Background: The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality.
In people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization. All of these relationships were independent of muscle mass, inflammatory markers, and comorbidity.
Background: Disease management programmes (DMPs) improve quality of care for patients with heart failure (HF). However, only a limited number of trials have studied the effi cacy of such programmes for patients with heart failure with preserved ejection fraction (HFPEF). Objective: To estimate the impact of a structured, nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF. Methods: Single blinded randomized clinical trial with an intervention over six months and a follow-up during 12 additional months. In the control group, the patients ( n ϭ 41) were managed according to Russian national guidelines. Patients in the intervention group ( n ϭ 44) received education on individual lifestyle changes and modifi cations of cardiovascular disease (CVD) risk factors, home-based exercise training and weekly nurse consultations in addition to usual care. Results: Six months after their inclusion, patients in the intervention group signifi cantly improved body mass index, waist circumference, six-min walk test distance, total cholesterol, low-density lipoprotein, left ventricular end-diastolic volume index, quality of life and level of anxiety. After 18 months, there were 11 deaths (25%) or hospitalizations in the intervention group and 12 (29%) in the control group ( P ϭ 0.134). Cardiovascular mortality and readmission rate were not reduced signifi cantly after six months of follow-up: the hazard ratio was 0.47 (95% CI: 0.17-1.28; P ϭ 0.197). After 18 months, this was 0.85 (0.42-1.73; P ϭ 0.658).
Conclusion:This primary care based DMP for patients with HFPEF improved the patients' emotional status and quality of life, positively infl uenced body weight, functional capacity and lipid profi le, and attenuated heart remodelling.
ObjectivesGeneral practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs’ perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement.DesignQualitative evidence synthesis.MethodsSearches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted. The Critical Appraisal Skills Programme's checklist for qualitative research was used for quality assessment. Thematic analysis was used as method of analysis.ResultsOf 5427 articles, 18 qualitative articles were included. Findings were organised in HF-specific factors, patient factors, physician factors and contextual factors. GPs’ uncertainty in all areas of HF management was highlighted. HF management started with an uncertain diagnosis, leading to difficulties with communication, treatment and advance care planning. Lack of access to specialised care and lack of knowledge were identified as important contributors to this uncertainty. In an effort to overcome this, strategies bringing evidence into practice should be promoted. GPs expressed the need for a multidisciplinary chronic care approach for HF. However, mixed experiences were noted with regard to interprofessional collaboration.ConclusionsThe main challenges identified in this synthesis were how to deal with GPs’ uncertainty about clinical practice, how to bring evidence into practice and how to work together as a multiprofessional team. These barriers were situated predominantly on the physician and contextual level. Targets to improve GPs’ HF care were identified.
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