Ethical issues concerning cardiac surgery in elderly patients — the nurse’s role as a patient advocate: A case report

Introduction: Frailty syndrome (FS) is one of the well-known risk factors for cardiac surgical treatment. Moreover, older patients are more likely to suffer from various comorbidities. Ethical issues that arise in patient care should be considered, including their identification, analysis, and appropriate resolution. The study aimed to present the nurse’s role in the therapeutic team, which should take the floor as a patientadvocate representing her/his interest.Case presentation: An 82-year-old patient was admitted to the Cardiac Surgery Clinic and was discussed in the context of emerging ethical dilemmas in clinical practice. The peri-operative risk was assessed as high; the nurse identified both frailty phenotype and FS. Currently, at postoperative day 40, the patient remains sedated, haemodynamically unstable, and has a poor long-term prognosis.Summary: If the patient is not presented with a risk assessment that includes FS assessment during the qualification process, it can be concluded that this omission violates the information component of informed consent. Nurses must speak out in those patients’ interests in order to preclude actions that may increase their vulnerability during cardiac surgery

Health-related quality of life of patients with cystic fibrosis assessed by the SF-36 questionnaire

Wstęp: Mukowiscydoza (CF) jest chorobą genetyczną, występującą najczęściej u osób populacji kaukaskiej. Na świecie choruje około 100 tysiąca osób, z czego w Europie liczba chorych wynosi około 25 000. Choć historia wiedzy o mukowiscydozie sięga najprawdopodobniej 1595 roku, to poznanie choroby mające wpływ na rozwój współczesnej wiedzy o CF dotyczy dopiero XX wieku. Jeszcze kilka lat temu uważana była za śmiertelną chorobę wieku dziecięcego, jednak aktualne dane statystyczne wskazują, że 50% chorych na mukowiscydozę ma szansę dożycia do 30. roku życia, a długość życia dzieci urodzonych w latach 90. XX wieku ma wynosić co najmniej 40 lat. Obserwuje się w związku z tym wzrost liczby chorych dorosłych na mukowiscydozę. Konieczne staje się zatem podejmowanie interdyscyplinarnych działań mających na celu zarówno poprawę skuteczności działań medycznych, jak i zminimalizowanie wpływu choroby i jej leczenia na jakość wydłużającego się życia chorych. Ingerencja mukowiscydozy we wszystkie najważniejsze obszary funkcjonowania rodzi potrzebę ciągłego, kompleksowego monitorowania jakości życia, co pozwoliłoby zwrócić szczególną uwagę na ich potrzeby, a także w razie konieczności umożliwiłoby modyfikacje podejścia terapeutycznego. Celem było zobrazowanie jakości życia chorych na mukowiscydozę, wykazanie różnic w samoocenie jakości życia w zależności od płci i wieku oraz porównanie jakości życia chorych z grupą kontrolną osób bez mukowiscydozy.Materiał i metody: Badanie przeprowadzono wśród pacjentów hospitalizowanych w Klinice Pneumonologii i Mukowiscydozy Instytutu Gruźlicy i Chorób Płuc w Rabce-Zdroju w okresie od lutego do kwietnia 2012 roku. Objęto nim 30 pacjentów (19 kobiet i 11 mężczyzn) z zaostrzeniem choroby oskrzelowo-płucnej w wieku 16–42 lat. W badaniu wykorzystano kwestionariusz ogólny SF-36 (Short Form 36) do oceny jakości życia uwarunkowanej stanem zdrowia. Grupa kontrolna obejmowała 30 zdrowych osób w podobnym wieku oraz dopasowanych pod względem rozkładu płci. Wyniki: Analiza jakości życia kwestionariuszem ogólnym SF-36 wykazała, że chorzy generalnie nisko oceniają swoją jakość życia. Średnie wyniki poniżej 50 uzyskali w podskalach dotyczących: ograniczenia aktywności z powodu zdrowia fizycznego (RP), ogólnej oceny stanu zdrowia (GH), witalności (VT), funkcjonowania społecznego (SF), poziomie aktywności fizycznej (PCS), poziomie aktywności umysłowej (MCS). W pozostałych podskalach średnie wyniki nieznacznie przekroczyły 50. Wśród kobiet niską jakość życia odnotowano w podskalach: RP — ograniczenia aktywności z powodu zdrowia fizycznego, BP — ograniczenia bólowe, GH — ogólnej ocenie stanu zdrowia, VT — witalności, SF — funkcjonowanie społeczne, PCS — poziomie aktywności fizycznej, MCS — poziomie aktywności umysłowej. Wśród mężczyzn średnie wyniki poniżej 50 odnotowano w podskalach: GH — ogólna ocena stanu zdrowia i VT — witalność. Ponadto kobiety oceniły swoją jakość życia gorzej niż mężczyźni we wszystkich podskalach. Chorzy powyżej 25 lat gorzej ocenili swoją jakość życia we wszystkich podskalach, oprócz podskali dotyczącej ograniczenia aktywności z powodu problemów emocjonalnych (RE). Wykazano istnienie różnic statystycznych w zakresie VT — witalności i MH — zdrowia psychicznego. Analiza wpływu wieku na jakość życia chorych na mukowiscydozę badana kwestionariuszem SF-36 wykazała, że istnieją zależności istotne statystycznie (przy p < 0,05) między wiekiem a domenami: PF — funkcjonowanie fizyczne, RP — ograniczenia aktywności z powodu zdrowia fizycznego, BP — dolegliwości bólowe, VT — witalność, SF — funkcjonowanie społeczne, MH — zdrowie psychiczne, PCS — poziom aktywności fizycznej. Porównując jakość życia chorych na mukowiscydozę z grupą kontrolną osób bez mukowiscydozy, wykazano istnienie różnic statystycznych we wszystkich podskalach. Jakość życia osób chorych jest w znacznym stopniu gorsza niż jakość życia osób bez mukowiscydozy.Wnioski: 1. Chorzy na mukowiscydozę generalnie nisko oceniają swoją jakość życia.2. Istnieją różnice w ocenie jakości życia pomiędzy kobietami a mężczyznami.3. Im starszy chory, tym gorsza jego jakość życia w większości podskal.4. Istnieją duże odstępstwa w ocenie jakości życia chorych na mukowiscydozę, a grupą kontrolną osób bez mukowiscydozy.5. Chorzy oceniają gorzej swoją jakość życia.Introduction: Cystic fibrosis (CF) is a genetic disorder, which is most common among Caucasians. There are about 100,000 people suffering from this disorder in the world, including 25 000 in Europe. Although the first mention of cystic fibrosis is thought to have occurred in 1595, recognition of the entire clinical spectrum of CF and the resultant development of contemporary knowledge occurred in the 20th century. In the past, CF was considered a fatal childhood disorder; however, contemporary statistical data shows that 50% of people with cystic fibrosis have a chance to live up to 30 years of age, and the lifespan of children born in the 1990s is projected to be at least 40 years. Consequently, the number of adults with cystic fibrosis is increasing, making it necessary for multidisciplinary actions aimed at the improvement of clinical management of the condition as well as minimizing the influence of CF and its treatment on the quality of continually extending life of patients. Since cystic fibrosis interferes with almost all important aspects of human functioning, quality of life (QoL) of individuals with CF should be constantly and closely monitored, thus allowing for consideration of their needs and providing an opportunity to modify the therapeutic approach if necessary. The aim of this study was to visualize the QoL of people with cystic fibrosis, to identify differences in their assessment of QoL depending on sex and age, as well as to compare the QoL of patients with CF with a control group of people without CF.Material and methods: The study was conducted among patients hospitalized at the Clinic of Pulmonology and Cystic Fibrosis at the Institute of Tuberculosis and Lung Diseases in Rabka-Zdrój from February to April 2012. The study encompassed 30 patients (19 women and 11 men), aged between 16 and 42 years, with acute episodes of bronchopulmonary disease. A Short Form-36 (SF-36) questionnaire was used to evaluate the health-related quality of life. The control group encompassed 30 healthy individuals with the same sex ratio and similar age ratio as in the group of patients.Results: The analysis of quality of life with the use of the SF-36 questionnaire showed that in general the quality of life of the assessed patients was low. The patients scored on average below 50 in the following subscales: Role Physical (RP), General Health (GP), Vitality (VT), Social Functioning (SF), Physical Component Summary (PCS) and Mental Component Summary (MCS). In other subscales the results slightly exceeded 50. In women, low quality of life was found in the following subscales: Role Physical, Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Physical Component Summary (PCS) and Mental Component Summary (MCS). In men, average results below 50 were found in the following subscales: General Health (GH) and Vitality (VT). Moreover, in all subscales, the quality of life assessed by women was lower than that reported by men.Patients > 25 years assessed their quality of life as lower in all subscales except for the Role Emotional (RE) subscale. Statistically significant differences were identified with regards to Vitality (VT) and Mental Health (MH). The analysis of the influence of CF patients’ age on their quality of life, conducted with the use of the SF-36 questionnaire, showed that there were statistically significant correlations (p < 0.05) between age and the following domains: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), Vitality (VT), Social Functioning (SF), Mental Health (MH) and Physical Component Summary (PCS). The comparison between the QoL of patients with CF and those of a control group of individuals not suffering from CF demonstrated that there were statistically significant differences in all subscales. Patients’ quality of life was significantly poorer than quality of life of individuals without CF.Conclusions:1. Patients with CF generally perceive their quality of life as low.2. There are differences in the assessment of quality of life between women and men.3. The older the patients, the worse their quality of life assessment in most subscales.4. There are critical differences in the quality of life assessment between patients with CF and a control group encompassing individuals without CF. Patients with CF find their quality of life poorer

