1,720,966 research outputs found
Myocardial infarction as a chance for life
No full textZusammenfassung Einen Myokardinfarkt zu er- und überleben stellt für die Betroffenen häufig eine vital und emotional bedrohliche Situation dar. Copingmechanismen im Umgang mit der Herzerkrankung können z. B. eine komplette Verleugnung oder psychische Dekompensation bewirken. Dagegen kann ein Verständnis des Myokardinfarktes als Grenz- oder Kairós-Situation eine theoretische Bereicherung für Kliniker*innen darstellen und auf einen dritten Verarbeitungsweg hindeuten: Dieser wurde als „posttraumatisches Wachstum“ beschrieben und wird von Betroffenen selbst als ein Weckruf bezeichnet. Für Behandler*innen ist das Wissen bedeutsam, dass sich nach einem Myokardinfarkt nicht selten ein Zeitfenster öffnet, das eine Möglichkeit sowohl für Lebensstilveränderungen als auch persönliche und emotionale Wachstumschancen der Patient*innen bietet. Ein solches Zeitfenster entsteht, sobald das akute und lebensbedrohliche Herzereignis bewältigt wurde und ein Veränderungsspielraum durch die Infragestellung der bisherigen Lebensführung entsteht. Als „teachable moment“, der von der*dem Behandler*in erkannt werden sollte, ist diese Phase nicht quantifizierbar und unterliegt intra- und interindividuellen Schwankungen. Daher soll im Folgenden der Versuch unternommen werden, die Frage zu beantworten, inwiefern das Wissen um philosophische und ethische Konzepte (z. B. gutes Leben, Grenzsituation und Kairós-Situation) und ein deliberatives Gesprächsmodell der Behandler*in-Patient*in-Kommunikation dazu beitragen kann, die Patient*innen in dieser vulnerablen Zeit nach der akuten Bewältigung eines Myokardinfarkts zu begleiten und – im Sinne eines posttraumatischen Wachstums – zu neuen Sichtweisen auf ein für sie gutes Leben zu befähigen.Abstract Definition of the problem A myocardial infarction is often a vitally and emotionally threatening situation for the affected. Unconscious coping mechanisms in dealing with the heart disease may result in, for example, complete denial or emotional decompensation. Argument An understanding of myocardial infarction as a borderline situation may provide theoretical enrichment for clinicians and point to a third coping avenue, described as “posttraumatic growth”. Affected individuals often refer to the event as a “wake-up call”. Clinical knowledge of these different coping mechanisms may in turn lead to a relativization of primarily subjectivist positions and substantively hedonistic or preferentialist notions of good life or “quality of life”. Such a position would in turn be compatible with the deliberative model of physician–patient communication. Consequences In the light of such a broader understanding of disease coping, the task of (psychosomatic) physicians would thus to accompany persons with heart disease, to be aware of the teachable moment and to enable a process of development for the patients
"If You Look Closely, You Have Everything …": Ideas of a Good Life Among Middle-Aged Individuals With Heart Disease: An Interpretative Phenomenological Analysis
No full textHeart disease at an early or middle age is critical, especially when accompanied by an acute cardiac event with or without sudden cardiac arrest (SCA). Owing to this situation, patients describe changes in their health-related quality of life as well as in their future plans and goals. This study examined changes in ideas of a good life due to heart disease treated in an acute hospital. In our study, 16 patients aged 30-59 years were included. Among them, four had SCA, seven myocardial infarction, and five other serious cardiac conditions, such as cardiac arrhythmia. Advanced chronic heart failure was noted in five, and four had implantable cardioverter defibrillators. Phenomenological semi-structured interviews of 50-100 min each were conducted with a purposive sample and analyzed using interpretative phenomenological analysis. The ideas of a good life and changes in future lifestyle following a serious heart disease were reported by patients. These experiences were summarized into five superordinate themes: "My bodily trust is gone," "Simply living a modest life," "Actively shaping my life again," "Being more in contact with relevant people," and "Grateful for the gift of my new life." Living a more modest life and actively shaping life again are two new aspects of the ideas of a good life. Further studies should be conducted in cardiac patients with lower disease burden and young patients with congenital heart disease, with a focus on sex-specific issues
