Bakgrund: I Europa antas cirka en till två procent av den vuxna befolkningen lida av hjärtsvikt och prevalensen beräknas vara cirka 10 procent hos personer över 70 år. Hjärtsvikt innebär att hjärtas pumpförmåga försämras och personen med hjärtsvikt drabbas ofta av typiska symtom för hjärtsvikt och kliniska fynd och kräver farmakologisk behandling. Trots en adekvat behandling är syndromet progriderande och övergår till sist i kronisk avancerad hjärtsvikt med hög symtombörda och hög mortalitet. Livskvaliteten hos personer med kroniska sjukdomar är ofta låg och livskvaliteteten hos personer med kronisk avancerad hjärtsvikt anses vara betydligt lägre än hos den genomsnittliga befolkningen. Syfte: Syftet med litteraturöversikten var att belysa vilka faktorer som påverkar livskvaliteten hos patienter med kronisk avancerad hjärtsvikt i ett palliativ skede. Metod: Arbetet utfördes som en litteraturöversikt med systematisk litteratursökning som utfördes i databaserna CINAHL och PubMed. Litteraturöversikten består av 16 vetenskapliga artiklar med kvantitativ och kvalitativ design vilka analyserades med en integrerad analys. Resultat: Resultatet visade att både personliga och omgivande faktorer var av betydelse. Fysiska och psykiska symtom kunde påverka livskvaliteten negativt medan en godkommunikation, kunskap och information samt vilken vårdtyp som erhölls var faktorer somkunde styrka livskvaliteten. Slutsats: Personer med kronisk avancerad hjärtsvikt lider ofta av en ökad fysisk och psykisk symtombörda där livskvaliteten kan påverkas negativt. Det visar också vikten av ett gott samarbete mellan patient och sjuksköterska där vårdtypen kunde utgöra en stor skillnad förpersonen. / Background: In Europe, about one to two percent of the adult population is assumed to suffer from heart failure and prevalence increases to an estimated 10 percent in people over the age of 70. Heart failure means that the pumping ability of the heart deteriorates and the person often suffers from serious symptoms, requiring pharmacological treatment. Despite there being adequate treatments widely available, the syndrome often turns in to advanced heartfailure with severe symptoms and a high mortality rate. The quality of life for people with chronic diseases is often low and lower still for people with chronic advanced heart failure. Those suffering are considered to have a significantly lower quality of life than the averageperson. Aim: The aim of the literature review was to highlight which factors affect the quality of life of patients with chronic advanced heart failure at a palliative stage. Method: The study was conducted as a literature review with systematic literature search conducted in the CINAHL and PubMed databases. The literature review consists of 16 scientific articles with quantitative and qualitative design that were analyzed with anintegrated analysis. Results: The results showed that both personal and surrounding factors were of importance. Physical and psychological symptoms could negatively affect quality of life, while good communication, knowledge, and information, as well as the type of care were factors thatcould improve the quality of life. Conclusion: Persons with chronic advanced heart failure often suffer from the burdens of both physical and mental symptoms, where the quality of life is negatively affected. It also shows the importance of good cooperation between patient and nurse, where a certain type of carecould represent a major improvement for the person.

