1,721,039 research outputs found
Burden of treatment in chronic heart failure: does symptom burden play a role?
No full textIn the past 12 years, chronic heart failure (CHF) prevalence has increased by 23%—it is responsible for a growing demand on health systems, hospitals, patients and their support networks (Conrad et al, 2018). A fundamental component of CHF care provision is empowering patients to self-manage their CHF with regular input from healthcare providers (Gardetto, 2011), including heart failure specialist nurses (HFSNs)
Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis
Full text linkBackground
For patients with heart failure (HF) and iron deficiency (ID), randomised trials suggest that intravenous (IV) iron reduces heart failure hospitalisations, but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomised trials investigating the effect of IV iron on clinical outcomes in patients with HF.
Methods
We identified randomised trials published between January 1st 2000 and November 5th 2022 investigating the effect of IV iron vs standard care/placebo in patients with HF and ID in any clinical setting, regardless of HF phenotype. Trials of oral iron or not in English were not included. The main outcomes of interest were a composite of hospitalisations for heart failure (HHF) and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality.
Results
Ten trials were identified with 3,373 participants, of whom 1,759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD [RR 0.75 (0.61-0.93), p<0.01] and first HHF or CVD [OR 0.72 (0.53-0.99), p=0.04]. Effects on cardiovascular [OR 0.86 (0.70-1.05), p=0.14] and all-cause mortality [OR 0.93 (0.78-1.12), p=0.47] were inconclusive. Results were similar in analyses confined to the first year of follow-up, which was less disrupted by the COVID-19 pandemic. Subgroup analyses found little evidence of heterogeneity for the effect on the primary endpoint, although patients with transferrin saturation <20% [OR 0.67 (0.49-0.92)] may have benefited more than those with values ≥20% [OR 0.99 (0.74-1.30)] (heterogeneity p = 0.07).
Conclusion
In patients with HF and ID, this meta-analysis suggests that IV iron reduces the risk of HHF but whether this is associated with a reduction in cardiovascular or all-cause mortality remains inconclusive
SYMptoms in chronic heart failure imPACT on burden of treatment (SYMPACT): a cross‐sectional survey
Full text linkAims: This study aimed to describe patient‐reported symptoms and burden of treatment (BoT) experienced by patients with chronic heart failure (CHF). BoT describes the illness workload, individual capacity to perform that work, and resultant impact on the individual. Overwhelming BoT is related to poor quality of life and worse clinical outcomes. This research is the first to explore symptoms and BoT in people with CHF, in the UK. Methods and results: This is a cross‐sectional questionnaire survey of CHF patients. Participants completed the Heart Failure Symptom Survey (HFSS; max score 10) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ; max scores: physical 40, emotional 25, and total 105), which measured symptoms. BoT was measured with the Patient Experience with Treatment and Self‐management (PETS; max score 100) questionnaires. Participant characteristics and questionnaire results were summarized using descriptive statistics. Relationships between symptoms and BoT, summarized by the workload and impact indices, were explored using Spearman's and Pearson's correlation coefficients together with scatter plots. The survey was completed by 333 participants, mean age of 71 (±13) years old. The majority (89%) were recruited from secondary care NHS trusts, and 25% were female. All types of heart failure were represented. Mean symptom scores were as follows: HFSS burden score: 2.4 (±2.1), and MLHFQ scores: physical score 20 (±12.4), emotional score 9.9 (±8.1), and total score 41.3 (±26.3). The highest mean PETS domain scores were exercise [51.3 (±24.7)], diet [40.3 (±22.7)], difficulty with healthcare services [39.9 (±21.3)], and physical and mental fatigue [36.0 (±25.7)]. Pairwise correlations were observed between HFSS scores and MLHFQ physical and emotional sub‐scores with PETS workload and impact indices. Positive correlations were weak to moderate (0.326–0.487) between workload index and symptoms, and moderate to strong between impact index and symptoms (0.553–0.725). The P value was 0.006, adjusted by Bonferroni's correction. Conclusions: Symptoms are associated with BoT in CHF patients. Although symptom burden was low, CHF patients reported higher levels of burden around self‐care activities of exercise, diet, healthcare interaction, as well as physical and mental fatigue due to engagement with self‐care regimens. Observed higher levels of burden were in key self‐care areas for CHF and suggest areas where service delivery and support of CHF patients may be improved to reduce BoT. Clinicians could individualize their consultations by focusing on troublesome symptoms, as well as alleviating illness workload, which may better enable patients to live well with CHF
How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed‐methods study
Full text linkAimsPatients with chronic heart failure (CHF) struggle to follow self‐care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self‐care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives.Methods and resultsWe used a sequential exploratory mixed‐methods design to investigate the interaction between symptoms and BoT in CHF patients.ConclusionsIf symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self‐care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Qualitative interviews results from heart failure survey respondents on the interaction between symptoms and burden of self-care work
Full text linkAims and objectives:
Following a cross-sectional survey, a sub-sample of participants was interviewed to explore the interaction between symptoms and burden of treatment.
