; 95% CI:1.01-1.15) and underlying heart disease (OR:3.5; 95% CI:1.00-11.89), significantly predicted all-cause hospitalisation. Overall HF (HR:1.8; 95% CI:1.06-2.94) significantly predicted time to first all-cause hospitalisations. For cardiovascular hospitalisations age (OR:1.1;95%CI:1.01-1.12), underlying heart disease (OR:3.4;95%CI:1.04-11.40) and NTproBNP ≥800 ng/L (OR:4,3;95%CI:1.5-12.50) were significant predictors. Conclusion: A confirmed diagnosis of HF was present in 45% of the patients. NPV was high, but not as high as in younger patients with HF. Patients with systolic HF had a higher mortality than patients with diastolic HF compared to patients with no HF. Patients with combined HF were at even higher risk for all-cause mortality and cardiovascular mortality. Age, kidney dysfunction, NTproBNP and smoking predicted mortality. Age and underlying heart diseases were predictors for all-cause hospitalisations and together with NTproBNP they also predicted cardiovascular hospitalisations.

No description available.

A descriptive design was used in this study to describe the feeding behaviors (as defined by changes in body position) in infants with congestive heart failure secondary to congenital heart disease. In addition, short term physiologic changes associated with the behaviors were measured through the use of pulse oximetry and cardiorespiratory monitors. Nine infants were observed in this study as they were being fed by their nurses. The method chosen was naturalistic observation. Descriptive statistics were used to analyze the demographic data and the measured physiologic variables. A point by serial correlation was conducted to describe any relationships between the position changes and the measured physiologic variables. Statistically significant relationships were found between certain positions and oxygen saturation, heart rate and respiratory rate. The results indicate that infants do experience position changes that are accompanied by changes in physiologic variables during feeding. These position changes can be categorized as infant-mediated or nurse-mediated.

Bakgrund: Antalet patienter med hjärtsvikt kommer att öka i framtiden då fler äldre överlever en hjärtinfarkt vilket är en vanlig orsak till hjärtsvikt. Många patienter med hjärtsvikt väljer att vårdas i sitt hem vilket innebär en utmaning för distriktssköterskor i den kommunala hälso- och sjukvården. Syfte: Syftet med denna studie är att belysa distriktssköterskors stöd till patienter med svår hjärtsvikt som vårdas i hemmet inom kommunal hälso- och sjukvård. Metod: Genom intervjuer samlades data in från sex distriktssköterskor. Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Ur analysen framträdde fem kategorier: samordna och utföra vårdinsatser, bygga upp nära samspel med anhöriga, följas åt från ett palliativt skede till slutet, bristande läkarmedverkan samt brister i organisationen. Konklusion: I resultatet framkommer att det är viktigt att distriktssköterskan känner sina patienter väl för att kunna ge rätt stöd. Det framträder också att anhöriga har behov av stöd för att orka och känna trygghet vilket kan vara avgörande om patienten kan vårdas i hemmet. Brister finns både internt och externt som kan ge konsekvenser. Fortsatta studier kan vara inom en kommun med läkarunderstödda team tillsammans med kommunal hälso- och sjukvård. / Background: The number of patients with heart failure will increase in the future as more older people survive a heart attack, which is a common cause of heart failure. Many heart failure patients choosing to receive care in their home which poses a challange for district nurses in the community health-care.  Aim: The aim of this study is to illuminate districtnurse´s support for patients with grave heart failure at home in community home care Method: Six interviews were conducted with districtnurse´s. The data from these interviews were analyzed with an inductive content analysis.  Results: From the analysis, five major categories were found; coordinate care efforts, build close interactions with relatives, follow each other from a palliative stage to the end, lack of physician involvement and deficiencies in the organization. Conclusion: The result shows that it is important that the district nurse know their patient´s well in order to provide the proper support. It also appears that relatives need support to cope and feel secure, which can be crucial if the patient can be cared for at home. Deficiencies are both internally and externally that can have consequenses. Further studies may be within a municipality with a physician-sponsored team together with community health-care.

