European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlström, Ulf; Ekman, Inger; Lainščak, Mitja; McDonald, Kenneth; Ryder, Mary; Strömberg, Anna; Jaarsma, Tiny

doi:10.1093/eurjhf/hfq221

Cited by 232 publications

(229 citation statements)

References 41 publications

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“…1,2,3 Patients often need complex care due to old age, cognitive decline, co-morbidities and polypharmacy. 4 The health care resources for these patients have been reported as not meeting the patients' needs. 5,6 The majority of HF care is provided by informal caregivers, thus they are a considerable resource to the health system.…”

Section: Introductionmentioning

confidence: 99%

Informal Caregivers’ Experiences and Needs When Caring for a Relative With Heart Failure

et al. 2016

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link Conflicts of interestThere are no conflicts of interest. Number of words and tablesThere are 4307 words and two tables in the manuscript. AbstractBackground: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care and identifying deterioration in health status. Caring for a relative with heart failure may affect informal caregivers' well-being and cause caregiver burden. Objective: To explore informal caregivers' experiences and needs when caring for a relative with heart failure in their homes. Methods: The study has a qualitative design with an inductive approach. Interviews were held with 14 informal caregivers. Data were analyzed using qualitative content analysis. Results: Two themes emerged: "Living in a changed existence" and "Struggling and sharing with health care". The first theme describes informal caregivers' experiences, needs and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also 2 expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs and ways of handling the health care. They felt counted upon but not accounted for as their carewas taken for granted while their need to be seen and acknowledged by health care professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with health care and not being provided with adequate knowledge. They were not invited to share information with health care professionals and their specific expertise was not requested. Health care professionals had neither provided them with knowledge on heart failure nor with information on support groups in the municipality.Informal caregivers appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by health care professionals. Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies in order to preserve a sense of "self" and of "us". Informal caregivers express a need for more involvement with health care professionals which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

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Section: Introductionmentioning

confidence: 99%

Informal Caregivers’ Experiences and Needs When Caring for a Relative With Heart Failure

et al. 2016

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“…It might be advocated that all patients with HF should be able to access the benefits of organized HF care. (24). It is also advocated to have an organization of care that includes the whole HF illness trajectory and phases of crisis, chronicity and the terminal stages.…”

Section:  Quality Improvementmentioning

confidence: 99%

Heart Failure Clinics Are Still Useful (More Than Ever?)

Jaarsma

Strömberg

2014

Canadian Journal of Cardiology

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Heart Failure (HF) clinics have had an important role in optimal HF management and the effectiveness of these clinics has been studied intensively. A HF clinic is one of the various ways to organize a HF disease management program. There is good evidence that HF disease management can improve outcomes in HF patients, but it is not clear what the optimal components of these programs are and what the relative effectiveness of a HF clinic is compared to other forms of HF management. After initial positive reports on the effect of HF clinics, these clinics were implemented in a lot of countries, although in different formats and of varying quality. In this paper we describe the initial need for HF clinics, reflect on their development over time and discuss the role of HF clinics in the current need for HF disease management.Introduction:

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“…The 2011 ESC/HF Association standards for HF care6 underline that the two main responsibilities of this type of nurse are the education of patients and their family, and the optimization of drugs (titration/prescription of drugs, depending on the country), recommending that such nurses have immediate access to cardiologists if advice is needed.…”

Section: Introductionmentioning

confidence: 99%

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

et al. 2017

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AimsHeart failure (HF) is associated with many hospital admissions and relatively high mortality, rates decreasing with administration of beta‐blockers (BBs), angiotensin‐converting‐enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. The effect is dose dependent, suboptimal doses being common in clinical practice. The 2012 European guidelines recommend close monitoring and dose titration by HF nurses. Our main aim is to compare BB doses achieved by patients after 4 months in intervention (HF nurse‐managed) and control (cardiologist‐managed) groups. Secondary aims include comparing doses of the other aforementioned drugs achieved after 4 months, adverse events, and outcomes at 6 months in the two groups.MethodsWe have designed a multicentre (20 hospitals) non‐inferiority randomized controlled trial, including patients with new‐onset HF, left ventricular ejection fraction ≤40%, and New York Heart Association class II–III, with no contraindications to BBs. We will also conduct qualitative analysis to explore potential barriers to and facilitators of dose titration by HF nurses. In the intervention group, HF nurses will implement titration as prescribed by cardiologists, following a protocol. In controls, cardiologists will both prescribe and titrate doses. The study variables are doses of each of the drugs after 4 months relative to the target dose (%), New York Heart Association class, left ventricular ejection fraction, N‐terminal pro B‐type natriuretic peptide levels, 6 min walk distance, comorbidities, renal function, readmissions, mortality, quality of life, and psychosocial characteristics.ConclusionsThe trial seeks to assess whether titration by HF nurses of drugs recommended in practice guidelines is safe and not inferior to direct management by cardiologists. The results could have an impact on clinical practice.

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European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

Cited by 232 publications

References 41 publications

Informal Caregivers’ Experiences and Needs When Caring for a Relative With Heart Failure

Informal Caregivers’ Experiences and Needs When Caring for a Relative With Heart Failure

Heart Failure Clinics Are Still Useful (More Than Ever?)

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

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