Methods to improve self-care and clinical management of heart failure are required, especially in light of the anticipated increase in heart failure prevalence and associated high costs. Remote patient monitoring (RPM) has been shown to improve heart failure outcomes, but the feasibility and efficacy of mobile phone-based RPM systems are still unknown. The main objectives of this research were to investigate the optimal design of a mobile phone-based RPM system, and to determine the effects of the system on self-care, clinical management, and health outcomes. A mobile phone-based RPM system was first developed using a user-centric design process. It was then evaluated with a six-month randomized controlled trial consisting of 100 patients attending a heart function clinic. The quality of life improved only for the intervention group, but both intervention and control groups improved with respect to self-care, heart function, and heart failure prognosis. The clinic was determined to be a confounder. Patients who were enrolled into the clinic for less than six months showed significantly greater improvements (six months is required for patients to stabilize from medication optimization). Therefore, a subgroup analysis using data from the 63 patients who were enrolled into the clinic for over six months at time of recruitment was performed. The results from the subgroup analysis indicated that the RPM system improved self-care, heart function, and heart failure prognosis at statistically significant and clinically meaningful levels. These improvements were found to be a result of enhanced self-care knowledge and practices, as well as enhanced clinical management enabled by the system. No differences in mortality or hospital admissions were found between groups, but the trial was underpowered to detect changes in these outcome measures. In summary, mobile phone-based RPM was found to be a feasible and effective tool to help improve heart failure management and outcomes.

Background: Symptomatic heart failure is a chronic and disabling condition that affects over 350 000 Canadians and is characterized by inevitable progression. Historically, research on the ways to increase survival has focused on biomedical factors. However, the continued poor prognosis of heart failure has prompted the search for other ways to improve the lives of these patients. Research in other chronic conditions demonstrates that social circumstances, described collectively as individual social interactions (e.g. social support, social participation) and community social factors (e.g. social capital, social norms), can influence health outcomes. Purpose: The purpose of this research was to describe and assess the impact of selected social circumstances potentially related to heart failure outcomes. Methods: Two literature reviews and one empirical study were performed. Conceptual models were proposed to describe the hypothesized pathways between selected social circumstances and heart failure outcomes. The first review was a systematic review of quantitative studies evaluating the relationship between social support and both rehospitalization and death. The review included a critical analysis of the methods employed by previous studies. The second review integrated the qualitative and quantitative literature describing the relationship between individual social interactions (including support, roles and participation) and the quality of life of patients or experience of living with heart failure. A narrative summary was provided and an integration of findings from both qualitative and quantitative study designs was performed. In the empirical study, patients‘ demographic and clinical information was examined simultaneously with selected community factors in a multilevel analysis. Outcomes of interest included rehospitalization or death of heart failure patients. Results: The systematic review shows that previous quantitative research has linked social support to reduced rehospitalization, but there is little evidence to link it with prolonged survival. The critique of the methods describes an inadequate conceptualization and inconsistent measurement of social support. A conceptual model showing how social support can influence rehospitalization is proposed. The integrative review presents qualitative research that identified the following social interactions as important components of the heart failure experience: social support, social participation and role fulfillment. However, no quantitative relationship between social support and quality of life was found. The potential reasons for the discrepant findings between the qualitative and quantitative studies include: the focus on social support as the only component of social interactions assessed in the quantitative literature; and the inconsistent measurement of social support. A conceptual model is presented to describe the multiple components of social interactions and the theoretical basis for their effects. The multilevel analysis demonstrates that individual factors exerted the strongest effect on heart failure outcomes in most models. Community characteristics had little influence on rehospitalization or death. Study design and analysis issues are proposed to explain these findings. Conclusion: The literature reviews and the empirical study provide a contribution to the population health literature, offering a broad approach to assessing the determinants of disease progression in heart failure patients. This thesis research advances the discussion about which social circumstances may influence heart failure outcomes and their pathways. The use of the proposed conceptual models in future research will help clarify the role of social circumstances in the prognosis of heart failure.