Background:
Burden of treatment considers both the work associated with illness and treatment, including self-care work, as well as the individuals' capabilities and resources to engage in that work. The recent survey revealed the existence of a complex interaction.
Design:
Qualitative abductive analysis of semi-structured interviews.
Methods:
Adults with heart failure who participated in the survey were purposely sampled and invited to participate in semi-structured interviews. Location and mode of interview varied by participant choice. Excerpts from the verbatim transcripts were assessed for interactions between symptoms and burden of treatment, and when identified these were characterised and explained. We followed COREQ checklist for reporting. The patient research ambassador group was involved from research design to dissemination.
Results:
Participants (n = 32) consistently discussed how symptoms altered their capability to engage in self-care work. As symptom intensity increased the difficultly of their self-care work increased. A number of intervening factors appeared to influence the relationship between symptoms and burden of treatment. Intervening factors included illness pathology, illness identity, the value of the tasks attempted and available support structures. These factors may change how symptoms and burden of treatment are perceived; a model was constructed to explain and summarise these interactions.
Conclusions:
The interaction between symptoms and burden of treatment is complex. Intervening factors—illness identity and pathology, task value and performance, and available support structures—appear to exert a strong influence on the interaction between symptoms and burden of treatment
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Safety and efficacy of intravenous ferric derisomaltose compared to iron sucrose for iron deficiency anemia in patients with chronic kidney disease with and without heart failure
Full text linkFerric derisomaltose (FDI) is an intravenous (IV) high-dose iron formulation approved in
the US for the treatment of iron deficiency anemia in adults who are intolerant of/have
had an unsatisfactory response to oral iron, or who have non-dialysis-dependent chronic
kidney disease (NDD-CKD). FERWON-NEPHRO was a randomized, open-label, multicenter clinical trial evaluating the safety and efficacy of a single infusion of FDI 1,000 mg
versus up to 5 doses of iron sucrose (IS) 200 mg (recommended cumulative dose, 1,000
mg) over 8 weeks in patients with NDD-CKD and iron deficiency anemia. Of 1,525 patients
included in the safety analysis, 244 (16%) had a history of heart failure (HF). Overall, the
rate of serious or severe hypersensitivity reactions was low and did not differ between
treatment groups. Cardiovascular adverse events (AEs) were reported for 9.4% of
patients who had HF and 4.2% who did not. Time to first cardiovascular AE was longer
following administration of FDI compared with IS (hazard ratio: 0.59 [95% CI: 0.37,
0.92]; p=0.0185), a difference that was similar in patients with or without HF (p=0.908 for
interaction). Patients achieved a faster hematological response (assessed by changes in
hemoglobin and ferritin concentrations, and increase in transferrin saturation) with FDI
versus IS. In conclusion, in patients with NDD-CKD, a single infusion of FDI was safe,
well tolerated, and was associated with fewer cardiovascular AEs and a faster hematological response, compared to multiple doses of IS. These effects were similar for patients with and without HF
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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