Hjärtsvikt är ett sjukdomstillstånd som utmanar patienten både fysisk, psykisk och socialt och utgör idag den vanligaste diagnosen för patienter över 65 år. Därmed är det även den vanligaste inläggningsorsaken för patienter i denna åldersgrupp. Syftet med litteraturstudien var att belysa hur patienter som lever med hjärtsvikt upplever sin hälsa och egenvård. Metoden grundar sig på Polit och Beck (2012) genomförande av en litteraturstudie där en nio-stegsmodell använts som mall för utförandet av litteraturstudien. Sammanlagt elva vetenskapliga kvalitativa studier granskades efter sökningar i de elektroniska databaserna CINAHL och PubMed. De valda studierna kvalitetsgranskades, dataanalyserades och bearbetades vilket resulterade i tre kategorier. Resultatets tre huvudkategorier var fysisk upplevelse, psykisk upplevelse samt social upplevelse. Kategorierna består av patienters upplevelse av hälsa och egenvård. Slutsats Patienter som lever med hjärtsvikt världen över upplever hälsa och egenvård på olika sätt relaterat till hur och om egenvård utförs samt patientens inställning till sitt sjukdomstillstånd.

Bakgrund: Hjärtsvikt är en kronisk sjukdom som ökar med stigande ålder över hela världen. Personer med hjärtsvikt har en hög symtombörda och det leder till begränsningar såväl psykiskt som fysiskt och socialt. Syfte: Att beskriva upplevelser i livets slutskede hos personer som lever med svår hjärtsvikt. Metod: Litteraturöversikt baserad på 13 kvalitativa vetenskapliga artiklar som analyserades enligt Fribergs modell. Resultat: Analysen resulterade i fem kategorier; Begränsningar i det dagliga livet, En förändrad identitet, Att uppleva trygghet, Att leva mellan hopp och förtvivlan och att planera för livets slut. Slutsats: Personer som lever med hjärtsvikt i livets slutskede upplever att de blir påverkade fysiskt, psykiskt, socialt och existentiellt i det dagliga livet. Personerna upplever en förlust av identitet. Att känna trygghet och kontinuitet upplevdes som viktiga komponenter för att hantera sjukdomens oförutsägbara natur. / Background: Heart failure is a chronic disease, increasing in the world as the population gets older. Persons living with heart failure has high symtom burden and that leads to limitations in a physical, psychological and social way. Aim: To describe experiences in the end of life among person´s living with advanced heart failure. Method: A literature study based on 13 scientific qualitative articles that was analyzed according to Friberg´s model. Results: The analysis resulted in five categories; Limitations in the daily life, a changed identity, sense of security, Living between hope and despair and Planning for the end of life. Conclusion: Persons living with advanced heart failure in the end of life experience that they become affected in their daily life in a physical, psychological, social and existential way. They experience a loss of their identity. To feel secure and continuity are important factors in dealing with the uncertainty of the disease.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / BACKGROUND: In order to improve the quality and efficacy of healthcare while reducing the overall cost to deliver that healthcare, it has become increasingly important to manage utilization of services for populations of patients. Healthcare systems are aggressively working to identify patients at risk for hospital readmissions. Although readmission rates have been studied before, parameters for identifying patients at risk for readmission appear to vary depending the patient population. We will examine existing Electronic Health Record (EHR) data at Banner Health to establish what parameters are clinical indicators for readmission risk. Three conditions were identified by the CMS to have high and costly readmissions rates; heart failure (HF), acute myocardial infarction (AMI), and pneumonia. This study will focus on attempting to determine the primary predictive variables for these three conditions in order to have maximum impact on cost savings. METHODS: A literature review was done and 68 possible risk variables were identified. Of these, 30 of the variables were identifiable within the EHR system. Inclusion criteria for individual patient records are that they had an index admission secondary to AMI, heart failure, or pneumonia and that they had a subsequent readmission within 30 days of the index admission. Pediatric populations were not studied since they have unique factors for readmission that are not generalizable. Logistics regression was applied to all data including data with missing data rows. This allowed all coefficients to be interpreted for significance. This model was termed the full model. Variables that were determined to be insignificant were subsequently removed to create a new reduced model. Chi square testing was then done to compare the reduced model to the full model to determine if any significant differences existed between the two. RESULTS: Several variables were determined to be the significant predictors of readmission. The final reduced model had 19 predictors. When analyzed using ROC analysis, the area under the curve (AUC) was 0.64. CONCLUSION: Several variables were identified that could be significant contributors to readmission risk. The final model had an AUC on it ROC of 0.64 suggesting that it would only have poor to moderate clinical value for predicting readmission.

