Background/Purpose: The American College of Cardiology/American Heart Association/Heart Failure Society of America guidelines for management of heart failure were recently updated to include use of sacubitril/valsartan due to its ability to reduce mortality and hospitalizations over the current standard of therapy. Based on these guideline updates, a champion research team at East Tennessee State University (ETSU) Family Medicine Associates worked to create and implement a process that identified patients with systolic heart failure and provided access to medications with mortality and morbidity benefits. The objective of this study is to improve provider knowledge of evidence-based heart failure pharmacotherapy and to assess provider acceptability of a process implemented at ETSU Family Medicine Associates. Methodology: This study was approved by the Institutional Review Board. On December 21, 2016 the champion research team presented a didactic session to all providers at ETSU Family Medicine Associates. Immediately prior to the education session, providers completed a pre-education clinical knowledge assessment on heart failure pharmacotherapy. A one-hour didactic session then followed focusing on evidence-based medication management of systolic heart failure and introduction of the new process being implemented. Following the presentation, providers completed a post-education clinical knowledge assessment and a pre-implementation process acceptability survey. Providers were then scheduled to complete a post-implementation process acceptability survey at two months post-process implementation and quarterly thereafter. A McNemars Test will be used to determine if statistically significant differences exist among pre- and post-education clinical knowledge assessments and pre- and post-implementation process acceptability surveys. Presentation Objective: Discuss the process implemented to improve provider knowledge of heart failure pharmacotherapy and improve patient access to evidence-based pharmacotherapy options. Self-Assessment: Did the one-hour didactic session improve provider knowledge of heart failure pharmacotherapy?

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.

Bakgrund: Hjärtsvikt är en folkhälsosjukdom som ökar i världen. Hjärtsvikt innebär att hjärtats pumpförmåga inte kan tillgodose kroppens organ och vävnader med blod. Sjukdomen medför en hög dödlighet som kan minskas med egenvårdsbehandling. Det handlar om åtgärder för att bibehålla livskvalitet trots sjukdomen. Syfte: Att belysa patienters upplevelser av egenvård vid hjärtsvikt. Metod: En litteraturöversikt genomfördes baserad på 13 kvalitativa vetenskapliga artiklar som analyserades enligt Fribergs analysmodell. Resultat: Det identifierades två teman och fem subteman. Temana är livsstilsförändring och symtom. Under temat livsstilsförändring framkom följande tre subteman: Kost och vätskeintag, utmaning med medicinhantering och erfarenhet av fysisk aktivitet och under temat symtom framkom följande två subteman: Att känna igen symtom vid försämring och att förbättra livskvalitet. Konklusion: Litteraturöversikten visar att personer med hjärtsvikt är i behov av kunskap och stöd för att kunna hantera sin egenvård på ett rätt sätt. Upplevelser av oro, ångest, ensamhet, frustration och rädsla nämndes och alla dessa var kopplade till brist på kunskap av sjukdomen och egenvården. / Background: Heart failure is a public health disease that is increasing worldwide. Heart failure means that the pumping ability of the heart cannot supply blood to the body's organs and tissues. The disease carries a high mortality rate that can be reduced by self-care treatment. This involves measures to maintain physical stability despite the disease. Aim: To describe patients’ experiences of self-care in heart failure. Method: A literature review was conducted based on 13 qualitative scientific articles that were analyzed according to Friberg's analysis model. Findings: Two themes and five subthemes were identified. The themes are lifestyle change and symptoms. Under the theme of lifestyle change, the following three subthemes emerged: Diet and fluid intake, challenges with medication management and experience of physical activity, and under the theme of symptoms, the following two subthemes emerged: Recognizing symptoms in case of deterioration and improving quality of life. Conclusion: People with heart failure need information and support to manage their selfcare appropriately. Experiences of worry, anxiety, loneliness frustration and fear were mentioned and all of these were linked to lack of information. The study shows how information, knowledge and support can help people to continue with their self-care.

No description available.

