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An evaluation of a service expansion to include patients with heart failure with preserved ejection fraction 对扩大服务范围以纳入射血分数保留型心力衰竭患者的评估
Pub Date : 2024-02-15 DOI: 10.12968/bjca.2023.0082
Jessica Peplow, Sharon Rees
The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction, in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service referral rates, length of stay in the service and clinical workload. A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in the service and key workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method. Data were analysed using Chi square test, Fisher’s exact test or the Wilcoxon signed rank test; a P value of <0.05 indicated statistical significance. The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced ejection fraction had a significantly longer stay of 35.57 weeks (P<0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant community clinic. This group was less likely to attend clinic, with 96.4% of face-to-face reviews taking place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups. The service expansion to include patients with heart failure with preserved ejection fraction has had a significant impact on workload, leading to a reduction in the quality of care for those with heart failure with reduced ejection fraction.
西赫特福德郡中央伦敦社区医疗信托基金的心力衰竭服务于 2020 年扩大,除了射血分数降低的心力衰竭患者外,还包括射血分数保留的心力衰竭患者。预计患者人数将增加一倍,需要对人员和服务进行调整;因此需要进行评估,以确定护理目标是否得以维持。本研究旨在评估服务扩展对服务转诊率、服务停留时间和临床工作量的影响。研究人员对 2020 年 10 月至 2021 年 4 月期间的服务数据进行了回顾性定量评估,以比较射血分数降低型心力衰竭患者和射血分数保留型心力衰竭患者的转诊率、住院时间和主要工作量指标。所有新诊断为心力衰竭(经超声心动图或磁共振成像确认)的转诊患者均被纳入评估范围。在250名符合条件的转诊者中,采用随机抽样的方法选取了81人进行评估。数据分析采用卡方检验、费雪精确检验或 Wilcoxon 符号秩检验;P 值小于 0.05 表示统计学意义显著。射血分数保留型心力衰竭患者的住院时间中位数为17周。射血分数减低型心力衰竭患者的住院时间为35.57周(P<0.001),而扩容前的住院时间约为17周。两组患者的工作量成正比。射血分数保留型心力衰竭患者更有可能接受多学科团队或顾问社区诊所的复查。这组患者到诊所就诊的可能性较低,96.4%的面对面复查是在家中进行的。两组患者接受电话复查的频率相似,均占随访的50%。射血分数降低的心力衰竭患者需要进行更多的药物治疗和药物滴定,因此需要进行更多的随访。将射血分数保留型心力衰竭患者纳入服务范围对工作量产生了重大影响,导致射血分数降低型心力衰竭患者的护理质量下降。
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引用次数: 0
A season of change: managing menopause with adult congenital heart disease 变化的季节:管理患有成人先天性心脏病的更年期患者
Pub Date : 2024-02-15 DOI: 10.12968/bjca.2023.0073
B. Greenaway
In this patient story, Beth Greenaway describes her experience of menopause and the additional challenges that a congenital heart condition can bring to this life stage.
在这个病人的故事中,贝丝-格林纳威描述了她的更年期经历,以及先天性心脏病给这个人生阶段带来的额外挑战。
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引用次数: 0
A season of change: managing menopause with adult congenital heart disease 变化的季节:管理患有成人先天性心脏病的更年期患者
Pub Date : 2024-02-15 DOI: 10.12968/bjca.2023.0073
B. Greenaway
In this patient story, Beth Greenaway describes her experience of menopause and the additional challenges that a congenital heart condition can bring to this life stage.
在这个病人的故事中,贝丝-格林纳威描述了她的更年期经历,以及先天性心脏病给这个人生阶段带来的额外挑战。
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引用次数: 0
An evaluation of a service expansion to include patients with heart failure with preserved ejection fraction 对扩大服务范围以纳入射血分数保留型心力衰竭患者的评估
Pub Date : 2024-02-15 DOI: 10.12968/bjca.2023.0082
Jessica Peplow, Sharon Rees
The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction, in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service referral rates, length of stay in the service and clinical workload. A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in the service and key workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method. Data were analysed using Chi square test, Fisher’s exact test or the Wilcoxon signed rank test; a P value of <0.05 indicated statistical significance. The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced ejection fraction had a significantly longer stay of 35.57 weeks (P<0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant community clinic. This group was less likely to attend clinic, with 96.4% of face-to-face reviews taking place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups. The service expansion to include patients with heart failure with preserved ejection fraction has had a significant impact on workload, leading to a reduction in the quality of care for those with heart failure with reduced ejection fraction.