Hjärtsvikt är ett kliniskt syndrom som ofta innebär stor påverkan på det dagliga livet med nedsatt livskvalitet och frekventa sjukhusinläggningar. Förekomsten av hjärtsvikt ökar i världen och behovet av sjukhusvård förväntas stiga de närmaste åren. Egenvården är en viktig del av behandlingen vid hjärtsvikt. En välinformerad och motiverad patient bidrar till optimal egenvård. Telemonitorering används i allt större utsträckning för att patienter ska kunna monitorera sina symtom och vitala parametrar i hemmet. Syftet var att undersöka patientens upplevelse av att använda telemonitorering som en del av egenvården vid hjärtsvikt. Metoden var litteraturöversikt med systematiskt arbetssätt. Databassökningar gjordes i PubMed och Cinahl där 16 artiklar inkluderades. Artiklarna var publicerade 2011–2021. Artiklarna kvalitetsgranskades med modifierat bedömningsunderlag av Caldwell et al. (2011). Analysen utfördes med integrerad analys. Resultatet visade att telemonitoreringen bidrog till att patienterna upplevde en ökad trygghet, tillgänglighet och delaktighet. Patienterna uppgav att deras självförtroende ökade när det kom till att ta hand om sin hjärtsvikt. Ansvaret och motivationen för egenvården blev större hos patienterna och de fick en ökad insikt om hur egenvården är kopplat till olika symtom. Genom telemonitoreringen fick patienterna en ny rutin i sin egenvård och tekniken var ett stöd för dem i sin egenvård och hälsa. Telemonitoreringen bidrog även till att några patienter upplevde att ansvaret över egenvården inte var deras utan att det låg på vårdpersonalen. Vissa patienter upplevde att tekniken var krånglig och svår vilket skapade sämre följsamhet och ökad oro hos patienterna. Slutsatsen är att telemonitorering upplevdes som ett egenvårdsstöd hos patienter med hjärtsvikt. Genom detta stöd kunde faktorer som egenvårdsunderhåll, uppfattning av symtom och egenvårdshantering blir möjliga vilka är grunden i en god egenvård vid hjärtsvikt. / Heart failure is a clinical syndrome that often has a major impact on daily life with reduced quality of life and frequent hospitalizations. The incidence of heart failure is increasing in the world and hospital care is expected to increase in the next few years. Self-care is an important part of the treatment for heart failure. A well-informed and motivated patient contributes to optimal self-care. Telemonitoring is increasingly used to enable patients to monitor their symptoms and vital parameters at home. The aim was to investigate patient's experience of using telemonitoring as a part of self-carein heart failure. Method was a literature review with a systematic approach. Database searches were performed in PubMed and Cinahl where 16 articles were included. The articles were published between 2011–2021. The articles were quality reviewed with a modified assessment tool by Caldwell et al. (2011). The analysis was done with integrated analysis. The results showed that telemonitoring contributed to the patients experiencing increased security, accessibility and participation. The patients stated that their self-confidence increased when it came to taking care of their heart failure. Responsibility and motivation for self-care increased among the patients and they gained an increased insight into how self-care was linked to different symptoms. Through telemonitoring, patients gained a new routine in their self-care and the technology was a support for them in their self-care and health. Telemonitoring also contributed to some patients feeling that the responsibility for self-care was not theirs but that it was up to the care staff. Some patients experienced that the technology was complicated and difficult to manage, which created poorer compliance and increased anxiety in the patients. The conclusion is that telemonitoring was perceived as a self-care support in patients with heart failure. Through this support factors such as self-care maintenance, symptom perception and self-care management may be possible which are the basis of good self-care in heart failure.