This thesis examines the retention of best practices by clinicians after the implementation of an integrated care pathway for patients with congestive heart failure. While the literature suggests there are many reasons why the implementation of best practices is difficult, there is little information on the sustainability of best practices once implemented.<p>Using a qualitative research design guided by Rogers theory of Diffusion of Innovations the researcher interviewed seven clinicians who participated in the implementation of the pathway. A thematic analysis revealed several themes that ran throughout participants responses. <p>While the participants indicated they see value in best practices, they also identified barriers to getting that knowledge into practice and keeping it there. A spectrum of factors, including individual autonomy, time, resources, organizational support and the organization of the system all played a role.<p>In the end, participants revealed that although small pieces of the pathway remain in practice, the pathway itself is no longer used by clinicians to manage patients with congestive heart failure.

A series of seven experiments were conducted to evaluate the risk of acute (sudden death syndrome; SDS) or chronic (congestive heart failure; CHF) heart failure associated with dietary over-supplementation of vitamin A, vitamin D3, vitamin E, vitamin C or cardiotoxic factors present in meat meal. The risk of heart failure associated with the above mentioned dietary factors was tested followed by gross, microscopic, ultrastructural and biochemical investigation for mechanisms associated with mentioned risk factors. Simultaneously, the molecular mechanisms underlying the deterioration of heart function in fast-growing commercial broilers were studied. Each compound was tested separately at a concentration higher than the recommended levels. The basic experimental unit comprised groups of 40 to 50 day old male broiler chickens at the start of experiment. Lowered thermal brooding temperature protocol, an approach resulting in clinical manifestation of heart failure in practically all broilers predisposed to heart disease, was used.<p> Broilers fed the vitamin D3 enriched diet were 2.5 fold more likely to succumb to acute heart failure (p<0.05). Simulated stress challenge with epinephrine revealed that broilers fed excess of vitamin D3 were more susceptible to ventricular arrhythmia. The risk of CHF was higher (P<0.05) in broilers fed the vitamin D3, vitamin A and methanol soluble extract from meat meal enriched diets as compared to groups fed the control diet. The incidence of CHF in broilers fed the diet fortified with vitamin E was not significantly different as compared to the control group, whereas supplementation of vitamin C in the diet tended (p=0.10) to reduce the incidence of CHF. The level of malondialdehyde equivalents, an indicator of lipid peroxidation, was significantly higher (p<0.05) in myocardium of broilers developing CHF irrespective of dietary factors. Antioxidant vitamins (E and C) did not prevent lipid peroxidation in broilers developing CHF. <p>In conclusion, the present findings indicate that over-supplementation of vitamin A and D3 increases the risk of heart failure in broilers. Meat meal contains some unknown cardiotoxic factors, capable of precipitating heart conditions in susceptible broilers. Oxidative stress is involved in the pathogenesis of heart failure in broilers, but supplementation of antioxidant vitamins did not prevent oxidative damage in broilers that developed CHF. The oversupplementation of vitamins (A and D3) should not be encouraged in broilers diet as they may increase the economic losses to broilers industry subsequent to heart related mortalities/morbidities.

Bakgrund: Hjärtsvikt är en kronisk sjukdom som blir allt vanligare i västvärlden, underliggande hjärt- och kärlsjukdomar är ofta bidragande orsaker till att hjärtsvikt uppstår. Sjukdomen har en allvarlig påverkan på kroppen och gör att personers hälsa sätts ur balans. Syfte: Syftet var att belysa upplevelser av att leva med diagnostiserad hjärtsvikt med minst NYHA II. Metod: En litteraturstudie har gjorts och baserats på 13 vetenskapliga artiklar. Resultat: Personer med hjärtsvikt upplever fysisk, social och psykisk påverkan på livet på grund av sjukdomen. Det väcker känslor av ilska, frustration och ångest. Personerna har ofta behov av att göra livstilsförändringar som påverkar deras sociala nätverk negativt och skapar känslor av ensamhet och sorg. Många funderar mycket på framtiden och hur familjesituationen kan komma att förändras. Diskussion: Fynden som diskuteras är den fysiska påverkan, osäkerheten inför framtiden och hur familj- och närståenderelationerna kan förändras. Slutord: Som sjuksköterska och andra yrkesgrupper inom vården  är det viktigt att  ha förståelse för vilka känslor som personer med hjärtsvikt har och upplever. Genom att förstå vilka fysiska begränsningar personerna har och vilka upplevelser det skapar, kan omvårdnadsarbetet underlättas. / Background: Heart failure is a chronic disease that is becoming increasingly more common in the Western civilization, where the underlying cardiovascular diseases often are contributing factors to the occurrence of heart failure. The disease has a serious impact on the body and makes health out of balance. Aim: The aim was to highlight experiences of living with diagnosed heart failure graded at least as NYHA II. Methods: A literature review has been made based on 13 scientific articles. Results: People’s experiences of living with heart failure are physical, social and psychological impact on life due to the disease. It arouses feelings of anger, frustration and anxiety. People often need to make lifestyle changes that affect their social networks negatively and this creates feelings of loneliness and sadness. Many think a lot about the future and how the family situation may change. Discussion: The findings which have been discussed are the physical impact, uncertainty about the future and how family and close relationships can change.Conclusion: As a nurse and other professionals in health care it´s important to understand the feelings that people with heart failure have. By understanding the physical limitations and the experiences it creates, nursing work might become easier.

