Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

Schjødt, Inge; Strömberg, Anna; Valentin, Jan Brink; Løgstrup, Brian Bridal

doi:10.1002/ehf2.12938

Cited by 13 publications

(15 citation statements)

References 45 publications

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“…This seems of particular relevance, as the study was conducted in the environment 29 where health indicators consistently show poorer levels of health and health-related behaviours and lower socio-economic standard, compared with other parts of Slovenia. 30 Other research 31,32 indicated particular challenges to self-care in such environments (i.e. limited economic resources, reduced use of HF care and lower levels of education).…”

Section: Discussionmentioning

confidence: 99%

Self‐care perception and behaviour in patients with heart failure: A qualitative and quantitative study

2021

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Background and objective Self-care strategies in heart failure (HF) are effective for disease management, yet adherence in many patients is inadequate. Reasons are presumably multifactorial but remain insufficiently investigated; thus, we aimed to analyse self-care adherence and associated factors in outpatients with HF. Methods and results To measure self-care levels and explore barriers and facilitators to self-care adherence in patients with HF, quantitative study using the European Self-Care Behaviour Scale (EHFScBS-9) (n = 80; NYHA II-III, mean age 72 ± 10 years, 58% male) and qualitative study using semi-structured interviews (n = 32; NYHA II-III, mean age 73 ± 11, 63% male) were conducted. We detected lowest adherence to regular exercise (39%) and contacts with healthcare provider in case of worsening symptoms (47%), whereas adherence was highest for regular medication taking (94%). Using the EHFScBS-9 standardized cut-off score ≤ 70, 51% of patients reported inadequate self-care. Binary logistic regression analysis showed significant influence of education (OR = 0.314, 95% CI: 0.103-0.959) and perceived control (OR = 1.236, 95% CI: 1.043-1.465) on self-care adequacy. According to the situation-specific theory of HF self-care, most commonly reported factors affecting the process of self-care were knowledge about HF self-care behaviours (84%), experience with healthcare professionals (84%), beliefs about their expertise (69%) and habits related to medication taking (72%). Among values, working responsibilities (53%) and maintenance of traditions (31%) appeared as the most prevalent socially based values affecting motivation for selfcare. Situational characteristics related to the person (self-confidence, 53%; adaptive coping strategies, 88%), problem (burdensome breathing difficulties, 56%; co-morbidities, 81%) and environment (practical support from family/caregivers, 59%; financial difficulties, 50%) were also commonly reported. Conclusions Various factors, including health-related beliefs, habits and socially based values, need to be taken into account when planning self-care interventions in patients with HF. A patient tailored approach should be based on adequate patient evaluation, taking into consideration the particular personal and social context.

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Section: Discussionmentioning

confidence: 99%

Self‐care perception and behaviour in patients with heart failure: A qualitative and quantitative study

2021

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“…Lower education has recently been associated with both higher morbidity 44 and inadequate health literacy 31 . Lower educational level and living alone, for example, have been associated with lower adherence to evidence‐based practice in heart failure care 45 . Regional differences in outcomes could indicate local differences in care provided.…”

Section: Discussionmentioning

confidence: 99%

“…31 Lower educational level and living alone, for example, have been associated with lower adherence to evidencebased practice in heart failure care. 45 Regional differences in outcomes could indicate local differences in care provided. This may translate into differences in access to vascular surgery 9 and underuse of evidence-based practices in wound care, which was seen in another study.…”

Section: Inequality In Healthmentioning

confidence: 99%

Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study

Madsen

Juel

2021

International Wound Journal

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This study aimed to investigate incidence and predictors of wound healing, relapse, major amputation, and/or death among patients with chronic leg wounds who were referred to specialist treatment at hospital for their condition. A nationwide register-based cohort study design was applied with 5 years of follow-up. All patients with diagnoses of chronic leg wounds in Denmark between 2007 and 2012 were included (n = 8394). Clinical, social, and demographic individual-level linked data from several Danish national registries were retrieved. Incidence rate per 1000 person-years (PY) was calculated. Predictors were investigated using Cox proportional hazards regression analysis. Incidence rates of having a healed wound was 236 per 1000 PY. For relapse, the incidence rate was 75 per 1000 PY, for amputation 16 per 1000 PY, and for death 100 per 1000 PY. Diabetes, peripheral arteria disease, or other comorbidities were associated with decreased chance of wound healing and increased risk of relapse, major amputation, and death. Regional differences in all four outcomes were detected. Basic or vocational education independently predicted risk of amputation and death. This study provides epidemiological data that may help identify patients at particular risk of poor outcomes. It also elucidates social inequality in outcomes.

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“…17 Tools for cardiac capacity stratification such as the New York Heart Association (NYHA) class, serve as a good prognostic factor in heart failure, lung disease, prescription pattern and quality of life. [18][19][20][21][22] Moreover, physicians' awareness of the number of drugs and benefit/risk profiles helps to prescribe fewer PIMs. 23 Presumably, CAD patients taking multiple medications, 24 or experiencing a high prevalence of frailty or transition to frail status, 25,26 are at the risks of receiving PIMs.…”

Section: Introductionmentioning

confidence: 99%

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

Zhao¹,

Song²,

Zheng³

et al. 2021

CIA

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Medication therapy is crucial in the management of chronic coronary syndrome (CCS). The use of potentially inappropriate medications (PIMs) contributes to poor outcomes in older patients, making it a major public health concern. However, few studies are available on PIMs use in older Chinese CCS patients. To investigate the frequency of prescribed PIMs at discharge and explore risk factors in older adults with CCS. Patients and Methods: The cross-sectional study was conducted in a tertiary hospital in China over three months, from 1st October to 31st December, 2019. CCS patients aged over 60 years who were discharged alive were recruited. Information on demographics and medications at discharge was collected. Clinical data including diagnoses, frailty status, New York Heart Association (NYHA) class and age-adjusted Charlson Comorbidity Index (ACCI) were evaluated in each patient. PIMs were identified using the 2019 Beers criteria. Binary logistic regression was performed to recognize variables related to PIMs. Results: A total of 447 eligible patients with 2947 medications were included. The prevalence of PIMs use was 38%. Medications to be avoided, to be used with caution, and with drug-drug interactions were 38.4%, 48.9% and 12.7% of the PIMs, respectively. Medications with drug-disease/syndrome interactions and those adjusted for kidney function were not identified. The common PIMs were diuretics (37.1%), benzodiazepines and benzodiazepine receptor agonist hypnotics (15.2%), glimepiride (13.1%), and co-prescription of potassiumsparing diuretics and renin-angiotensin system (RAS) inhibitors (9.7%). Individuals with frailty syndrome, polypharmacy, multiple comorbidities, atrial fibrillation, psychiatric disorders and greater NYHA class severity were more likely to receive PIMs. Conclusion: Prescription of PIMs was a common burden in older adults. A CCS multidisciplinary team is needed to control PIMs, especially in vulnerable older patients.

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Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

Cited by 13 publications

References 45 publications

Self‐care perception and behaviour in patients with heart failure: A qualitative and quantitative study

Self‐care perception and behaviour in patients with heart failure: A qualitative and quantitative study

Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

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