Reducing heart failure risk standardized readmissions rates (RSRRs) continues to be a challenge in the United States. Among Medicare beneficiaries, the U.S. national rate for heart failure RSRRs is 23, and Georgia only has 3 hospitals with heart failure RSRRs that are better than the national rate. The hospital component of the chronic care model (CCM) was the theoretical framework used in this study because the model was designed to assist heath care organizations in improving chronic care outcomes. Researchers have indicated that the Hospital to Home Initiative (H2H), a national quality improvement campaign launched in 2009, is effective in reducing RSSRs. However, very little research has been conducted to determine which specific H2H strategies and categories of strategies are associated with reducing heart failure RSRRs in Georgia. The purpose of this nonexperimental, cross-sectional quantitative research study was to address this gap. The H2H Survey used in this study is a valid instrument that was previously used in a national study. Surveys were sent to 35 hospitals in Georgia participating in the H2H. A series of one-way ANOVAs were used to test the hypotheses. Key findings were as follows: (a) heart failure RSRRs were reduced when hospitals implemented the H2H, (b) the number of implemented H2H strategies was associated with a reduction in heart failure RSRRs, and (c) categories of strategies were associated with a reduction in heart failure RSRRs. These findings can be used for promoting positive social change because hospital administrators can implement changes using effective strategies to reduce both heart failure RSRRs and government penalties associated with these readmissions.

<p>  </p> <p><strong>Background: </strong></p> <p>Torsades de pointes (TdP) is a polymorphic ventricular tachycardia (VT) associated with heart rate-corrected QT interval (QTc) prolongation on the electrocardiogram (ECG). TdP can cause sudden cardiac arrest (SCA), a catastrophic outcome. The antiarrhythmic drugs dofetilide and sotalol can cause QTc prolongation and arrhythmias, as can more than 200 other medications available on global markets. Heart failure (HF) with reduced ejection fraction (HFrEF) is a risk factor for drug-induced TdP, and HFrEF heightens sensitivity to drug-induced QTc lengthening. However, ~55% of patients with HF have preserved, rather than reduced, ejection fraction. It remains unknown whether patients with HF with preserved ejection fraction (HFpEF) are at increased risk for drug-induced VT/SCA. Assessment of the risk of drug-induced VT/SCA in HFpEF patients is important, so that recommendations can be made regarding the safety of QTc-prolonging drugs and need for enhanced ECG monitoring in this population. </p> <p><strong>Objective:</strong></p> <p>In aim 1, we sought to determine the risk of VT and SCA associated with dofetilide and sotalol in patients with HFpEF. In aim 2, we were able to use QTc interval to determine the odds of dofetilide/sotalol-associated QT interval prolongation in patients with HFpEF. In Aim 3, we investigated the influence of HFpEF on VT and SCA associated with a broader group of drugs known to cause TdP (“known “TdP drugs”), as designated by the QT drugs list at www.crediblemeds.org. </p> <p><strong>Methods:</strong></p> <p>In aim 1, we used Medicare claims (2014-2016) and ICD-9/10 codes to identify patients taking the QT interval-prolonging drugs dofetilide or sotalol, which are used commonly in patients with HF and atrial fibrillation, as well as non-dofetilide or sotalol users among 3 groups: HFpEF, HFrEF, and no HF. Multinomial propensity score-matching was performed. Cochran–Mantel–Haenszel statistics and standardized differences were used to compare baseline characteristics. A generalized Cox proportional hazards model was used to estimate hazard ratios (HRs) and test the association of VT and SCA among dofetilide/sotalol users, HFpEF, HFrEF, and no HF.</p> <p>In Aim 2, the data source was electronic health records from the Indiana Network for Patient Care (February 2010 to May 2021). After removing patients with overlapping diagnoses of HFpEF and HFrEF, no diagnosis code, absence of QT interval records, and no validated record of using dofetilide or sotalol, we identified patients taking dofetilide or sotalol among three groups: HFrEF, HFpEF, and no HF. Cochran–Mantel–Haenszel statistics were used to compare baseline characteristics. QT interval prolongation was defined as heart rate-corrected QT (QTc) > 500 ms during dofetilide/sotalol therapy. Unadjusted odds ratios (OR) of QT interval prolongation were determined by univariate analysis, and adjusted ORs were determined by generalized estimating equations (GEE) with logit link to account for an individual cluster with different times of hospitalization and covariates.</p> <p>In aim 3, we used Medicare enrollment in fee-for-service medical and pharmacy benefits (2014 to 2016) and ICD-9/10 codes, we identified patients taking drugs known to cause torsades de pointes (TdP drugs; www.crediblemeds.org) and non-TdP drug users among three groups: HFrEF, HFpEF, and no HF. Multinomial propensity score-matching was performed to minimize baseline differences in covariates (patient demographics, comorbidities, health care utilization and drug history). Cochran–Mantel–Haenszel statistics and standardized differences were used to compare baseline characteristics. A generalized Cox proportional hazards model was used to estimate HRs and test the association of VT and SCA among TdP drug users with HFpEF, HFrEF, and no HF.</p> <p><strong>Results:</strong></p> <p>In Aim 1, VT and SCA occurred in 166 (10.68%) and 16 (1.03%), respectively, of 1,554 dofetilide/sotalol users with HFpEF, 543 (38.76%) and 40 (2.86%) of 1,401 dofetilide/sotalol users with HFrEF, and 245 (5.06%) and 13 (0.27%) of 4,839 dofetilide/sotalol users with no HF. The adjusted HR for VT in patients with HFrEF was 7.00 (95% CI 6.12-8.02) and in patients with HFpEF was 1.99 (1.71-2.32). The risk of VT associated with dofetilide/sotalol was increased across the overall study population (HR: 2.47 [1.89-3.23]). Use of dofetilide/sotalol increased the risk of VT in patients with HFrEF (HR: 1.53 [1.07-2.20]) and in those with HFpEF (HR: 2.34 [1.11-4.95]). However, while the overall risk of SCA was increased in patients with HFrEF (HR: 5.19 [4.10-6.57]) and HFpEF (HR: 2.53 [1.98-3.23]) compared to patients with no HF, dofetilide/sotalol use was not significantly associated with an increased risk of SCA.</p> <p>In Aim 2, QTc prolongation associated with dofetilide/sotalol occurred in 51.2% of patients with HFpEF, 70.1% of patients with HFrEF, and 29.4% of patients with no HF. After adjusting for age, sex, race, serum potassium and magnesium concentrations, kidney function, concomitant drug therapy, and comorbid conditions, the adjusted odds of having QTc interval larger than 500ms during the hospital stay were 5.23 [3.15-8.67] for HFrEF and 1.98 [1.17-3.33] for HFpEF with no HF as the reference group. </p> <p>In Aim 3, of 23,910 known TdP drug users with HFrEF, VT and SCA occurred in 4,263 (17.8%) and 493 (2.1%) patients, respectively. In comparison, among 31,359 known TdP drug users with HFpEF, VT and SCA occurred in 1,570 (5.0%) and 340 (1.1%) patients. VT and SCA occurred in 3,154 (0.8%) and 528 (0.1%) of 384,824 known TdP drug users without HF. The overall HR of both VT and SCA was increased in patients with HFrEF (HR: 7.18 [6.13-8.40])  and in those with HFpEF (HR: 2.09 [1.80-2.42]). The risk of VT associated with known TdP drugs was increased across the overall population (HR: 1.34 [1.20-1.51]). Use of known TdP drugs significantly increased the risk of VT and SCA in patients with HFrEF (HR: 1.34 [1.07-1.67]), but not in patients with HFpEF.</p> <p><strong>Conclusion:</strong></p> <p>HFpEF may exhibit an enhanced response to drug-associated VT, and is associated with a higher risk of drug-associated QTc interval prolongation. Further study is needed to identify methods to minimize this risk for patients with HFpEF requiring therapy with dofetilide, sotalol, or drugs known to cause TdP. </p>