“I No Longer Felt Sick, I Always Felt Free”: Growing Up With Congenital Heart Disease and the Struggle for a Good Life—An Interpretative Phenomenological Analysis
No full textAdvancements in surgical, interventional, and intensive-care medicine have significantly increased the life expectancy of individuals born with congenital heart disease (CHD). As a result, growing numbers of affected children now reach adulthood. Despite medical progress, CHD remains a lifelong condition that influences how individuals perceive and shape their lives. This qualitative study explored ideas of a good life among 14 young adults aged 18–29 years living with CHD. Data were gathered through semi-structured phenomenological interviews and analyzed using interpretative phenomenological analysis. The pursuit of a “normal” life, characterized by equal developmental opportunities compared to peers without CHD, emerged as a central pattern. This experience was reflected in four key themes: “My Whole Life I Have to Fight for Normality,” “Being Treated Normally by Others Is Part of a Good Development,” “Normal Development Includes Lightheartedness,” and “I Need to Stand on My Own Two Feet.” These findings carry important implications for healthcare providers, particularly regarding the promotion of normality and autonomy among individuals with CHD. Patients should be supported in adopting this perspective—as should their parents, since they significantly shape the lives and well-being of patients during their formative years, playing a crucial role in laying the foundation for healthy development and a good life. At the same time, healthcare providers should avoid paternalistic attitudes that risk replicating patterns of parental overprotection. Finally, our findings point to the importance of future research exploring how gender and cultural background shape ideas of a good life with CHD.German Research Foundation 50110000165
Longitudinal association between N-terminal B-type natriuretic peptide, anxiety and social support in patients with HFpEF: results from the multicentre randomized controlled Aldo-DHF trial
No full textBackground
Higher plasma levels of natriuretic peptides (NPs) have been associated with reduced anxiety in experimental research and a number of patient samples. As NP levels are elevated in heart failure patients, we investigate whether this elevation is related to anxiety in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
Post-hoc regression and mediation analyses were conducted, using data of 422 patients with HFpEF from the randomized, placebo-controlled, double-blinded, two-armed, multicentre aldosterone in diastolic heart failure trial, testing associations and their mediators between the N-terminal B-type natriuretic peptide (NT-proBNP) and anxiety at baseline and over 12-month follow-up. Anxiety was measured by the Hospital Anxiety and Depression Scale (HADS), social support by the ENRICHD Social Support Inventory and physical functioning by the Short Form 36 Health Survey.
Results
The mean age of the study population was 66.8 ± 7.6 years, 47.6% were male and 86.0% had NYHA class II. NT-proBNP showed a weak negative correlation with HADS anxiety scores at baseline (r = − 0.087; p = 0.092), which was significant (r = − 0.165; p = 0.028) in men but not in women. NT-proBNP also tended to predict lower anxiety at 12-months in men. On the other hand, higher anxiety at baseline was associated with lower NT-proBNP scores 12 months later (r = − 0.116; p = 0.026). All associations lost significance in multivariate regression for age, perceived social support (ESSI), physical function (SF-36) and study arm. Mediation analyses revealed that social support acts as a full mediator for the link between NT-proBNP levels and anxiety.
Conclusion
The mechanisms linking NT-proBNP to anxiety may be more complex than originally assumed. While effects of NT-proBNP on anxiety may be mediated by perceived social support, there may be an additional negative effect of anxiety on NT-proBNP. Future research should consider this possible bi-directionality of the association and assess the potential influence of gender, social support, oxytocin and vagal tone on the interaction of anxiety and natriuretic peptide levels.
Trial Registration
http://www.controlled-trials.com
(ISRCTN94726526) on 07/11/2006.