Influence the acceptance of the disease on quality of life of patients with hypertension

Wstęp Nadciśnienie tętnicze (NT) jest jedym z najpoważniejszych czynników ryzyka chorób układu sercowo-naczyniowego, które są odpowiedzialne za blisko 17 milionów zgonów rocznie. Wpływ przewlekłej choroby na jakość życia jest niepodważalny. Istotne znaczenie w samoocenie jakości życia u chorych na NT ma akceptacja ograniczeń przez nią narzuconych. Celem badania była analiza związku między akceptacją choroby a jakością życia chorych na NT oraz określenie czynników oddziałujących na akceptację choroby. Materiał i metody Zbadano 105 osób, których średnia wieku wynosiła 60,7 ± 10,4 roku. Do zebrania materiału badawczego wykorzystano analizę dokumentacji medycznej oraz dwa standaryzowane narzędzia badawcze: skalę akceptacji choroby (AIS) oraz ogólny kwestionariusz do oceny jakości życia WHOQoL-Bref. Wyniki Najliczniejszą część grupy badawczej stanowili pacjenci ze średnim (40%) i dobrym (41%) poziomem AIS. Zaobserwowano istotny statystycznie związek między chorobą niedokrwienną serca (p = 0,003) oraz miażdżycą i chorobami naczyń (p < 0,001), a poziomem akceptacji choroby. We wszystkich czterech domenach WHOQoL-Bref jakość życia silnie korelowała z poziomem akceptacji choroby (p < 0,001). Poziom jakości życia wzrastał wraz ze wzrostem poziomu AIS. Wnioski 1. Jakość życia pacjentów z NT istotnie koreluje ze stopniem akceptacji choroby. 2. Czynnikami wpływającym negatywnie na AIS jest współwystępowanie choroby niedokrwiennej serca oraz miażdzycy i choroby naczyń.Background Hypertension is a brilliant idea of the most important risk factors for cardiovascular disease which are responsible for nearly 17 million deaths per year. The impact of chronic disease on quality of life is indisputable. Important role in the self-assessment of quality of life in patients with hypertension is accepting the limitations imposed by it. The aim of the study was to analyze the relationship between the acceptance of the disease and the quality of life in patients with arterial hypertension and to determine the factors influencing the acceptance of the disease. Material and methods Examined 105 people, average age 60.7 ± 10.4 years. To gather research material used in the analysis of medical records and two standardized research tools: scale acceptance of the disease (AIS) and a questionnaire to assess the overall quality of life WHOQOL-Bref. Results The largest part of the research group consisted of patients with a mean (40%) and good (41%) level of AIS. There was a significant correlation between coronary heart disease (p = 0.003), and atherosclerosis and vascular diseases (p < 0.001), and the level of acceptance of the disease. In all four domains WHOQOL-Bref quality of life strongly correlated with the level of acceptance of the disease (p < 0.001). The level of quality of life increased with increasing levels of AIS. Conclusions 1. Quality of life in patients with hypertension significantly correlated with the degree of acceptance of the disease. 2. Factors influencing negatively the AIS is the co-existence of coronary heart disease and atherosclerosis and vascular disease