Bakgrund: Hjärtsvikt är en global sjukdom där patienten är i behov av egenvård som ett komplement till konventionell behandling. Hur patienten engagerar sig i egenvård är relaterat till livssituationen, men även den fysiska samt psykiska förmåga. Patienters erfarenheter av egenvård behöver beaktas för ett kunna ge effektivt stöd för deras sjukdom samt egenvård.  Syfte: Syftet med denna studie var att undersöka patientens erfarenheter av egenvård vid hjärtsvikt.  Metod: En litteraturöversikt med kvalitativ ansats baserad på 14 artiklar, där en tematisk analys användes för att analysera data. Resultat: Två teman med två respektive subteman presenterades i resultatet. Det första temat är "Att övervinna utmaningarna som medföljer hjärtsvikten” som har subteman “Navigera känslomässiga utmaningar och acceptera förändring” och ”Förändrad förmåga”. Det andra temat som presenterades är “Att upprätthålla egenvård” som har subteman “Behov av stöd” och “Behov av kunskap och information”.  Slutsats: Egenvård är viktigt för att hantera hjärtsvikt, men erfarenheterna varierar och påverkar hälsa och livskvalitet. Stöd från vårdgivare, familjemedlemmar samt relevant information är nyckeln till att uppnå förtroende till sina förmågor och därmed uppnå självständighet i sin egenvård. / Background: Heart failure is a global disease that necessitates self-care management. How patients engage in self-care is related to their life situation, but also their physical and mental abilities. Patients experience of self-care needs to be taken into account for effective support in their illness and self-care.  Aim: The aim of this study was to explore patients experience of self-care in heart failure. Method: A literature review with a qualitative approach based on 14 articles, where a thematic analysis was used to analyze the data. Results: The study identified two themes with two sub-themes each. The first theme was “Overcoming the challenges that come with heart-failure” which has the sub-theme “Navigating emotional challenges and accepting change” and “Changed ability”. The second theme was "To maintain self-care" which has the sub-themes "The need of support" and "The need of knowledge and information". Conclusions: Self-care is essential in heart failure management, but experiences vary and affect health and quality of life. Support from healthcare providers and family members, and relevant information and resources are key to achieving confidence in their abilities and therefore independence in self-care management.

Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure. Background: Global work index (GWI) and global constructive work (GCW) are calculated bymeans of speckle tracking, blood pressuremeasurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown. Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation. Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In themultivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%). Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure.

Ventricular Assist Devices (VADs) are mechanical pumps used to off-load a deceased heart, primarily in late stage congestive heart failure patients. VAD employment may facilitate cardiac recovery, but most often provides time before a suitable heart transplant can be found. Lately, long term use VAD systems have been introduced as an alternative to a heart transplant. Traditionally, design of VADs has employed either displacement based pump technologies or radial-flow pumps, also known as rotodynamic pumps. A displacement pump induces a mechanical force on a fluid contained within a defined space, hence giving it motion. Radial-flow pumps impart momentum to a fluid, most often by placing a rotating device in the fluid. This thesis introduces a novel pumping concept, combining features from both displacement and radial-flow pumps. A first prototype, the VivicorTM pump, has been designed, fabricated and evaluated In Vitro, the results reported in this thesis. The In Vitro evaluation of the VivicorTM pump provides evidence of a pump with mechanical self-regulation based on pump pre-load level, much like a displacement pump. The VivicorTM pump also displays pulsating outflow in combination with an inflow both during pump systole and diastole. The latter provides potential advantages over traditional displacement pumps as smaller cannulae or catheters can be used, facilitating miniaturization. Continuos filling throughout the pumping cycle also require less pressure to be exerted on the fluid, compared to displacement pumps, limiting the risk of mechanical damage to the pumped fluid. The In Vitro evaluation has also provided further insights on necessary design modifications in the second-generation VivicorTM prototype, currently planned. The VivicorTM pumping technology is highly interesting for further development and evaluation for use in ventricular assist applications. / QC 20101129

Bakgrund: Att leva med hjärtsvikt innebär att leva med en allvarlig kronisk sjukdom, vilket ställer höga krav på patienten. Konsekvensen av låg följsamhet kan bli att symptomen förvärras vilket i sin tur leder till sjukhusvistelse. För att förbättra följsamheten hos dessa patienter behöver alternativa strategier lyftas fram. Som bakgrund till detta tar studien upp hjärtsvikt och dess behandling, hälsolitteracitet som begrepp och användningsområde, låg följsamhet och låg hälsolitteracitet samt sjuksköterskans omvårdnadsperspektiv. Syfte: Syftet med litteraturstudien var att undersöka upplevda orsaker till låg följsamhet hos patienter med hjärtsvikt. Metod: Studien genomfördes som en litteraturstudie med kvalitativ ansats, inriktad på patienter med hjärtsvikt och deras perspektiv. Databassökning genomfördes med blocksökningar i CINAHL och PubMed. 12 artiklar granskades med en granskningsmall för kvalitativa artiklar, utformad av SBU. En enkel form av innehållsanalys enligt Forsberg och Wengström, användes vid analysförfarandet. Resultat: Patienter upplevde sig ha svårt att förstå sin sjukdom, de kände att stort ansvar lades på dem, saknade stöd, fick bristfällig information och upplevde otydlig kommunikation med hälso- och sjukvården. De hade även svårt att ändra vanor och upplevde sig gå miste om sociala situationer till följd av känslan av den begränsning som rekommendationerna medförde. Detta ledde i sin tur till låg följsamhet. Resultatet presenterades i fyra teman: att inte förstå sin sjukdom, upplevelse av bristande stöd, upplevelse av bristande kommunikation och information och upplevelse av bristande välbefinnande. Slutsats: Resultatet visade på de svårigheter som patienter upplever i att leva med hjärtsvikt. De fyra teman diskuterades utifrån hälsolitteracitet, sjuksköterskans omvårdnadsperspektiv och personcentrerad vård. Studien lyfte fram patienters perspektiv av orsaker till låg följsamhet men även hur sjuksköterskan skulle kunna påverka patienter till ökad följsamhet. Ett personcentrerat perspektiv och kunskap om hälsolitteracitet lyfts fram som alternativa sätt att nå patienter med låg följsamhet. / Background: To live with heart failure means living with a severe cronic disease, this requires a lot of the patients. The consequence of low compliance can result in worsened symptoms which leads to hospitalization. To improve patients’ compliance alternative strategies needs to be highlighted. The background in this study contains four parts: heart failure and its treatment, health literacy as a concept and its usability, low compliance and low health literacy, and a nursing perspective. Aim: The aim was to explore perceived reasons for low compliance in patients with heart failure. Method: The study was conducted as a literature review with a qualitative approach, with a focus on patients with a heart failure and their perspective. The database search was performed with searches in CINAHL and PubMed. 12 articles were reviewed with a template by SBU. A simple form of content analysis was used for analysing the articles. Result: Patients experienced that it was difficult to understand their disease, they felt a large responsibility were imposed on them, they experienced a lack of support, inadequate information and experienced inexplicit communication with the health care. Patients also experienced difficulty changing habits and to miss out on social occasions because of the limitations the recommendations imposed. All this led to low compliance. The results were presented in four themes: to not understand one’s disease, experience of a lack of support, experience of inadequate communication and information, and experience of insufficient wellbeing. Conclusion: The results show the difficulties that patients experience when living with heart failure. The four themes were discussed from a health literacy perspective, a nursing perspective and patient-centered care. The study highlights the patient perspective on reasons for low compliance but also how the nurse can influence patients to increase their compliance. Health literacy and patient-centered care are discussed as alternative ways to reach patients with low compliance.