Thesis (M.S.)--Auburn University, 2008. / Abstract. Includes bibliographical references (p. 118-127).

Thesis (Ph. D.)--University of Wisconsin-Madison, 2002. / Includes bibliographical references (p. 240-252). Also available on the Internet.

It has been known that anthracycline-based chemotherapy has the potential to cause cardiac dysfunction in breast cancer patients; however, recently evidence has shown that the addition of trastuzumab increases this risk. The study objective was to compare the cost-effectiveness of monitoring for cardiotoxicity with B-type natriuretic peptide (BNP), multi-gated acquisition scanning (MUGA), echocardiography (ECHO) or no monitoring from a payer’s prospective. Cost-effectiveness was compared between alternatives using an incremental cost-effectiveness ratio with outcomes of 1) quality-adjusted life-years and 2) percentage of patients diagnosed with each monitoring strategy. Costs estimates (in 2010 U.S. Dollars) of each strategy (obtained from the Center for Medicare and Medicaid Services website [www.cms.gov]) included the cost of the test, cost of treating heart failure once discovered (which includes medications, routine office visits, medication management) and the cost of potential acute care (which includes emergency department visits and hospitalizations). Estimates for the probabilities of heart failure development, disease progression, need for acute care, and mortality, as well as utility estimates for all disease stages were obtained from published literature. A 15-year time-frame was used with a 3% discount rate for both costs and QALYs. In the base-case analysis, the average costs and QALYs for monitoring patients were $10,062/ 6.92 QALY, $13,627/4.22 QALY, $14,739/ 6.61 QALY and $15,656/ 6.49 QALY for BNP, No Monitoring, ECHO and MUGA respectively. When comparing all alternatives to BNP, the ICER values were negative, indicating that BNP was the dominant monitoring strategy. Percent detection was similar between the three monitoring methods [21-22 % for HER-2(-) and 30-31% for HER-2(+) patients]. Again BNP was dominant over the other monitoring strategies. Sensitivity analyses were robust to changes in discount rate, probability of patients testing HER-2 (+), probability of patients being diagnosed in an asymptomatic stage, incidence of cardiac dysfunction in patients receiving anthracycline therapy ± trastuzumab and estimate of disutility associated with additional testing. A probabilistic sensitivity analysis conducted via Monte Carlo simulation led to the same conclusion as the base-case analysis; BNP was the dominant strategy over all monitoring alternatives. / text

Impedance has been used as a tool for cardiac research since the early 1940’s. Recently there have been many advances in this field in the diagnosis of human heart failure through the measurement of pacemaker and ICD coupled impedance detection to determine the state of pulmonary edema in patients through drops in lung impedance. These new detection methods are far downstream of the initial changes in physiology, which signify heart failure risk, namely, an increased left ventricular (LV) end-diastolic volume (also known as preload). This dissertation presents the first formal validation of the complex admittance technique for more accurate blood volume measurement in vivo in mice. It aims to determine a new configuration of admittance measurement in a large scale animal model (pigs). It also aims to prove that “piggybacking” an admittance measurement system onto previously implanted AICD and bi-ventricular pacemakers is a feasible and practical measurement that will serve as an early warning system for impending heart failure through the measurement of LV preload, which appears before the currently measured drop in lung impedance using previous techniques. / text

Ο ρόλος της εξωκυττάριας ουσίας στην καρδιακή ανεπάρκεια. / The functional role of extracellular matrix in heart failure.