Effect of implantable cardioverter-defibrillator on quality of life — a review of research

Implantacja kardiowertera-defibrylatora (ICD) w celu zmniejszenia śmiertelności u pacjentów obciążonych wysokim ryzykiem wystąpienia zagrażających życiu arytmii komorowych stała się leczeniem z wyboru. Skutkuje to dynamicznie zwiększającą się liczbą chorych z ICD. W ostatnim czasie rośnie zainteresowanie jakością życia (QoL) takich pacjentów. Wnioski z badań dotyczących wpływu ICD na QoL są niejednoznaczne. Celem niniejszej publikacji jest przegląd wybranych badań dotyczących wpływu terapii za pomocą ICD na jakość życia chorych, ze szczególnym uwzględnieniem wpływu na QoL interwencji wysokoenergetycznych.  Implantation of cardioverter-defibrillator (ICD) to reduce mortality in patients at high risk of life threatening ventricular arrhythmias has become treatment of choice. Population of patients with ICD has been dynamically increasing. Recently there has been growing interest in quality of life (QoL) in this group of patients. Results of studies remain controversial. The aim of this paper is to provide a systematic review of studies dedicated to the influence of therapy with the use of ICD on QoL

"The Weak Heart" as an educational model for patients hospitalized due to decompensation of heart failure with reduced ejection fraction

Introduction. KONS (Kompleksowa opieka nad chorymi z niewydolnością serca) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I - training and certification of nurses to perform the role of heart failure nurse specialists; phase II - checking the effectiveness of the model in a clinical setting; and phase III - implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients' health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care

„W trosce o słabe serce” — model edukacji chorych hospitalizowanych z powodu dekompensacji niewydolności serca ze zmniejszoną frakcją wyrzutową

Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice.Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice

A patient with heart failure, who is frail: How does this affect therapeutic decisions?

Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: “elderly, frail”; “frailty, elderly”; “frail older adults”; “frailty, older adults”; “adult, frail older”; “frailty, heart failure”; “frailty, multimorbidity”; “multimorbidity, heart failure”; “multimorbidity, elderly”; “older adults, cardiovascular diseases”. In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery

The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure

Pathological processes associated with ageing increase the risk of cognitive deficits and dementia. Frailty syndrome, also known as weakness or reserve depletion syndrome, may significantly accelerate these pathological processes in the elderly population. Frailty syndrome is characterized by decreased physiological function and neuropsychiatric symptoms, including cognitive decline and depressive states. In people with cardiovascular disease, the risk of frailty is 3 times higher. Frailty syndrome is particularly prevalent in severe heart failure, which increases the risk of mortality, increases hospital readmission, and reduces patients’ quality of life. In addition, co-occurrence of cognitive impairment and frailty syndrome significantly increases the risk of dementia and other adverse outcomes, including mortality, in the heart failure population