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Knowledge Acquisition in Patients with Heart Disease
Sophiahemmet University.ORCID iD: 0000-0002-3883-468X
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim was to evaluate different aspects of the knowledge acquisition process in patients with heart disease. Three different education programs were evaluated.

In Paper I 208 patients with systolic heart failure (HF) aged >60 years, were included. They were randomized to the nurse-based outpatient clinic or to the patients´ general practitioners (GP). The aim was to assess effects of a nurse-based management program – intended to increase the knowledge of the HF disease and its self-care – and relate the results to gender and cognitive function. The results showed that the nurse-based outpatient clinic has an important role in patient education, and increases patients´ knowledge about self-care and the disease. The results indicate that females have more to gain than men from such management programs. Patients demonstrating signs of cognitive dysfunction when in hospital did also benefit.

In Paper II 224 patients, aged <75 years suffering from an acute AMI or who had underwent coronary artery by-pass grafting, were randomized to intervention (an expanded cardiac rehabilitation program) or to control (usual care). The aim was to investigate the effect of an expanded cardiac rehabilitation program on psychosocial characteristics including depression, anxiety, and quality of life (QoL) in type D and non-type D coronary artery disease (CAD) patients. The results show that an expanded rehabilitation program significantly reduces type D score, improves QoL, and decreases self-estimated depression and anxiety in CAD patients in the highest quartile of type D score.

In Paper III and IV 182 patients with chronic heart failure (CHF) were included and referred to the nurse-based outpatient clinic. They were randomized to intervention (patients decided on how they should be informed and by which information technique) or to control (the nurse decided according to usual routine).

The aim in Paper III was to compare patient-based selection of information with nurse-based selection of information in patients with HF and to evaluate the effects on knowledge acquisition, QoL, visits to the outpatient clinic, drug therapy and readmissions. Patients had fewer visits to the nurse-based outpatient clinic and a trend to a more flexible diuretic regimen, if patients were involved in the decision on how to be informed. Both groups increased QoL, knowledge their doses of relevant medication, and readmissions did not differ between the two groups.

The aim in Paper IV was to compare patient-based and nurse-based New York Heart Association (NYHA) classification and its relation to grade of depression and knowledge acquisition in patients with HF. The results show a mismatch between the NYHA classifications performed by patients respectively by the nurse. Furthermore, patients in a depressed mood at baseline had more clinical events during the first year after hospitalization due to CHF. However, there was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood.

The conclusion is that information given at a nurse-based outpatient clinic has an important role in patient education. Females and patients with in-hospital cognitive dysfunction had the greatest gains Patients who are involved in the decision on how to be informed had fewer visits to the nurse-based outpatient clinic. The fewer visits did not affect knowledge, QoL, readmissions, or medical treatment in a negative way. Patients assessed a higher NYHA class than a nurse. Patients who were depressed had an increased incidence of clinical events during the first year after hospitalisation due to HF. There was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood. An expanded rehabilitation program significantly reduces type D score, improves quality of life, and decreases self-estimated depression and anxiety in patients with CAD in the upper quartile of type D score.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2007. , 55 p.
Keyword [en]
Chronic heart failure, Coronary artery disease, NYHA classification, Depression, Type-D personality, Cardiac rehabilitation, Knowledge, Information techniques
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-138ISBN: 978-91-7357-257-6 (print)OAI: oai:DiVA.org:shh-138DiVA: diva2:314345
Public defence
2007-09-28, 09:00 (English)
Opponent
Supervisors
Available from: 2010-04-27 Created: 2010-03-12 Last updated: 2016-06-09Bibliographically approved
List of papers
1. A nurse-based management program in heart failure patients affects females and persons with cognitive dysfunction most
Open this publication in new window or tab >>A nurse-based management program in heart failure patients affects females and persons with cognitive dysfunction most
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2005 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 58, no 2, 146-53 p.Article in journal (Refereed) Published
Abstract [en]

It is important that congestive heart failure (CHF) patients know how to monitor and manage disease-associated signs and symptoms. CHF patients were randomised to follow-up at a nurse-based outpatient clinic (intervention group (IG); n = 103), or to follow-up in primary healthcare (control group (CG); n = 105). Patient knowledge of CHF and self-care were assessed by a questionnaire and cognitive function by a Mini Mental State Examination (MMSE) at baseline and at six months. Men knew more about CHF as compared to females at baseline (p < 0.01). However, females in the IG increased their knowledge of self-care between baseline and six months as compared to CG females (p < 0.05). Patients with cognitive dysfunction (MMSE < 24) presented lower scores on knowledge as compared to those with a MMSE of >24 at baseline (p < 0.01). These differences disappeared after the intervention. Thus, females seemed to gain more than men from a nurse-based management program and patients with in-hospital signs of cognitive dysfunction should be encouraged to participate.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-95 (URN)10.1016/j.pec.2004.08.005 (DOI)16009290 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-15Bibliographically approved
2. Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics
Open this publication in new window or tab >>Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics
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2007 (English)In: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 30, no 3, 253-61 p.Article in journal (Refereed) Published
Abstract [en]

Type D personality has been shown to increase the risk for cardiovascular events in patients with coronary artery disease (CAD). We investigated the effects of expanded cardiac rehabilitation on type D score and psychosocial characteristics in 224 CAD patients randomised to either expanded cardiac rehabilitation (stress management, increased physical training, stay at a "Patient Hotel" after discharge and cooking sessions), or routine rehabilitation. Follow-up was 1 year. At baseline patients with a high type D score [patients in the upper quartile of type D score (Q4) i.e., type D patients] had a lower sense of coherence (p < 0.001), a lower quality of life (p < 0.001), more depressive symptoms (p < 0.001) and increased anxiety (p < 0.001) as compared to patients with a low type D score (Q1). During follow-up, type D patients (Q4) randomised to intervention had significant decrements in type D-score (p < 0.01), depression and anxiety (p < 0.05) and an increment in quality of life scores (p < 0.001). Quality of life was also improved in control type D patients (Q4; p < 0.01) but no significant changes were seen in type D score, depression or anxiety. Expanded cardiac rehabilitation reduces type D score, anxiety and depressive symptoms, and improves the quality of life in type D patients.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-94 (URN)10.1007/s10865-007-9096-5 (DOI)17417723 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-15Bibliographically approved
3. Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation
Open this publication in new window or tab >>Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation
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2008 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 4, 306-18 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the effects of expanded cardiac rehabilitation with multifactorial interventions on metabolic and inflammatory markers, exercise performance and on established cardiovascular risk factors. DESIGN: Single-centre prospective randomized controlled trial. SETTING: A university hospital. SUBJECTS: Two hundred and twenty-four patients with an acute myocardial infarction or patients undergoing coronary artery by-pass grafting. INTERVENTION: Patients were randomized to expanded cardiac rehabilitation including stress management, increased physical training, staying at a 'patient hotel' and cooking sessions, or to usual cardiac rehabilitation. MAIN MEASURES: Biochemical risk markers and exercise performance; follow-up was one year. RESULTS: There were no significant differences between the two treatment groups in the changes of biochemical risk markers or in exercise performance. Thus, low-density lipoprotein (LDL)-cholesterol levels decreased from 3.00 (0.97) to 2.54 (0.66) mmol/L in the intervention group and from 3.20 (0.85) to 2.54 (0.63) mmol/L in the control group, fibrinogen levels decreased from 5.30 (2.00) to 4.25 (1.01) g/L in the intervention group and from 5.29 (1.89) to 4.33 (0.83) g/L in the control group and C-reactive protein (CRP) levels decreased from 3.04 (2.79) to 2.09 (2.13) mg/L in the intervention group and from 4.01 (3.49) to 2.39 (2.49) mg/L in the control group. Total workload (W) improved from 118 (35) to 136 (34) in the intervention group and from 117 (36) to 133 (39) in the control group. CONCLUSION: There was no further significant benefit in biochemical risk markers or in exercise performance among patients undergoing the expanded rehabilitation as compared to the control group which received usual cardiac rehabilitation.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-93 (URN)10.1177/0269215507085379 (DOI)18390974 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-15Bibliographically approved
4. Patient-based vs. nurse-based NYHA classification of patients with chronic heart failure: influence of mood
Open this publication in new window or tab >>Patient-based vs. nurse-based NYHA classification of patients with chronic heart failure: influence of mood
2008 (English)In: European Journal of Cardiovascular Nursing, ISSN 1873-1953, E-ISSN 1474-5151, Vol. 7, no Suppl 1, S17- p.Article in journal (Other academic) Published
Abstract [en]

Patients' symptom perceptions and grade of depression have recently been recognized to hold otherwise unrecognized prognostic information in patients with chronic heart failure (CHF)

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-113 (URN)10.1016/j.ejcnurse.2008.01.031 (DOI)
Note

Abstracts 8th Annual Spring Meeting on Cardiovascular Nursing: Malmö Meeting, 8th Annual Spring Meeting on Cardiovascular Nursing

Available from: 2010-03-02 Created: 2010-03-01 Last updated: 2014-10-15Bibliographically approved

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