Chronic cardiovascular and pulmonary diseases are prevalent in the US home health population. Heart failure and chronic obstructive pulmonary disease are both chronic and terminal, but they are not always perceived as serious illnesses with imminent death. Therefore, they provide a context for advance care planning that is distinct from the diagnostic contexts of cancer, end-stage renal disease, or dementia. Advance care planning is defined as a process that supports adults at any age or stage of health in understanding and sharing their goals, values, and preferences about future medical care, including the designation of a surrogate decision-maker. This study tests the hypothesis that US home health agencies with higher percentages of patients with chronic cardiovascular and pulmonary conditions have less robust advance care planning protocols. The Spearman correlation coefficient was r = 0.22 (S = 74684, P =.025, 1-tailed), which was statistically significant and an unexpected finding. The greater percentage of patients with chronic cardiac and pulmonary diagnoses in an agency, the more robust the advance care planning protocol was. This supports our previous findings and existing literature indicating that agencies may be using exacerbation events marked by acute care use as opportunities to initiate or repeat advance care planning.

Bakgrund: Hjärtsvikt är en allvarlig sjukdom med hög dödlighet. Globala siffror visar att cirka 64 miljoner människor har hjärtsvikt. I Sverige är det cirka 250 000 individer som har drabbats av sjukdomen. Hjärtsvikt är i dag den vanligaste orsaken till sjukhusinläggningar bland personer över 65 år. Syfte: Syftet med denna litteraturstudie var att beskriva patienters erfarenheter av att leva med hjärtsvikt. Metod: Litteraturstudien var av beskrivande design och baserades på tio kvalitativa vetenskapliga artiklar. Artiklarna söktes fram via databasen PubMed. Huvudresultat: I resultatet framkom huvudtemat; Förändrad vardag med subteman fysisk påverkan, psykisk påverkan, social och ekonomisk påverkan. Andra huvudtemat som framkom var; Att hantera sin sjukdom med subteman livstilsanpassningar, andlighet och upplevelser av information från vården. Slutsats: Hjärtsviktpatienter upplevde fysiska, psykiska och sociala utmaningar, samtidigt som det framkom brister i kommunikation och information kring bland annat egenvård. Det framkom även en brist i vården när det gäller kontinuitet. Det är avgörande att sjuksköterskor erbjuder stöd och information till patienterna för att säkerställa högkvalitativ vård och individanpassad information. / Background: Heart failure is a serious illness with high mortality. The global figures show that approximately 64 million people have heart failure. In Sweden, there are approximately 250,000 individuals that has the disease. Today, heart failure is the most common cause of hospitalizations among people over 65 years of age. Aim: The aim of this literature review was to describe patients' experiences of living with heart failure. Method: The literature review had a descriptive design and was based on ten qualitative scientific articles. The articles were retrieved through the PubMed database. Main results: The result revealed the main theme; Changed everyday life with subthemes physical impact, psychological impact, social and economic impact. Another main theme that emerges was; Managing one's illness with subthemes lifestyle adjustments, spirituality and experiences of information from healthcare. Conclusion: Heart failure patients experiences physical, psychological and social challenges, while deficiencies in communication and information regarding self-care were revealed. The study also revealed a deficiency in care regarding continuity. It is crucial for nurses to provide support and information to patients to ensure high-quality care and tailored information.