Bakgrund  Hjärtsvikt är en folksjukdom som orsakar lidande hos de drabbade och medför dessutom ett stort ansvar för den egna hälsan. Egenvård är för personer med hjärtsvikt en viktig del för att förhindra försämringar då snabba förändringar av sjukdomstillståndet kan ske. Om den drabbade saknar den motivation eller kunskap som krävs kan det följaktligen medföra komplikationer. Sjuksköterskan har därför ett stort ansvar att utbilda och stödja den drabbade för att förhindra detta. E-hälsa kan därför vara ett bra stöd för att underlätta både för den drabbade och sjuksköterskan.  Syfte  Syftet med arbetet var att kartlägga förväntningar och upplevelser på E-hälsa som stöd till egenvård, hos personer med hjärtsvikt.  Metod  För att besvara syftet genomfördes en icke-systematisk litteraturöversikt som baserades på 15 vetenskapliga artiklar. Både kvalitativa och kvantitativa artiklar inkluderades. Artiklarna inhämtades med hjälp av relevanta sökord i databaserna PubMed och CINAHL. För att säkerställa att artiklarna var av god kvalitet användes Sophiahemmet Högskolas bedömningsunderlag, vidare utfördes en integrerad analys där två huvudkategorier och sju subkategorier identifierades.  Resultat  Resultatet delades in i förväntningar av kommunikation och förståelsesamt upplevelser av påverkad sjukdomsförståelse som huvudkategorier. I resultatet framkom det att patienter med hjärtsvikt förväntade sig en förbättrad vårdrelation, förbättrad egenvård och ökad förståelse för sin sjukdom. Vidare upplevde patienterna ökade kunskaper om egenvård vid hjärtsvikt vilket medförde förbättrad egenvård. Dessutom upplevdes en förbättrad kontakt med sjukvårdspersonal och ökad motivation till att fortsätta med goda rutiner. Problem med tekniken var en vanlig komplikation.  Slutsats  I den aktuella litteraturöversikten framkom det att många ansåg E-hälsotjänster som ett bra stöd till egenvård då de fick en ökad förståelse för sin sjukdom. Fynden anses därför vara ett stöd för att finna egenvårdsbalans. Vidare forskning av ämnet anses dock vara nödvändigt för att resultatet ska kunna betraktas som överförbart. / Background  Heart failure is a widespread disease that causes suffering for those who are affected and brings a great deal of responsibility of their own health. Self-care plays a crucial part in preventing deterioration for people with heart failure, since rapid changes of the medical condition can occur. If the affected lacks the required motivation or knowledge, it can consequently lead to complications. Therefore, the nurse has a great deal of responsibility to educate and aid the affected to prevent this. E-health is for that reason believed to be a good support to facilitate for both the affected and the nurse.  Aim  The aim was to describe expectations and experiences of E-health as a support for self- care, among people with heart failure.  Method  A non-systematic literature review based on 15 scientific articles was made to answer the purpose. Both qualitative and quantitative articles were included. The articles were collected using relevant keywords in the data bases PubMed and CINAHL. To ensure that the articles were of good quality, the assessment basis of Sophiahemmet University were used. Furthermore, an integrated analysis was performed where two main categories and seven subcategories were identified.  Results  The result was divided into the two main categories expectations of communication and understanding and experiences of affected understanding of the disease. It emerged in the result that patients with heart failure expected improved care relationship, improved self- care and improved understanding of one’s disease were expected. Furthermore, increased knowledge about self-care in heart failure was experienced, which led to improved self- care. Additionally, there was an improved contact with healthcare staff and an increased motivation to proceed with good practices. The most common complication were problems with the E-health technology.  Conclusions  The current literature review emerged that many considered E-health as a good support for self-care as they gained an increased understanding of one’s disease. The findings are therefore considered to be a support to find self-care balance. However, further research of the subject is considered necessary for the result to be considered transferable.

Background - This study tested the hypothesis that β1-adrenoreceptor blockade modulates the angiotensin II (Ang II)-evoked neural release of norepinephrine (NE) and epinephrine (Epi) into the cardiac interstitial fluid (ISF) space in experimentally induced mitral regurgitation (MR) in the dog. Methods and Results - Normal dogs (n=8) were compared with dogs with MR of 2 (n=8) and 4 (n=6) weeks' duration and with dogs with MR treated with β1-receptor blockade (RB; extended-release metoprolol succinate, 100 mg QD; MR+β1-RB) that was started 24 hours after MR induction for 2 (n=6) and 4 weeks (n=8). Left ventricular end-diastolic dimension increased 20% as plasma Ang II levels increased >5-fold in both MR and MR+β1-RB dogs at 2 and 4 weeks. Ang II infusion into the left atrium produced increases in ISF NE and Epi in normal dogs, which were further increased in 2- and 4-week MR dogs but were restored to normal in 4-week MR+β1-RB dogs. Ang II infusion produced 4-fold increases in circulating NE and Epi in 2- and 4-week MR dogs that returned to normal in 4-week+β1-RB dogs. Left ventricular angiotensin-converting enzyme activity and ISF Ang II were increased in 4-week MR dogs but were decreased in 4-week MR+β1-RB dogs. Conclusions - β1-RB decreases renin-angiotensin system sympathostimulation and activation by attenuating the Ang II-mediated NE and Epi release into the cardiac ISF and circulation and by decreasing left ventricular angiotensin-converting enzyme expression in the early phases of volume overload.

