近年，研究發現許多心臟衰竭患者的左室射血分數在正常範圍內。這種類型的心臟衰竭，已被稱為“射血分數保持的心臟衰竭（HFPEF）。研究還發現，HFPEF患者往往是老年女性，有高血壓病史，其預後比射血分數降低的心衰更好。 / 然而，很少人研究過中國人中HFPEF患者的死亡率。同時，經治療后HFPEF患者長期的生活質量是否改善沒有得到很好的研究，特別是在老年HFPEF患者中。此外，到目前為止，一直沒有一個風險評分系統用於預測HFPEF患者的預後。 / 我們從2006年至2010年在一所大學附屬醫院建立的心臟衰竭注冊研究中，前瞻性納入了847 名HFPEF的患者進行研究。此外，我們通過國際疾病分類第九版臨床修正（ICD-9- CM）代碼428進行數據檢索，回顧性分析了2001年至2005年入住我院的心臟衰竭的患者。其中170名射血分數超過50的患者納入本研究。爲了消除兩組病人基線差異對臨床終點的影響，我們計算出傾向性得分。在建立風險評分方面，所有HFPEF患者隨機分為推導組和驗證組。從推導組中，我們得到了風險評分，然後我們再在驗證組中測試評分系統是否可行。本研究中，生活質量是通過明尼蘇達州心力衰竭問卷（MLHFQ）進行評估。 / 我們研究的主要發現包括： / 1、與2001-2005年納入的HFPEF患者比，2006-2010年納入的HFPEF患者，一年生存率有顯著提高（76.9%比65.5%，P = 0.001），心臟衰竭的再次住院率也顯著下降（33.3%比50.6%，P <0.001）。傾向得分匹配調整後1年生存率提高（78.9%比68.1%，P = 0.02）和心衰再次住院率降低（34.3&比51.2%，P = 0.002）仍然顯著。 / 2、各個年齡組基線（32±16比30±15比34±11，P = 0.12）和12個月（16±14比16±12比19±13，P = 0.62）的MLHFQ得分均沒有顯著。HFPEF患者12個月時生活質量得到改善的比例在年齡組之間相似（84.0%比80.2%比87.5%，P = 0.68）。 / 3、我們通過Cox多因素回歸分析得到了了6個獨立的預測HFPEF患者1年死亡率的預後因素。每個因素根據其回歸系統獲得一個分數：低蛋白血症（5分），不使用鈣通道阻滯劑（3分），充血性心臟衰竭病史（2.5分），腦血管疾病病史（2.5分），尿素氮> 10mmol / L（2.5分），年齡> 78歲（2分）。每一個患者根據風險分數而被分為三個危險人群：低風險（0至5.5分），中等風險（10.5分）和高風險（11至17.5分）。在推導隊列，這三組的1年死亡率分別為10.5%，22.3%和48.7%分別。在驗證隊列，相應的死亡率分別為15.4%，25.3&和39%。 / 4、低蛋白血症為HFPEF患者1年死亡率的最有力的預測指標。 / 綜上所述，我們發現，近年來，HFPEF患者一年的死亡率和心臟衰竭再次住院率有所下降。與相對年輕的HFPEF患者相比，老年HFPEF患者經歷了類似的生活質量的改善。從臨床常用的變量得到的風險評分可用於預測HFPEF患者1年死亡率。低蛋白血症為HFPEF患者1年死亡率的最有力的預測指標。 / Recently, many studies have found that many patients presenting with clinical heart failure (HF) had a left ventricular ejection fraction in the normal range. This entity has been termed “heart failure with preserved ejection fraction (HFPEF). Previous studies have indicated that patients who have HFPEF tend to be older, female, and to have a history of hypertension. / However, little was known about the clinical outcome and related predictors of HFPEF patients in Chinese population. Long term quality of life (QOL) after treatment in HFPEF patients have not been well studied, especially in very elderly HFPEF. Furthermore, there has been no a risk score used HFPEF patients. / We studied 847 HFPEF patients who were prospectively enrolled into a HF Registry from 2006 to 2010 at a teaching hospital. In addition, a historical cohort of patients admitted in our hospital from 2001 to 2005 was retrospectively retrieved and data searched using the ICD-9-CM code 428. Among this, 170 with HFPEF were selected for study. To adjust for the impact of baseline differences between the 2 cohorts on clinical outcomes, we calculated a propensity score. To establish a risk score, HFPEF patients were randomly divided into derivation group and validation group. We got a risk score from the derivation group and then checked in the validation one. QOL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) instruments. / Main findings of our study included: / 1. 1-year survival rates improved (65.5% vs. 76.9%, p=0.001) and HF re-hospitalization rates decreased (50.6% vs. 33.3%, p<0.001 in HFPEF patients admitted between 2001-2005 and 2006-2010, respectively). The improvement in 1-year survival (68.1% vs. 78.9%, p=0.02) and HF re-hospitalization (51.2% vs. 34.3%, p=0.002) remained significant after propensity score matching. / 2. Baseline (30±16 vs. 28±16 vs. 29±16, p=0.87) and 12-months (15±14 vs. 16±14 vs. 15±12, p=0.92) MLHFQ score showed no significant differences with advancing age. Proportion of patients who experienced improvement in QOL at 12-months were similar among age groups (84.0% vs. 80.2% vs. 87.5%, p=0.68). / 3. Six independent prognostic factors were identified, and each was assigned a number of points proportional to its regression coefficient: hypoalbuminemia (5 points), not use of CCB (3 points), history of HF (2.5 points), history of CVD (2.5 points), BUN>10mmol/L (2.5 points), age>78 years (2 points). Wecalculated risk scores for each patient and defined three risk groups: low risk (0 to 5.5 points), intermediate risk (6 to 10.5 points) and