How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF-specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF-specific electronic health care record and database platform

Feel4Diabetes healthy diet score: Development and evaluation of clinical validity

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson''s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson''s correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner

Supportive Care Interventions to Promote Health-Related Quality of Life in Patients Living With Heart Failure: A Systematic Review and Meta-Analysis

Supportive care (physical, psychosocial, and spiritual) may be beneficial as a coping resource in the care of patients with heart failure (HF). Nurses may provide individualised supportive care to offer positive emotional support, enhance the patients' knowledge of self-management, and meet the physical and psychosocial needs of patients with HF. The aim of this study was to examine the potential effectiveness of supportive care interventions in improving the health- related quality of life (HRQoL) of patients with HF. Related outcomes of depression and anxiety were also examined. A systematic search of PubMed, CINAHL, and the Cochrane Library was performed to locate randomised controlled trials (RCTs) that implemented any supportive care interventions in patients with HF published in the English language. Identified articles were further screened for additional studies. Ten (10) RCTs were selected for the meta-analysis. Effect sizes were estimated between the comparison groups over the overall follow-up period, and presented along with confidence intervals (CIs). Statistical heterogeneity for each comparison was estimated using Q (chi square test) and I2 statistics with 95% CIs. Statistical heterogeneity was observed in all study variables (i.e., HRQoL and dimensions). There was a positive, but not statistically significant, effect of social support on HRQoL (mean difference [MD], 5.31; 95% CI, −8.93 to 19.55 [p=0.46]). The results of the two dimensions suggested a positive and statistically significant effect of the supportive care interventions (physical: MD, 7.90; 95% CI, 11.31–4.50 [p=0.00]; emotional dimension: MD, 4.10; 95% CI, 6.14–2.06; [p=0.00]). The findings of the current study highlight the need to incorporate supportive care to meet the needs of patients with HF. Patients with HF have care needs that change continuously and rapidly, and there is a need of a continuous process in order to address the holistic needs of patients with HF at all times and not just in a cardiology department or an acute care setting. Patients with HF have multiple needs, which remain unmet. Supportive care is a holistic, ongoing approach that may be effective in identifying and meeting the care needs of patients with HF along with the patient. This review includes all interventions provided in individuals with HF, giving clinicians the opportunity to choose the most suitable ones in improving the clinical outcomes of their patients with HF

A qualitative meta-synthesis of patients with heart failure perceived needs

Supportive care may have significant input into the treatment of patients with heart failure (HF). Support, understanding and being treated as a whole and unique person are vital for patients with HF. In order to develop a person-centred program, it is important to know patients' needs from their perspectives. The aim of the current review and meta-synthesis was to explore the needs of patients with HF from their perspective. A qualitative review was conducted using the keywords: (''needs" OR "need") AND (''heart failure") AND (''qualitative") in four databases. Pre-defined inclusion and exclusion criteria were set. The 'Consolidated criteria for reporting qualitative studies' item checklist was used to assess the research methodologies of the included studies. A ''thematic synthesis'' methodological approach was used: (1) Line by line coding of the findings from primary studies. (2) The resulting codes were organized into related areas thus building descriptive themes. (3) Analytical themes were developed. Eleven articles were included in the present review. The results from the meta-synthesis extracted five different categories covering patents' needs: Self-management, palliative care, supportive care, social support and continuing person-centred care. The need for continuing empowerment and support to meet those needs was also identified, revealing the core theme: 'Wind beneath my wings'. The meta-synthesis quotations highlighted the necessity for dynamic and interactive continuing person-centred care focusing on the ongoing patients' needs through the HF trajectory. Giving more emphasis to the human dimension and holistic approach of patients with HF, along with cardiology medicine development might be a key factor in improving clinical outcomes and health related quality of life

A qualitative meta-synthesis of patients with heart failure perceived needs

Supportive care may have significant input into the treatment of patients with heart failure (HF). Support, understanding and being treated as a whole and unique person are vital for patients with HF. In order to develop a person-centred program, it is important to know patients' needs from their perspectives. The aim of the current review and meta-synthesis was to explore the needs of patients with HF from their perspective. A qualitative review was conducted using the keywords: (''needs" OR "need") AND (''heart failure") AND (''qualitative") in four databases. Pre-defined inclusion and exclusion criteria were set. The 'Consolidated criteria for reporting qualitative studies' item checklist was used to assess the research methodologies of the included studies. A ''thematic synthesis'' methodological approach was used: (1) Line by line coding of the findings from primary studies. (2) The resulting codes were organized into related areas thus building descriptive themes. (3) Analytical themes were developed. Eleven articles were included in the present review. The results from the meta-synthesis extracted five different categories covering patents' needs: Self-management, palliative care, supportive care, social support and continuing person-centred care. The need for continuing empowerment and support to meet those needs was also identified, revealing the core theme: 'Wind beneath my wings'. The meta-synthesis quotations highlighted the necessity for dynamic and interactive continuing person-centred care focusing on the ongoing patients' needs through the HF trajectory. Giving more emphasis to the human dimension and holistic approach of patients with HF, along with cardiology medicine development might be a key factor in improving clinical outcomes and health related quality of life