Background: Cellular cardiomyoplasty is the method of transplanting myogenic cells into injured myocardium to restore the lost heart muscle cells and to improve ventricular function. Method: Three patients, all with a history of coronary heart disease, underwent coronary artery bypass grafting and implantation of autologous satellite cells. A muscle biopsy of 2-4 g from the right vastus lateralis muscle was obtained for satellite cell (myogenic stem cell from skeletal muscle) isolation and proliferation before implanted into the donor's heart. The cells were suspended in serum-free medium and injected into 30-40 sites at and around the ischemic areas just before reversing the hypothermic cardioplegia to eliminate arrhythmia and to improve retention. After recovery, each patient was maintained at the intensive care unit for 3-4 days with ECG monitoring before transferring to the patient floor. Results: All patients survived the procedure with an uneventful recovery and were discharged from the hospital. At 3-4 months follow-up examination, increased left ventricular ejection fraction of 11% (35-46%), 5.4% (40-45.4%) and 1% (40-41%) and decreased left ventricular diastolic diameter of 4, 2 and 9 mm were observed for the patients, respectively. Arrhythmia was not detected during the follow-up evaluation by ECG. Improved perfusion (99mTC-MIBI) and increased metabolic activity (18F-deoxyglucose) were found at the sites of satellite cell implantation. Significant increase of wall thickness and movement at the areas of cell injection was also observed using 2D-echo. Conclusion: Cellular cardiomyoplasty using autologous satellite cells is a safe procedure with encouraging beneficial outcomes in patients.

Increasing diastolic dysfunction (DD) grade is associated with increased heart failure (HF). Patients with preserved ejection fractions and grade 1 DD may have left atrial dilatation, e′ < 8 cm/sec, increased left ventricular (LV) mass, or variable E/e′ ratios. The aim of this study was to test the hypothesis that LV hypertrophy or E/e′ ratio > 8 may be associated with a greater incidence of HF. Methods Two hundred twelve patients with grade 1 DD and ejection fractions > 50% were retrospectively studied. Group 1 comprised 108 patients with E/A ratios < 0.8, without LV hypertrophy, e′ < 8 cm/sec, and E/e′ ratios < 8. Group 2 comprised 104 patients with LV hypertrophy or E/e′ ratios > 8. Patients with incident HF and valvular or coronary disease were excluded. Using two-dimensional Doppler echocardiography, LV and left atrial volumes and transmitral spectral and tissue Doppler were analyzed. Medical records were examined for laboratory data, HF admissions, and all-cause mortality from 2004 to 2012. Results Despite similar ejection fractions, patients in group 2 had greater LV and left atrial volumes, LV mass index values, and E/e′ ratios (P < .01 for all). HF incidence was greater in group 2 (30 vs 4, P < .001). Combined HF or all-cause mortality was greater in group 2 (46 vs 14, P < .001). Multivariate analysis revealed that HF was associated with E/e′ ratio (P < .0001), systolic blood pressure (P = .0123), and LV mass index (P = .042). Combined HF or all-cause mortality was associated with E/e′ ratio (P < .0001), LV mass index (P = .009), and lower calcium channel blocker use (P = .0011). Conclusions HF alone or HF and all-cause mortality were increased in patients with grade 1 DD in the presence of LV hypertrophy or elevated LV filling pressures.

Pathological cardiac hypertrophy often leads to heart failure. Activation of autophagy has been shown in pathological hypertrophic hearts. Autophagy is regulated positively by Class III phosphoinositide 3-kinase (PI3K). However, it is unknown whether Class III PI3K plays a role in the transition of cardiac hypertrophy to heart failure. To address this question, we employed a previously established cardiac hypertrophy model in heat shock protein 27 transgenic mice which shares common features with several types of human cardiomyopathy. Age-matched wild-type mice served as control. Firstly, a prolonged activation of autophagy, as reflected by autophagosome accumulation, increased LC3 conversion and decreased p62 protein levels, was detected in hypertrophic hearts from adaptive stage to maladaptive stage. Moreover, morphological abnormalities in myofilaments and mitochondria were presented in the areas accumulated with autophagosomes. Secondly, activation of Class III PI3K Vacuolar protein sorting 34 (Vps34), as demonstrated by upregulation of Vps34 expression, increased interaction of Vps34 with Beclin-1, and deceased Bcl-2 expression, was demonstrated in hypertrophic hearts from adaptive stage to maladaptive stage. Finally, administration with Wortmaninn, a widely used autophagy inhibitor by suppressing Class III PI3K activity, significantly decreased autophagy activity, improved morphologies of intracellular apartments, and most importantly, prevented progressive cardiac dysfunction in hypertrophic hearts. Collectively, we demonstrated that Class III PI3K plays a central role in the transition of cardiac hypertrophy to heart failure via a prolonged activation of autophagy in current study. Class III PI3K may serve as a potential target for the treatment and management of maladaptive cardiac hypertrophy.