high risk (11 to 17.5 points). In the derivation cohort, the 1-year mortality rates for these three groups were 10.5%, 22.3%, and 48.7% respectively. In the validation cohort, the corresponding mortality rates were 15.4%, 25.3% and 39%. / 4. Hypoalbuminemia was the most powerful predictor of 1 year mortality for HFPEF patients. / In summary, we found that the mortality of HFPEF patients in the first year decreased over time. Elderly HFPEF patients experienced similar improvements in QOL compared to younger ones. The clinical based risk score can be used to predict mortality of HFPEF patients. Hypoalbuminemia was the most powerful predictor of 1 year mortality for HFPEF patients. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Liu, Ming. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 124-150). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Declaration of originality --- p.i / Acknowledgement --- p.ii / List of abbreviations --- p.iv / Publications --- p.vii / Full paper --- p.vii / Abstracts --- p.viii / Abstract --- p.ix / 中文摘要 --- p.xii / Table of Contents --- p.xiv / List of Tables --- p.xx / List of Figures --- p.xxi / Chapter SECTION I --- LITERATURE REVIEW --- p.1 / Chapter CHAPTER 1 --- DEFINITION, PATHOPHYSIOLOGY AND DIAGNOSIS OF HFPEF --- p.1 / Chapter 1.1 --- Definition of HFPEF --- p.2 / Chapter 1.2 --- Pathophysiology of HFPEF --- p.3 / Chapter 1.2.1 --- Structure abnormality in HFPEF --- p.3 / Chapter 1.2.2 --- Diastolic dysfunction in HFPEF --- p.10 / Chapter 1.2.3 --- Systolic function in HFPEF --- p.12 / Chapter 1.2.4 --- Left atrial dysfunction in HFPEF --- p.14 / Chapter 1.2.5 --- Peripheral factors in HFPEF --- p.15 / Chapter 1.3 --- Diagnosis of HFPEF --- p.16 / Chapter 1.3.1 --- Clinical features --- p.17 / Chapter 1.3.2 --- Echocardiographic features of HFPEF patients --- p.18 / Chapter 1.3.3 --- BNP AND N-pro BNP assays --- p.18 / Chapter CHAPTER 2 --- EPIDEMIOLOGY OF HFPEF --- p.28 / Chapter 2.1 --- Prevalence of HFPEF among HF patients --- p.28 / Chapter 2.2 --- Demographic features and comorbid conditions --- p.29 / Chapter 2.2.1 --- Age --- p.30 / Chapter 2.2.2 --- Gender --- p.31 / Chapter 2.2.3 --- Hypertension --- p.31 / Chapter 2.2.4 --- Coronary artery disease --- p.32 / Chapter 2.2.5 --- Atrial fibrillation --- p.33 / Chapter 2.2.6 --- Diabetes Mellitus --- p.34 / Chapter 2.2.7 --- Renal Dysfunction --- p.34 / Chapter 2.2.8 --- Body Mass Index --- p.35 / Chapter 2.2.9 --- Anemia --- p.35 / Chapter 2.2.10 --- Chronic Obstructive Pulmonary Disease --- p.35 / Chapter 2.3 --- Mortality of HFPEF patients --- p.36 / Chapter 2.3.1 --- Mortality rates --- p.36 / Chapter 2.3.2 --- Pattern of death --- p.37 / Chapter 2.4 --- Prognostic predictors --- p.38 / Chapter 2.5 --- Health related quality of life in HFPEF patients --- p.40 / Chapter CHAPTER 3 --- TREATMENT OF HFPEF PATIENTS --- p.42 / Chapter 3.1 --- Non-pharmacologic Therapy --- p.42 / Chapter 3.2 --- Medical and Surgical Therapy --- p.43 / Chapter 3.2.1 --- Clinical Studies --- p.43 / Chapter 3.2.2 --- Randomized Controlled Clinical Trials --- p.43 / Chapter 3.2.3 --- Current Therapeutic Recommendations --- p.45 / Conclusions --- p.46 / Chapter SECTIONS II --- STUDIES ABOUT HFPEF --- p.47 / Chapter CHAPTER 4 --- OBJECTIVES AND HYPOTHESIS --- p.47 / Chapter 4.1 --- Objectives of the study --- p.47 / Chapter 4.2. --- Hypothesis --- p.48 / Chapter CHAPTER 5 --- METHODOLOGY --- p.49 / Chapter 5.1 --- Patient population --- p.49 / Chapter 5.2 --- Definition of HFPEF patients --- p.49 / Chapter 5.3 --- Baseline patient data --- p.50 / Chapter 5.4 --- Echocardiogram --- p.50 / Chapter 5.5 --- Health related quality of life assessment --- p.51 / Chapter 5.6 --- Follow-up and clinical outcome --- p.51 / Chapter 5.7 --- Statistical analysis --- p.52 / Chapter CHAPTER 6 --- IMPROVED 12 MONTH SURVIVAL OF PATIENTS ADMITTED WITH HFPEF OVER THE LAST DECADE --- p.54 / Chapter 6.1 --- Introduction --- p..54 / Chapter 6.2 --- Methods --- p.54 / Chapter 6.2.1 --- Patient population --- p.54 / Chapter 6.2.2 --- Baseline patient data --- p.55 / Chapter 6.2.3 --- Study endpoints --- p.56 / Chapter 6.2.4 --- Statistical analysis --- p.56 / Chapter 6.3 --- Results --- p.57 / Chapter 6.3.1 --- Baseline patient characteristics --- p.57 / Chapter 6.3.2 --- Unadjusted clinical outcomes --- p.57 / Chapter 6.3.3 --- Propensity score adjusted clinical outcomes --- p.58 / Chapter 6.4 --- Discussion --- p.58 / Chapter 6.5 --- Conclusions --- p.61 / Chapter CHAPTER 7 --- QUALITY OF LIFE IN ELDERLY PATIENTS WITH HFPEF --- p.67 / Chapter 7.1 --- Introduction --- p.67 / Chapter 7.2 --- Methods --- p.68 / Chapter 7.2.1 --- Patient population --- p.68 / Chapter 7.2.2 --- Health related quality of life assessment --- p.69 / Chapter 7.2.3 --- Follow-up --- p.69 / Chapter 7.2.4 --- Statistical analysis --- p.69 / Chapter 7.3 --- Results --- p.70 / Chapter 7.3.1 --- Baseline patient characteristics --- p.70 / Chapter 7.3.2 --- Mortality --- p.71 / Chapter 7.3.3 --- Health-related quality of life --- p.71 / Chapter 7.3.4 --- Therapy --- p.71 / Chapter 7.3.5 --- Predictors of HRQoL improvement in HFPEF patients --- p.72 / Chapter 7.4 --- Discussions --- p.72 / Chapter 7.5 --- Conclusions --- p.75 / Chapter CHAPTER 8 --- A RISK SCORE TO PREDICT 1 YEAR MORATALITY IN PATIENTS WITH HFPEF --- p.83 / Chapter 8.1 --- Introduction --- p.83 / Chapter 8.2 --- Methods --- p.84 / Chapter 8.2.1 --- Patient population --- p.84 / Chapter 8.2.2 --- Candidate Predictor Variables --- p.84 / Chapter 8.2.3 --- Statistical analysis --- p.85 / Chapter 8.3 --- Results --- p.86 / Chapter 8.3.1 --- Patient Characteristics and Outcomes --- p.86 / Chapter 8.3.2 --- Predictors of Mortality --- p.87 / Chapter 8.3.3 --- Generation of the Risk score --- p.87 / Chapter 8.3.4 --- Validation of the risk score --- p.88 / Chapter 8.4 --- Discussions --- p.88 / Chapter 8.5 --- Conclusions --- p.91 / Chapter CHAPTER 9 --- ALBUMIN LEVELS PREDICT SURVIVAL IN PATIENTS WITH HFPEF --- p.97 / Chapter 9.1 --- Introduction --- p.97 / Chapter 9.2 --- Methods 97 --- p.xviii / Chapter 9.2.1 --- Patient population --- p.97 / Chapter 9.2.2 --- Baseline measurement --- p.98 / Chapter 9.2.3 --- End points --- p.99 / Chapter 9.2.4 --- Statistical analysis --- p.99 / Chapter 9.3 --- Results --- p.100 / Chapter 9.3.1 --- Baseline patient characteristics --- p.100 / Chapter 9.3.2 --- Hypoalbuminemia and Cardiac Events --- p.101 / Chapter 9.3.3 --- Albumin and body mass index (BMI) --- p.102 / Chapter 9.3.4 --- Causes of hypoaluminemia in HFPEF patients --- p.102 / Chapter 9.4 --- Discussion --- p.103 / Chapter 9.4.1 --- Liver dysfunction --- p.104 / Chapter 9.4.2 --- Hemodilution --- p.105 / Chapter 9.4.3 --- BMI and hypoalbuminemia --- p.105 / Chapter 9.4.4 --- Renal failure --- p.106 / Chapter 9.4.5 --- B-type Natriuretic Peptides and albumin --- p.107 / Chapter 9.5. --- Conclusions --- p.109 / Chapter CHAPTER 10 --- GENERAL SUMMARY --- p.117 / Chapter 10.1 --- Main findings of our study --- p.117 / Chapter 10.2 --- Clinical implications --- p.119 / Chapter 10.3 --- Potential for final development of research --- p.120 / Chapter CHAPTER 11 --- CONCLUSIONS --- p.123 / References --- p.124

published_or_final_version / Nursing Studies / Master / Master of Nursing

