16 research outputs found
Factors Associated With Patient Delay in Seeking Care After Worsening Symptoms in Heart Failure Patients
Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials)
Serum potassium is routinely measured at admission for acute heart failure (AHF), but
information on association with clinical variables and prognosis is limited. Potassium
measurements at admission were available in 1,867 patients with AHF in the original cohort
of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume
Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients
were grouped according to low potassium (<3.5 mEq/l), normal potassium (3.5 to 5.0 mEq/l),
and high potassium (>5.0 mEq/l) levels. Results were verified in a validation cohort of 1,023
patients. Mean age of patients was 71 – 11 years, and 66% were men. Low potassium was
present in 115 patients (6%), normal potassium in 1,576 (84%), and high potassium in 176
(9%). Potassium levels increased during hospitalization (0.18 – 0.69 mEq/l). Patients with
high potassium more often used angiotensin-converting enzyme inhibitors and mineralocorticoid
receptor antagonists before admission, had impaired baseline renal function and a
better diuretic response (p [ 0.005), independent of mineralocorticoid receptor antagonist
usage. During 180-day follow-up, a total of 330 patients (18%) died. Potassium levels at
admission showed a univariate linear association with mortality (hazard ratio [log] 2.36,
95% confidence interval 1.07 to 5.23; p [ 0.034) but not after multivariate adjustment.
Changes of potassium levels during hospitalization or potassium levels at discharge were
not associated with outcome after multivariate analysis. Results in the validation cohort
were similar to the index cohort. In conclusion, high potassium levels at admission are
associated with an impaired renal function but a better diuretic response. Changes in potassium
levels are common, and overall levels increase during hospitalization. In conclusion,
potassium levels at admission or its change during hospitalization are not associated
with mortality after multivariate adjustment
Effect of moderate or intensive disease management program on outcome in patients with heart failure:Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)
Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure
Response to letter to the editor: Seasonal variation in physical activity in patients with heart failure
Patient-nurse communication about prognosis and end-of-life care
Background: Although several studies advise that discussions about prognosis and end-of-life care should be held throughout the whole heart failure (HF) trajectory, data is lacking on the prevalence and practice of such discussions in HF care. Objective: The study objective was to explore how often and why HF nurses in outpatient clinics discuss prognosis and end-of-life care in the context of patient education. Methods: This was a descriptive and comparative study. Participants were HF nurses from Swedish and Dutch HF outpatient clinics. Measurements were taken via a survey for both quantitative and qualitative data. Additional data was collected via open-ended questions and analyzed with content analysis. Results: Two hundred seventy-nine nurses registered 1809 patient conversations using a checklist. Prognosis and end-of-life care were among the least frequently discussed topics, whereas symptoms of HF was discussed most often. Prognosis was discussed with 687 patients (38%), and end-of-life care was discussed with 179 patients (10%). Prognosis and end-of-life care were discussed more frequently in The Netherlands than in Sweden (41% versus 34%, p < 0.001, 13% versus 4%, p < 0.001). The nurses did not always recognize prognosis and end-of-life care discussions as a part of their professional role. Conclusions: Currently, patient-nurse communication about prognosis and end-of-life care does not seem to be routine in patient education in HF clinics, and these discussions could be included more often. The reasons for nurses to discuss these topics were related to clinical routines, the patient's situation, and professional responsibilities. To improve future care, communication with patients needs to be further developed