Factors Associated With Delay in Seeking Care for Acute Decompensated Heart Failure

Sethares, Kristen A.; Sosa, Mary-Elizabeth; Fisher, Paige L.; Riegel, Bárbara

doi:10.1097/jcn.0b013e3182a37789

Cited by 48 publications

(62 citation statements)

References 49 publications

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“…The mean HFSPS score in this study was higher than similar studies in the United States and Italy, along with another study that used this scale for a different purpose in China [12,31,[33][34][35]. In addition, the HFSPS was used to examine patients' physical symptoms in China as well [31].…”

Section: Discussioncontrasting

confidence: 50%

“…Meanwhile, as reported in prior studies, the higher NYHA functional class level and LVEF level indicated that more symptoms were experienced [38,39]. Symptom clusters, even in different cultural groups, were found to be significantly related to symptom perception [35,40,41]. A study reported that symptom education could significantly improve patients' short-term prognosis [42].…”

Section: Discussionmentioning

confidence: 66%

“…Although significant differences were identified in implementing and evaluating treatment among different educational status groups, there were no differences on recognizing and evaluating change, which was the main variable in the current study. Other studies found no correlations between educational status and symptom perception [34,35,38,46]. Further studies exploring symptom perception with adequate samples of different educational status are recommended.…”

Section: Discussionmentioning

confidence: 88%

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Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration

Hong

Lindell

Jurgens

et al. 2020

IJERPH

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A growing body of evidence supports the fact that optimal health-related quality of life is largely dependent on patient competence in symptom perception. However, many studies have reported poor symptom perception in patients with heart failure. In China, there has been no previous research on assessing the symptom perception ability of patients with heart failure. This study aimed to describe how Chinese patients with heart failure perceive their symptoms, as well as to explore their influencing factors. A theory-based, descriptive, correlational cross-sectional design was used in this study. Data on symptom perception and factors related to symptom perception were collected via structured interviews and medical records. A convenience sample of 208 hospitalized patients was enrolled. The degree of symptom perception in this study was at a high level. The results showed that the level of depression, the New York Heart Association functional class, the left ventricular ejection fraction, and educational background were identified as independent factors of symptom perception in Chinese patients with heart failure. The degree of symptom perception of patients with heart failure was affected by personal, psychological, and physiological factors. Health policy and healthcare providers should pay more attention and deepen the understanding to Chinese patients with heart failure to provide better healthcare.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 88%

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Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration

Hong

Lindell

Jurgens

et al. 2020

IJERPH

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“…Normalizing symptoms allowed patients to minimize the impact of their illness and continue with normal life activities such as returning to work to meet their financial needs. Although normalizing symptoms may have also helped patients to maintain a sense of routine life and continuity, normalizing prevented patients from the understanding that they were living with a life-threatening illness [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Multidimensional needs of patients living and dying with heart failure in Kenya: a serial interview study

2018

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BackgroundHeart failure is an emerging challenge for Sub Saharan Africa. However, research on patients’ needs and experiences of care is scarce with little evidence available to support and develop services. We aimed to explore the experiences of patients living and dying with heart failure in Kenya.MethodsWe purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in depth interviews with patients at 0, 3 and 6 months after recruitment, and conducted bereavement interviews with carers. Interviews were recorded, transcribed into English and analyzed using a thematic approach, assisted by Nvivo software package.ResultsForty-four interviews were conducted. Patients experienced physical, psychosocial, spiritual and financial distress. They also had unmet needs for information about their illness, how it would affect them and how they could get better. Patients experience of and their interpretation of symptoms influenced health care seeking. Patients with acute symptoms sought care earlier than those with more gradual symptoms which tended to be normalised as part of daily life or assumed to be linked to common treatable conditions. Nearly all patients expected to be cured and were frustrated by a progressive illness poorly responsive to treatment. Accumulating costs was a barrier to continuity of care and caused tensions in social relationships. Patients valued information on the nature of their illness, prognosis, self-care, lifestyle changes and prevention strategies, but this was rarely available.ConclusionsThis is the first in-depth study to explore the experiences of people living with advanced heart failure in Kenya. This study suggests that patients would benefit from holistic care, such as a palliative approach that is aimed at providing multidimensional symptom management. A palliative approach to services should be provided alongside chronic disease management aimed at primary prevention of risk factors, and early identification and initiation of disease modifying therapy. Further research is needed to determine best practice for integrating palliative care for people living and dying with heart failure.

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“…For example, patients who live alone may be unable to get to the ED at night, or on the weekends due to availability of family or friends to transport them to the ED and other factors such as patient preferences may play a role in mode of transportation. 21 Prehospital delay has also not been linked to clinical outcomes; however, patients with <24 h since symptom onset have a lower BNP and a shorter length of stay. 22 Indeed, when added to the multivariable model, these factors were not independently significant predictors of clinical outcomes in ASCEND-HF.…”

Section: Discussionmentioning

confidence: 99%

Arrival by ambulance in acute heart failure: insights into the mode of presentation from Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND-HF)

et al. 2016

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ObjectivesLimited data exist assessing the relationship between ambulance versus self-presentation and outcomes in patients with acute heart failure (AHF).SettingClinical trial sites in North America.Participants1068 patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial.Primary and secondary outcome measuresThe association between ambulance use and dyspnoea improvement, 30-day mortality or HF rehospitalisation and 180-day mortality.ResultsOf the 1068 patients in the substudy, 832 (78%) self-presented (SP) and 236 (22%) patients presented via ambulance. Patients presenting via ambulance were older, more likely to be female, have a higher ejection fraction but similar natriuretic peptide levels as patients who SP. Patients presenting by ambulance (compared with SP) trended towards more dyspnoea improvement at 6 (p=0.09) and 24 h (p=0.10). The co-primary end point (30-day mortality or HF rehospitalisation) was similar between groups (ambulance 12.2% vs SP 11.4%, p=0.74). Patients who presented by ambulance had a higher 30-day and 180-day mortality rate than those who SP (30-day: 4.3% vs 2.2%, p=0.08; 180-day: 15.1% vs 10.3%, p=0.04). After adjustment for baseline characteristics, patients arriving by ambulance (compared with SP) had a 2-fold high risk of 30-day mortality (OR 2.12, 95% CI 0.94 to 4.79), but no relationship to the composite of 30-day mortality/HF rehospitalisation (OR 1.01, 95% CI 0.63 to 1.63).ConclusionsAmong patients with AHF, 30-day and 180-day mortality is 1.5–2 times higher for those with presenting via ambulance compared with patients who self-present. Understanding patient-related and system-related factors of ambulance use for patients with AHF is important.Trial registration numberNCT00475852.

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Factors Associated With Delay in Seeking Care for Acute Decompensated Heart Failure

Cited by 48 publications

References 49 publications

Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration

Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration

Multidimensional needs of patients living and dying with heart failure in Kenya: a serial interview study

Arrival by ambulance in acute heart failure: insights into the mode of presentation from Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND-HF)

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