Heart failure (HF) affects 6 million Americans, has an expected increasing prevalence in the next 20 years, and has a 5-year mortality rate of 50%. It represents the number one reason for hospitalization in patients older than 65 years. Recent legislation has increased the accountability of care of patients with HF, specifically readmission rates for HF in less than 30 days. This increased focus on HF readmission rates has led many health care organizations to reassess transition-of-care issues (i.e., from home to hospital, from hospital to home) and possible interventions to positively impact these readmission rates. During this process, home health care providers play an integral role and should be aware of possible issues to ensure optimum care for patients.

Background: Oxidative stress and myocyte apoptosis are thought to play an important role in the pathogenesis, progression and prognosis of heart failure (HF). Heat shock protein 27 (Hsp27) has been found to confer resistance to oxidative stress in cultured cells; however, the role of Hsp27 in in-vivo hearts remains to be determined. Aim: To investigate the effects of Hsp27 over-expression on doxorubicin-induced HF. Methods and Results: Transgenic mice (TG) with cardiac specific over-expression of Hsp27 and their wild type littermates (WT) were challenged with doxorubicin (25 mg/kg, IP) to induce HF. At day 5, TG mice had significantly improved cardiac function and viability and decreased loss of heart weight following doxorubicin exposure compared with WT. In another parallel experiment, doxorubicin-induced increased levels of reactive oxygen species, protein carbonylation, apoptosis and morphologic changes were detected in the mitochondria in WT hearts, whereas these effects were markedly attenuated in TG hearts. In addition, upregulation of heat shock protein 70 and heme oxygenase-1 was present in the TG hearts after doxorubicin stimulation in comparison to WT hearts. Conclusion: These findings indicate that Hsp27 may play a key role in resistance to doxorubicin-induced cardiac dysfunction.

Sympathetic nerve activity increases in the heart during cardiac failure. Here, we hypothesized that β1 integrins play a protective role in chronic β-adrenergic receptor-stimulated cardiac myocyte apoptosis and heart failure. l-isoproterenol (iso; 400 μg/kg per hour) was infused in a group of wild-type (WT) and β1 integrin heterozygous knockout (hKO) mice. Left ventricular structural and functional remodeling was studied at 7 and 28 days of iso-infusion. Western blot analysis demonstrated reduced β1 integrin levels in the myocardium of hKO-sham. Iso-infusion increased heart weight:body weight ratios in both groups. However, the increase was significantly higher in WT-iso. M-mode echocardiography indicated increased left ventricular end-diastolic diameter, percentage of fractional shortening, and ejection fraction in the WT-iso group. The percentage of fractional shortening and ejection fraction were significantly lower in hKO-iso versus hKO-sham and WT-iso. Peak left ventricular developed pressure and left ventricular end-diastolic pressure measured using Langendorff-perfusion analyses were significantly higher in the WT-iso group (P<0.05 versus WT-sham and hKO-Iso). The number of TUNEL-positive myocytes was significantly higher in hKO-iso hearts 7 and 28 days after iso-infusion. The increase in myocyte cross-sectional area and fibrosis was higher in the WT-iso group. Matrix metalloproteinase-9 protein levels were significantly higher in WT-iso, whereas matrix metalloproteinase-2 levels were increased in hKO-iso hearts. Iso-infusion increased phosphorylation of c-Jun N-terminal kinase and extracellular signal-regulated kinase 1/2 in both groups. The increase in c-Jun N-terminal kinase phosphorylation was significantly higher in hKO-iso (P<0.001 versus WT-iso). Thus, β1 integrins play a crucial role in β-adrenergic receptor-stimulated myocardial remodeling with effects on cardiac myocyte hypertrophy, apoptosis, and left ventricular function.