No description available.

Congestive heart failure (CHF) is one of the leading causes of hospitalisation, morbidity and mortality in the UK. The incidence and prevalence of CHF is expected to increase due to the aging population and improved survival in heart disease. Exercise has been recognised as a valuable treatment and has proved to be beneficial in CHF. The present study applied the Theory of Planned Behaviour (TPB) and the Commonsense Model of Self-regulation to fitness, daily activity and medication-adherence in elderly patients with CHF. The study was in parallel with a randomised controlled trial of a 3-month exercise programme. A TPB questionnaire was used at baseline and at 3 months. Illness representations were assessed by IPQ-R at baseline. Fitness (measured by 6 minute walk test) and daily activity (measured by an accelerometer) were assessed at baseline, 3 and 6 months. ACEI-adherence (assessed by measuring serum ACE level) was assessed at baseline. The main findings from 81 CHF patients (mean age = 81 years) showed that Subjective norm (SN) was the only predictor of Intention (IN1) at baseline; Attitude, Perceived behavioural control (PBC) were predictors of INT at 3 months; fitness was predicted by PBC at 3 months. The exercise intervention led to significant changes in Attitude and PBe. The finding also indicated that the participants were more likely to attribute their illness to Chance, BiolOgical factors and God. Identity and Illness coherence predicted fitness, and Consequences predicted daily activity. Participants who believed that their illness was chronic or serious were less likely to adhere to ACEI medication. Conclusion: both the TPB and IPQ-R were useful instruments to predict behaviours in elderly patients with CHF. The IPQ-R had a greater predictive power than the TPB in this population. Illness representations may play a role in influencing the formation of intention as background factors.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF.

No description available.