Bakgrund: Hjärtsvikt kan vara ett påfrestande tillstånd och är vanligt bland den äldre befolkningen. Behandlingen består utöver medicinska åtgärder till stor del av egenvård för den drabbade. Personen måste därför ta mycket eget ansvar, vara väl informerad och ha bra stöd ifrån vården, vilket kräver att vården måste vara personcentrerad. Syfte: Att ur ett patientperspektiv beskriva upplevelsen av att leva med hjärtsvikt och hur det påverkar livskvaliteten. Metod: En Litteraturöversikt med litteratur hämtad från databaserna CINAHL, PubMed, PsycINFO och Web of Science. Resultat: Personerna med hjärtsvikt upplevde många olika besvär, både fysiska, psykiska och sociala som påverkade deras dagliga liv i olika omfattning. Situationen gick att lära sig leva med och det var möjligt att uppleva livskvalitet. Många ville lära sig mer men en del var inte medvetna om att de hade hjärtsvikt.. Slutsats: Livet med hjärtsvikt kan innebära stora påfrestningar och påtvingade förändringar både fysiskt, psykiskt och socialt. Men det finns möjlighet att leva ett tillfredsställande liv och känna god livskvalitet. Kontakten med sjukvården är både en tillgång såväl som en källa till frustration. Upplevelserna bör beaktas för att sjuksköterskan ska kunna ge både vård och stöd som är individanpassad och som främjar personens egna resurser samt egenvårdsförmåga. / Background: Heart failure can be a trying and distressing condition, common among the elderly population. Apart from the medical measures, treatment involves a lot of self-care. Healthcare professionals need to provide education and support, since this involves the patient taking a great deal of personal responsibility. With this in mind, healthcare needs to be person-centered. Aim: To describe, from a patients’ perspective, the experience of living with heart failure and how it affects quality of life. Method: A literary review, with studies collected from databases CINAHL, PubMed, PsycINFO and Web of Science. Results: The findings show that people with heart failure experienced many different issues, physical, social and mental, which had an impact on their daily life. Despite this, it was possible to come to terms with the situation and experience quality of life. The will to learn more about the condition was common although many were not aware of their diagnosis. Conclusion: Living with heart failure can be trying and mean forced alterations to physical, mental and social aspects of life. However, it is possible to live a satisfying life and experience good quality of life. Having access to healthcare is both an asset as well as a source of frustration. Nurses need to be aware of these experiences in order to be able to provide patient-centered care and support the patient’s resources and self-care abilities.

The overall aim of the present thesis was to describe the meaning of living with heart failure as a middle-aged person. In particular, the relation between the persons’ life-situations and formal care was explored. An additional aim was to uncover the meaning of support as experienced by people living with heart failure in middle age. The study used a caring science perspective and a reflective lifeworld approach, founded on phenomenological philosophy. Interviews were used for data collection and data were analyzed using essence-seeking analysis. The thesis is based on four empirical studies and the results were synthesized into a general structure, presented in the thesis. The results of study I illuminate influences and changes to the life-situation that people living with heart failure in middle age can experience. The social world, i.e. intersubjective relationships, vocational situations, and formal care emerge as fundamental to the individuals, as well as the individuals’ own experiences of themselves and their body. The life-situation is frail and depicted by insecurity and uncertainty. The results of study II illuminate that people living with heart failure in middle age experience exposure and vulnerability in relation to formal care. While the context of formal care provides alleviation and medical treatments, the results at the same time revealed experiences of dependency and unclear participation. The results from studies III and IV clarify that support means to know that help is available concerning practical matters or flexibility at work. However, it also reveals that support means a sense of security or safety in relation to other people, such as friends, families, employees, and formal carers. Knowledge, and control are central aspects of the phenomenon of support in relation to heart failure. The phenomenon’s general structure illustrate that living with heart failure as a middle-aged person is depicted by ambiguity in relation to other persons, daily life and formal care. The general structure is intertwined with an altered experience of the body, and a life-situation in a borderland between health and illness. The phenomenon is illuminated by the meaning constituents: A borderland between health and illness, and A tension between what is supportive and what is not. The phenomenon’s outer horizon is understood as A changed body and a threat against life, meaning that the phenomenon stands out against a background of the limits which the body sets on the persons. The present study illustrates that support from others give people living with heart failure in middle age inner strength which they need if they are to adjust their life goals. However, the results also revealed that formal care at times is insufficient and the support which the patient’s need is forsaken. When people living with heart failure in middle age are to take on their own responsibilities for their health process they need information, knowledge and to be participating in care. Furthermore, formal carers need to focus more on the patient’s social roles and networks. A lifeworld-led perspective in formal care can unite a biomedical and a caring science perspective, and formal carers will be able to pay more attention to the patients’ changed life-situation rather than focusing the patient’s failing hearts.