Eudra-CT-number: 2006–002,605-31.Open-Access-Publikationsfonds 202
“That kind of changes things”: a meta-synthesis of the lived experiences of people with chronic heart disease
No full textAbstract Aims To explore the lived experiences of people with chronic heart disease (PCHD). Design Systematic meta-synthesis. Methods Following preregistration on PROSPERO, a systematic literature search was conducted in PubMed, PsycInfo, PsycArticles, and PSYNDEX between February 2023 and March 2024. Articles were assessed for eligibility based on predefined criteria and evaluated for methodological quality using a modified CASP tool. The results of the included primary studies were weighted according to their methodological quality and synthesized using Interpretative Phenomenological Analysis. The reporting adheres to PRISMA and ENTREQ guidelines. Results The analysis of 43 articles revealed an overarching theme: “The broken flow of life.” This theme illustrates the disruption of normalcy, as perceived by patients through distinct dimensions. These dimensions are represented by the four subthemes: (1) I no longer feel safe in my body, (2) Suddenly, I have less of a future, (3) My identity feels shattered, and (4) My disease strains my relationships. Conclusions The findings suggest that PCHD perceive their condition as a profound disruption of normalcy, affecting bodily, relational, and psychological dimensions that extend beyond established HRQOL measures. Implications The findings have direct implications for the assessment of HRQOL in medicine. To adequately evaluate holistic treatments, a deeper understanding of how the disease affects life planning and future perspectives is essential. Consequently, established HRQOL measures may need to be extended both in content and temporal scope to capture these broader impacts
Working towards a new normal: a meta-synthesis of patient-reported aspects of a good life with heart disease
No full textAbstract Aims This meta-synthesis challenges the medical notion of health-related quality of life (HRQOL) by identifying aspects of the more holistic philosophical concept of the good life from the perspective of patients with heart disease. Design Systematic meta-synthesis. Methods Following preregistration on PROSPERO, a systematic literature search was conducted in PubMed, PsycInfo, PsycArticles, and PSYNDEX from February 2023 to March 2024. Studies focusing on the experiences of adults living with heart disease were included based on predefined criteria. Articles were assessed for methodological quality using a modified CASP tool, and data synthesis followed Interpretative Phenomenological Analysis. Reporting adheres to PRISMA and ENTREQ guidelines. Results Forty-three articles were included, revealing the overarching theme of “Working towards a new normal,” with four sub-themes: (1) Feeling safe in my own body again, (2) Important relationships provide security and meaning, (3) Taking my life into my own hands again and (4) Living more consciously. Conclusions While HRQOL is a valuable and widely used concept, it primarily captures quality of life from a functional perspective. Qualitative studies on individuals with heart disease reveal the additional aspects of coherence, connectedness, and self-determination that align more closely with the concept of a good life. Implications To enhance care and counseling for patients with heart disease, the concept of HRQOL should be broadened to incorporate preferences, interests, and needs regarding life planning, aligned with the notion of a good life
Covid-19-Pandemie: Angsterleben von niedergelassenen und Krankenhaus-Psychiatern
No full textZusammenfassung Hintergrund Bisher gibt es keine Studien, die das Pandemie bedingte Belastungserleben von stationär im Vergleich zu ambulant tätigen Psychiatern untersucht hat. Es soll deshalb das Ausmaß der Covid-19-Exposition, die Angst, das Belastungserleben und die Bewältigungsmöglichkeiten bei niedergelassenen Psychiatern im Vergleich zu Ärzten in psychiatrischen und psychosomatischen Kliniken untersucht werden. Methode Zur Erfassung von Angst- und Belastungserleben wurden E-Mail-gestützte Fragebögen mit 13 Items genutzt. Insgesamt wurden 105 niedergelassene Psychiater, und 73 Ärzte und Psychologen aus vier Klinikern (inkl. Klinik für Psychosomatische Medizin und Psychotherapie) zwischen Anfang April bis Mitte Mai 2020 befragt. Ergebnis In ihrem Belastungserleben fühlten sich niedergelassene im Vergleich zu Krankenhauspsychiatern häufiger stark eingeschränkt (52,4 vs. 32,9% p=0,010), infektionsgefährdet (35,2 vs. 13,7%, p<0,001) und finanziell bedroht (24,7 vs. 6,9%, p=0,002). Der Anteil gut Informierter niedergelassener Psychiater war geringer (47,6 vs. 63,0%, p=0,043) und der Anteil mit fehlender Schutzausrüstung höher (27,6 vs. 4,1%, p<0,001). Bei