Cardiotoxicity associated with many cancer drugs is a critical issue facing physicians these days and a huge hurdle that must be overcome for a side effects-free cancer therapy. Survival of cardiac myocytes is compromised upon the exposure to certain chemotherapeutic drugs. Unfortunately, the mechanisms implicated in cardiac toxicity and the pathways governing myocyte survival are poorly understood. The following thesis addresses the mechanisms underlying the cardiotoxicity of two anticancer drugs, doxorubicin (DOX) and Imatinib mesylate (Gleevec). Transcription factor GATA-4, has recently emerged as an indispensable factor in the adult heart adaptive response and cardiomyocyte survival. Therefore, the specific aim of this project was to determine the role of GATA-4, its upstream regulators, as well as partners in survival. A combination of cell and molecular techniques done on in vivo, and ex vivo models were utilized to tackle these issues. In this study, we confirmed the cardiotoxicity of the anticancer drug, Imatinib mesylate and found to be age dependent. GATA-4, already known to be implicated in DOX-induced toxicity, was confirmed as an Imatinib target. At the molecular level, we identified IGF-1 and AKT as upstream regulators of GATA-4. Moreover, we confirmed ZFP260 (PEX-1), a key regulator of the cardiac hypertrophic response, as a GATA-4 collaborator in common prosurvival pathways. Collectively, these results provide new insights on the mechanisms underlying drug-induced cardiotoxicity and raise the exciting possibility that cancer drugs are negatively affecting the same prosurvival pathway(s), in which GATA-4 is a critical component. Therapeutic interventions aimed at enhancing GATA-4 activity may be interesting to consider in the context of treatments with anticancer drugs.

Heart failure (HF) is a chronic condition affecting older adults. It is estimated over 5.8 million Americans are currently diagnosed with HF, with an anticipated increase to seven million by 2030. HF patients are faced not only with the physical symptoms, but also with emotional tolls, and socioeconomic burdens related to HF. Low income and rural facilities, which lack financial resources, are at greater risk for closure if there are concerns of loss of reimbursement. Hospitals are now challenged to prevent readmissions and to avoid penalties associated with HF admission within the 30-day window. Incorporating various interventions have shown improvements in readmission rates. Nurse practitioners and registered nurses can serve as patient educators regarding topics such as diagnoses, procedures, disease monitoring, medications, and medication side effects. In most hospitals, RNs at patients' bedside are at the forefront of providing HF patients discharge instructions and education, which should include symptom recognition and management. The aim of this project inquiry was to assess the knowledge of HF education and perceived barriers to providing HF education by nurses and nurse practitioners, such that improved transition of care for patients in the rural health setting can occur.

Bakgrund:Hjärtsvikt är en sjukdom som blir vanligare vid stigande ålder och cirka 250 000 svenskar är drabbade (Hjärt-lungfonden, 2016). Patienter ska enligt Patientlagen (SFS 2014:821; SFS 1982:763) få information om sitt hälsotillstånd, vilka former av undersökningar, vilken vård som kan användas, förväntade behandlingsförlopp, riskerna och eftervård. Patienten får inte alltid nödvändig information. Bristen på information kan bero på allt från patientens okunskap till vårdgivarens tidsnöd på grund av hög arbetsbelastning. Syfte: Att undersöka sjuksköterskornas sätt att informera och olika perspektiv på innehållet på den information som förmedlas till patienter med hjärtsvikt på en kardiologisk slutenvårdsavdelning. Metod:En deskriptiv intervjustudie med kvalitativ ansats och innehållsanalys. Resultat: Resultat visar att den information som förmedlas till patienter med hjärtsvikt kan se olika ut beroende på vilken sjuksköterska som ger informationen. Slutsats:Informationen sjuksköterskor förmedlar till patienter med hjärtsvikt varierar beroende på patientens kunskap, hälsotillstånd, intresse och grad av kognitiv förmåga. Dock kan hög arbetsbelastning förhindra sjuksköterskan att ge individuellt anpassad information. / Background: Heart failure is a condition that becomes more common with age, and about 250 000 Swedes are affected (Heart-Lung Foundation, 2016). Patients should, under the Patient Act (SFS 2014: 821, SFS 1982: 763), obtain information on their health status, the types of treatment, what care may be used, the expected course of treatment, risks and aftercare. The patient does not always get the necessary information. The lack of information may depend on everything from the patient's lack of knowledge to the caregiver's shortage of time, because of the heavy workload. Aim: To investigate the nurses' ways of informing and different perspectives on the content of the information conveyed to patients with heart failure in a cardiologic healthcare department. Method: A descriptive interview study with qualitative approach and content analysis. Results: Results show that the information given to patients with heart failure may vary depending on the nurse who provides the information. Conclusion: The information nurses convey to patients with heart failure vary depending on the patient's knowledge, state of health, interest and degree of cognitive ability. However, high workload can prevent the nurse to provide personalised information.