Across the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual care. The HFNN is a home health RN with specialized training in HF care. The HFNN visited intervention group (IG) participants once in the hospital, followed by weekly home visits for one month. Control group (CG) participants received usual care, consisting of discharge teaching by their primary nurse and follow-up with their primary care provider (PCP) or cardiologist. Using a sequential mixed methods research design, this experimental randomized controlled trial measured HF knowledge, HF self-care, and HF quality of life (QOL) at enrollment and one month after discharge. Hospital readmissions and/or ED visits were tracked in both groups. IG participants were interviewed using semi-structured questions, findings of which were analyzed using conventional content analysis. There were fewer all-cause hospital readmissions in the IG (3 of 19) than the CG (6 of 21.) CG participants were 2.2 times more likely to be readmitted than the IG participants. [x(1)=.935, p=.334 O.R.=2.2219]. Due to limited enrollment, these results were underpowered and not statistically significant. There was improvement in HF knowledge (p=.06) and HF self-care maintenance (p=.07), approaching significance. HF self-care maintenance improved in both groups, although the IG was not significantly better (p=.48). There was significant improvement in the IG for HF confidence (p=.002) and HF QOL (p<.001). The qualitative findings revealed two main categories from the IG: (1) personal clarification of patient education, especially related to diet, exercise, and medications and (2) feelings of support, reassurance, and safety. The HFNN may be one role to meet the triple aim of improving patient quality care and health outcomes at a reduced cost, especially in areas where a comprehensive HF management program is not available. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Aims: The overall aims of the study were to identify the information needs of Chinese HF population and to examine the effectiveness of a heart failure disease management programme (HFDMP) on patients' clinical outcomes, health-related quality of life (HRQoL), and psychological status. / Background: Heart failure (HF) is a major and increasing public health problem globally. In China, there were approximately 4,000,000 patients with HF in the year 2000 and the number is continuously increasing due to the aging population. HF greatly influences patients' lives in all aspects. Programmes are therefore in imperative need to manage the disease and increase patients' sense of well-being. / Conclusion: Findings of the study provide further evidence that the simple combination of education and telephone follow-up could improve patients' medication adherence, HRQoL, and psychological status among Chinese HF population. Moreover, booklet developed in the study, to a certain extent, can be used as the tool for clinical HF education in China. The study also provides clues and direction for health professionals to develop interventions under the situation of busy clinical work and limited resources in Chinese health care practice. / Methods: First of all, a questionnaire survey (phase I, n=347), of which the questionnaire validation (n=247) was also included, and qualitative interviews with 26 patients and 24 health professionals (phase II) were consecutively conducted to know the information needs of patients with HF. According to the results of phase I and phase II studies, a booklet was developed to address the information needs of patients. Then a prospective controlled trial (phase III, n=160) was undertaken to examine the effectiveness of a HFDMP, including the components of two-session inpatient booklet education and weekly telephone follow-up for 4 weeks after discharge, on patients' performance of 6-minute walking test (6-MWT), clinical outcomes [death, cardiac-related admission (CRA) and length of stay (LoS) in hospital], medication adherence, HRQoL, and psychological status (depression and anxiety). Data collection was carried out at baseline, at 4 weeks (programme end) and 3 months (study end) after hospital discharge. Inferential statistics including independent t-test, paired t-test, Chi-square test, Fisher's exact test, the Mann-Whitney U test, and the Generalized Estimating Equation model, were used to compare the baseline and various outcome variables within and