gleichem COVID-19 Expositionsniveau (8,6 vs. 8,2%) berichteten niedergelassene Psychiater im Vergleich zu Krankenhaus-Psychiatern häufiger, wenn auch nicht signifikant, große Angst (18,1 vs. 9,6%, p=0,114). Risikofaktoren für ein Angsterleben waren in beiden Gruppen das Gefühl der Einschränkung (OR=5,52, p=0,025) und die erlebte Infektionsgefahr (OR=5,74, p=0,005). Keinen Einfluss hatten das Expositionsniveau, die Klinik- bzw. Praxiszugehörigkeit, das Alter, das Geschlecht und andere Dimensionen des Bedrohungserlebens und des Bewältigungsverhaltens. Diskussion Niedergelassene Psychiater fühlten sich im Vergleich zu den Kollegen im Krankenhaus durch die COVID-19 Pandemie mehr belastet und bedroht. Das Erleben von Angst war abhängig vom Gefühl der Einschränkung und der Expositionsgefahr, nicht jedoch von der Exposition, der Ausstattung mit Schutzmitteln. Für die Ausprägung der Angst scheinen weniger objektive Indikatoren als das subjektive Erleben eine wichtige Rolle zu spielen.Zusammenfassung Hintergrund Bisher gibt es keine Studien, die das Pandemie bedingte Belastungserleben von stationär im Vergleich zu ambulant tätigen Psychiatern untersucht hat. Es soll deshalb das Ausmaß der Covid-19-Exposition, die Angst, das Belastungserleben und die Bewältigungsmöglichkeiten bei niedergelassenen Psychiatern im Vergleich zu Ärzten in psychiatrischen und psychosomatischen Kliniken untersucht werden. Methode Zur Erfassung von Angst- und Belastungserleben wurden E-Mail-gestützte Fragebögen mit 13 Items genutzt. Insgesamt wurden 105 niedergelassene Psychiater, und 73 Ärzte und Psychologen aus vier Klinikern (inkl. Klinik für Psychosomatische Medizin und Psychotherapie) zwischen Anfang April bis Mitte Mai 2020 befragt. Ergebnis In ihrem Belastungserleben fühlten sich niedergelassene im Vergleich zu Krankenhauspsychiatern häufiger stark eingeschränkt (52,4 vs. 32,9% p=0,010), infektionsgefährdet (35,2 vs. 13,7%, p<0,001) und finanziell bedroht (24,7 vs. 6,9%, p=0,002). Der Anteil gut Informierter niedergelassener Psychiater war geringer (47,6 vs. 63,0%, p=0,043) und der Anteil mit fehlender Schutzausrüstung höher (27,6 vs. 4,1%, p<0,001). Bei gleichem COVID-19 Expositionsniveau (8,6 vs. 8,2%) berichteten niedergelassene Psychiater im Vergleich zu Krankenhaus-Psychiatern häufiger, wenn auch nicht signifikant, große Angst (18,1 vs. 9,6%, p=0,114). Risikofaktoren für ein Angsterleben waren in beiden Gruppen das Gefühl der Einschränkung (OR=5,52, p=0,025) und die erlebte Infektionsgefahr (OR=5,74, p=0,005). Keinen Einfluss hatten das Expositionsniveau, die Klinik- bzw. Praxiszugehörigkeit, das Alter, das Geschlecht und andere Dimensionen des Bedrohungserlebens und des Bewältigungsverhaltens. Diskussion Niedergelassene Psychiater fühlten sich im Vergleich zu den Kollegen im Krankenhaus durch die COVID-19 Pandemie mehr belastet und bedroht. Das Erleben von Angst war abhängig vom Gefühl der Einschränkung und der Expositionsgefahr, nicht jedoch von der Exposition, der Ausstattung mit Schutzmitteln. Für die Ausprägung der Angst scheinen weniger objektive Indikatoren als das subjektive Erleben eine wichtige Rolle zu spielen
"Shortly Afterwards I Was Practically Dead"-Temporal Experiences of Middle-Aged Individuals With Heart Disease: An Interpretative Phenomenological Analysis
No full textChanges in the experience of time have originally been described in mental disorders within the framework of the phenomenological psychopathology of the lived time. Both phenomenological and qualitative empirical studies have shown that physical illnesses, such as cancer or chronic pain, can be accompanied by a change in experienced temporality. Likewise, the sudden onset of severe heart disease in early and middle age represents a biographical break for the patient and can lead to numerous changes in the experience of time. In our qualitative study, a purposive sample of sixteen patients aged 30-59 years was included. Of these, four patients had sudden cardiac arrest, seven had myocardial infarction, and five had other severe cardiac diseases. Phenomenological semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis. Patients reported that their temporality changed after serious heart disease. The experience of the participants can be summarized in five themes: "Heart disease as a biographical turning point," "The clock can stop any moment," "Feeling prematurely aged by heart disease," "Other people's time is not my time," and "Just living in the moment." From a psychocardiological perspective, a temporal analysis of severe heart disease can help caregivers understand and support patients better. Further studies should be conducted on cardiac patients with a lower disease burden, sex-specific issues, and young cardiac patients with congenital heart disease
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