Heart Failure (HF) Nurses and Allied Professionals Specialists Contribute to Differential Diagnosis of Patients with HF and Comorbidities

Patient presentation: A 76 years old male patient with Heart Failure (HF) enrolled in the nurse-led management program ‘Support Heart’ is presented in the current clinical case. Even though he was well educated and supported through the program, he had several deterioration and re-hospitalizations, during a few months period. The symptoms remained after his discharge and specialist nurses of the program advised him to visit a cardiologist specialist on HF and other specialists as well who diagnosed amyloidosis. Initial work-up: The patient was introduced to the management program ‘Support Heart’ after he was diagnosed with HF with preserved Ejection Fraction (HFpEF). ‘Support Heart’ program includes specialist nurses and physiotherapists on HF who collaborate with cardiologists; and provide monthly follow-up meetings in which the patients are educated, ask questions, do exercise, walking etc. During the pandemic and the lockdowns (a few months period), the patient was admitted three times within the cardiology ward with dyspnea NYHA III and swelled legs with ulcers. The first meeting of the program after the lockdown was only a few days after discharge. HF nurses during his assessment found that the symptoms were not better and undertook a more detailed medical history when they found out that his brother died from a liver disease. The family history with the unknown disease and the continuing symptoms were the reasons that nurses referred the patient to a HF cardiologist specialist. The cardiologist suspected amyloidosis and asked for further evaluation tests. Diagnosis and management: The scintigraphy and hematological tests suggested transthyretin amyloidosis. His therapy then was optimized and upgraded with disease specific treatment (tafamidis) for amyloidosis and the clinical presentation of the patient was improved. His NYHA stage became II and the ulcers were much better. The nurses of the ‘Support Heart’ program were informed by the cardiologist about the new therapy and the necessary follow-up treatment. Follow-up: Amyloidosis is an increasingly recognized but too often underestimated cause of HF. It is often underdiagnosed due to the lack of clinical manifestations. The new possibilities of imaging and tests along with a careful clinical assessment and medical history provide the opportunity for early diagnosis, optimization of the therapy and improved clinical outcomes. The HF nurses of the ‘Support Heart’ program explained to the patient about cardiac amyloidosis and how it changes his treatment and follow-up of the multi-disciplinary team. Then, they made together with the physiotherapist of the program a new program of physical activity since his physical condition along with his mental condition were improved. Conclusion-Learning points: Specialist nurses and physiotherapists in HF and supportive nurse-led management programs may contribute to differential diagnosis of patients with HF and comorbidities and improve the outcomes of the patient and the coordination of health professional specialists. Patients with HF who are mostly older people with comorbidities need continuing support, evaluation and optimization of therapy

Development and Validation of the Greek version of Self-Care Heart Failure Index (Gr-SCHFI) in Patients with Heart Failure

Background: Self-care of patients with heart failure (HF) is essential for the effective self-management of their disease, especially during the pandemic era. Self-care assessment instruments give the opportunity to Health Professionals to early recognize possible self-care needs and management of patients with HF. Aim: The translation and validation of the Greek version of the instrument “Self-Care of Heart Failure Index’’ (Gr-SCHFI), as well as the investigation of the psychometric properties of the instrument in a Greek-speaking population with HF. Methods: It’s a methodological study of an instrument validation. The psychometric properties of the Greek version of Gr-SCHFI were evaluated through reliability factors (Cronbach’s a and Composite Reliability), reliability of repeat test-retest and validity measures (content validity and concurrent validity). Brislin's (1970) methodology was used to translate the instrument to Greek language. Results: The study involved 176 patients, of whom 138 (78%) were men with an average of 69 years old. Most participants were in the NYHA III category [76 (57%)]. Confirmatory factor analysis showed very good measurements in the criteria: RMSEA = 0.07, CFI = 0.97, GFI = 0.98, AGFI = 0.98, NFI = 0.95, TLI = 0.97. The Cronbach's alpha index and the Composite reliability index had satisfactory internal coherence indicators (Cronbach's alpha 0.80-0.92, and Composite reliability 0.88-0.96, respectively). Conclusions: The Gr-SCHFI scale is a reliable and valid self-care assessment instrument for patients with HF. Self-care is necessary in HF where the evaluation and assessment of the self-care of the specific population is very important along the trajectory of the disease