between groups. / Results: According to the results of phase I, the questionnaire entitled "Heart Failure Patient Learning Needs Inventory" is valid and reliable to measure learning needs among Chinese HF population. Based on the information needs identified in phase I and II, infonnation about HF regarding definition, symptoms, risk factors, classification, treatment strategies, and self-management strategies such as weight and symptoms monitoring, low-salt diet, medication compliance, exercise, and emotion management was included in the booklet. The accuracy, readability, and applicability of the booklet were established by an expert panel and potential users. / With regard to the effectiveness of the HFDMP on patients' outcomes, patients in the experimental group showed greater improvement through the study period than those in control group in the following aspects: a significantly better medication adherence (p &lt; 0.001) as measured by the Chinese version of the Morisky Medication Adherence Scale, a significantly better HRQoL (p &lt; 0.001) as assessed by the Chinese version of the Minnesota Living with Heart Failure Questionnaire, and a significantly greater reduction in depression and anxiety (p &lt; 0.001) as assessed by the Chinese version of the Hospital Anxiety and Depression Scale. However, effectiveness of the programme on patients' 6-MWT, death, CRA, and LoS were not confirmed in the present study. / Yu, Mingming. / Adviser: Sek Ying Chair. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 267-310). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

Chronic heart failure (HF) affects one in five Americans over age 40. It is the leading cause of emergency room visits and hospitalizations. More Medicare dollars are spent for the diagnosis and treatment of HF than any other condition. This study examined emotional representation of HF symptoms after a five-minute verbalization of feelings about these symptoms: 1) What are the characteristics of language used by participants in a verbalization of feelings related to HF symptoms? 2) How does positive affect, negative affect, heart rate (HR), blood pressure (BP), salivary alpha-amylase (sAA), and salivary cortisol (sC) vary over time after verbalization of feelings related to HF symptoms? And 3) What are the significant relationships between emotional word usage, positive and negative affect, HR, BP, sAA, and sC after verbalization of feelings about HF symptoms? A sample of sixty-adults (46 males) with symptomatic HF had a mean age of 71.99 years (SD 9.40), mean education 14.14 (SD 2.86), and Mini-Mental State Exam mean of 29.10 (SD 1.64). They were primarily Caucasian (85%) and married (56.67%) and had a mean time since diagnosis of HF of 104.75 months (SD 106.01). Participants' positive and negative emotional words usages were similar to samples with cancer, HIV/AIDES, and caregivers of chronically ill children. Positive and negative affect, BP, and HR were stable over time. Negative affect scores nearly doubled the reported means for healthy older adults. After speaking about HF symptoms, pulse pressure (F= 5.42, p= .007) and cortisol decreased (t=2.27, p= .027), whereas sAA was elevated (t= -4.31, p< .001). This finding was unexpected in a sample where 90% of the participants were treated with [beta]-blocking medications. Activation of the sympathetic nervous system (SNS) occurred after speaking about feelings related to HF in 70% of this sample. This is relevant given the role of the SNS in HF progression. This was the first study to explore relationships between a description of symptoms, hemodynamic measures, and neurohormonal responses from a verbal description of HF symptoms. This study has demonstrated that human emotions are a representation of the daily health experience of older adults with symptomatic HF. / text

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy