Abstract: BACKGROUND: The relationship between experience of fatigue and emotional and symptom distress in chronic heart failure (CHF) needs to be thoroughly explored, because fatigue has major impact on daily activities in life. AIMS: The purpose was to examine the association between fatigue, as a multidimensional experience and anxiety, depression and symptom distress, and to explore the relationships between individual symptoms and the dimensions of fatigue in patients with CHF. METHODS: A consecutive sample of 112 patients with exacerbation of symptoms of CHF answered the Multidimensional Fatigue Inventory (MFI-20), the Hospital Depression and Anxiety (HAD) Scale and the Symptom Distress Scale (SDS). RESULTS: Anxiety was associated with mental fatigue, whereas depression was associated with reduction of activity, low motivation and decreased functioning. Physical fatigue was affected by symptom distress, with women reporting more distress than men. With exception of breathlessness, poor agreement was found between fatigue and the most intensive reported symptoms. CONCLUSIONS: The relationship between emotional distress and the experience of fatigue in patients with CHF may have a devastating affect on the patient's ability to cope and manage daily activities, including self-care and adherence to recommended treatment.
Abstract: BACKGROUND: Valid assessments of health-related Quality of Life (HRQL) are increasingly important in chronic, incurable conditions, such as chronic heart failure (CHF). AIMS: To evaluate the psychometric properties of a Swedish version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in hospitalized patients with decompensated CHF. METHOD AND RESULTS: The KCCQ and SF-36 were administered to patients (n=118) with CHF at baseline and then 1 (n=51) and 4 months (n=83) after admission. The Swedish version of the KCCQ appears to have acceptable convergent and discriminant validity for all suggested health domains. Cronbach's alpha and test-retest reliability met for most of the scales the minimum of 0.70. Known-groups comparison indicated that the KCCQ discriminated between patients differing in the New York Heart Association (NYHA) classification (criterion validity). The KCCQ was also more responsive to changes in the NYHA classification as compared with the SF-36. However, KCCQ has some weakness in the response distributions for two questions and the convergent validity in one question. CONCLUSION: Overall, the KCCQ is a valid and reliable instrument in a Swedish CHF population. It yields reliable and valid scores and is quite responsive to clinical change.
Abstract: BACKGROUND: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. AIM: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. METHODS: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. RESULTS: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p=0.05). CONCLUSION: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.
Abstract: BACKGROUND: Patients with chronic heart failure (CHF) have frequent episodes of exacerbation leading to recurrent hospitalization. AIMS: To explore factors related to patients seeking care for worsening CHF. METHODS: Eighty-eight patients diagnosed with a deteriorating CHF condition were interviewed. Data were analysed using content analysis. RESULTS: Overall, 51 (58%) patients sought emergency care because of their symptoms while 37 (42%) were either sent by relatives or referred from outpatient clinics. Delay in seeking care was explained by 62 (71%) patients as a "wait and see" strategy, 9 (10%) were reluctant to use the health care system and 10 (11%) felt that it was futile to seek care. Fifty percent of the patients were uncertain about their current deteriorating status. Only 4 patients reported their symptoms to be related to heart failure. CONCLUSIONS: Although symptoms were the dominant reason for seeking emergency care, only a few patients related their symptoms to worsening CHF, which might be an important factor for not seeking emergency care earlier. Patient education programs should make efforts to improve understanding of symptom recognition.
Abstract: BACKGROUND: Coronary heart disease is a major problem in both men and women, but several studies have shown sex differences in symptoms of acute coronary syndromes (ACS). Some findings, however, have been disparate and inadequate, and thus a comprehensive overview of this literature would be of value. METHOD: Fifteen studies that identified symptoms of ACS for both women and men were examined through a review of the literature from 1989 to 2002. Terms used for the search included "myocardial infarction," "symptoms," "gender differences," and "acute coronary syndromes." RESULTS: Although chest pain was the most common symptom in both men and women, several differences were also noted. In all types of ACS, women had significantly more back and jaw pain, nausea and/or vomiting, dyspnea, indigestion, and palpitations. In a number of studies, which solely sampled patients with acute myocardial infarction, women demonstrated more back, jaw, and neck pain and nausea and/or vomiting, dyspnea, palpitations, indigestion, dizziness, fatigue, loss of appetite, and syncope. Men reported more chest pain and diaphoresis in the myocardial infarction sample. The designs and methodologies of the studies varied considerably. CONCLUSION: In addition to the typical symptom of chest pain in ACS, women experience other atypical symptoms more frequently than men. Thus, there may be sex differences in the symptoms of ACS, differences that have a bearing not only on clinical practice, but also on the interpretation of available clinical studies and the design of future investigations.