西赫特福德郡中央伦敦社区医疗信托基金的心力衰竭服务于 2020 年扩大,除了射血分数降低的心力衰竭患者外,还包括射血分数保留的心力衰竭患者。预计患者人数将增加一倍,需要对人员和服务进行调整;因此需要进行评估,以确定护理目标是否得以维持。本研究旨在评估服务扩展对服务转诊率、服务停留时间和临床工作量的影响。研究人员对 2020 年 10 月至 2021 年 4 月期间的服务数据进行了回顾性定量评估,以比较射血分数降低型心力衰竭患者和射血分数保留型心力衰竭患者的转诊率、住院时间和主要工作量指标。所有新诊断为心力衰竭(经超声心动图或磁共振成像确认)的转诊患者均被纳入评估范围。在250名符合条件的转诊者中,采用随机抽样的方法选取了81人进行评估。数据分析采用卡方检验、费雪精确检验或 Wilcoxon 符号秩检验;P 值小于 0.05 表示统计学意义显著。射血分数保留型心力衰竭患者的住院时间中位数为17周。射血分数减低型心力衰竭患者的住院时间为35.57周(P<0.001),而扩容前的住院时间约为17周。两组患者的工作量成正比。射血分数保留型心力衰竭患者更有可能接受多学科团队或顾问社区诊所的复查。这组患者到诊所就诊的可能性较低,96.4%的面对面复查是在家中进行的。两组患者接受电话复查的频率相似,均占随访的50%。射血分数降低的心力衰竭患者需要进行更多的药物治疗和药物滴定,因此需要进行更多的随访。将射血分数保留型心力衰竭患者纳入服务范围对工作量产生了重大影响,导致射血分数降低型心力衰竭患者的护理质量下降。
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引用次数: 0
Enhancing patient outcomes: 2023 focused clinical update on heart failure 提高患者疗效:2023 年心力衰竭重点临床更新
Pub Date : 2024-02-02 DOI: 10.12968/bjca.2023.0103
Mairead Lehane, Antonia Docherty, Becky Hyland, Maggie Simpson, Leeanne Macklin
This article provides an overview of the European Society of Cardiology 2023 focused clinical update on heart failure and considerations for practice. The latest focused clinical update provides an overview of up-to-date recommendations based on all major clinical trials and meta-analyses exploring heart failure that were published since 2021. The update outlined recommendations on treatment and management of chronic heart failure, acute heart failure, and comorbidities (including chronic kidney disease, type 2 diabetes, iron deficiency) and the prevention of heart failure.
本文概述了欧洲心脏病学会 2023 年心力衰竭重点临床更新及实践注意事项。最新的重点临床更新概述了基于 2021 年以来发表的所有探讨心力衰竭的主要临床试验和荟萃分析的最新建议。更新概述了慢性心力衰竭、急性心力衰竭、合并症(包括慢性肾病、2 型糖尿病、缺铁)的治疗和管理以及心力衰竭的预防建议。
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引用次数: 0
Highlighting the latest research: February 2024 突出最新研究:2024 年 2 月
Pub Date : 2024-02-02 DOI: 10.12968/bjca.2023.0104
Sarah Jane Palmer, Helen Cowan
Sarah Jane Palmer presents a selection of recently published articles of interest to nurses working in cardiovascular nursing, while Helen Cowan explores their application to practice. The aim of this roundup is to provide a brief overview of the research papers selected and highlight their relevance to cardiac nursing practice. A full reference is provided for those who wish to look at the research in further detail.
莎拉-简-帕尔默(Sarah Jane Palmer)精选了近期发表的心血管护理领域护士感兴趣的文章,而海伦-考恩(Helen Cowan)则探讨了这些文章在实践中的应用。本综述旨在对所选研究论文进行简要概述,并强调其与心血管护理实践的相关性。我们还为希望进一步了解研究细节的读者提供了完整的参考文献。
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引用次数: 0
Calcium supplementation for the prevention of hypertension: a synthesis of existing evidence and implications for practise 补钙预防高血压:现有证据综述及对实践的影响
Pub Date : 2024-02-02 DOI: 10.12968/bjca.2023.0010
O. Hamer, Areej Mohamed, Zundus Ali-heybe, Emma Schnieder, J. Hill
In this commentary, Oliver Hamer and colleagues critically appraise the methods and findings presented in a Cochrane systematic review exploring the effectiveness of calcium dietary supplementation in preventing hypertension.
在这篇评论中,Oliver Hamer 及其同事对 Cochrane 系统综述中探讨膳食钙补充剂预防高血压有效性的方法和结果进行了批判性评估。
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引用次数: 0
COVID-19 outcomes in patients with pre-existing cardiovascular disease and risk factors: perspectives from a hospital in Ireland 已有心血管疾病和风险因素的患者的 COVID-19 结果:爱尔兰一家医院的观点
Pub Date : 2024-01-25 DOI: 10.12968/bjca.2023.0097
Deirdre McGuone, Nicola Farrand, Geraldine Prizeman, Frances O'Brien
COVID-19 has led to substantial changes in the provision of emergency healthcare services. International data suggest that COVID-19 is associated with increased morbidity and mortality in patients with pre-existing cardiovascular disease and cardiovascular risk factors. This study aimed to explore the association between pre-existing cardiovascular disease and/or cardiovascular risk factors and COVID-19 disease severity and outcomes in an Irish hospital. This retrospective study obtained data from a bioresource database of patients with confirmed COVID-19 infection (n=649) in a large hospital in Dublin. Data were collected on patients' demographic characteristics, cardiovascular diseases, cardiovascular disease risk factors and medications taken for cardiovascular conditions. The World Health Organization progression scale was used to assess the severity of COVID-19 infection in each patient. Cross-tabulation analysis was used to analyse associations between variables, with a P value of ≤0.05 indicating significance. Mortality rates were six times greater in patients with cardiovascular disease compared to those without cardiovascular disease (18.6% vs 3.1%). A higher percentage of patients with one or more cardiovascular risk factors had moderate (53.4%) or severe (19.1%) COVID-19 and higher mortality rates (10.7%) than those without cardiovascular risk factors. Of the patients who died from COVID-19 (n=40), 60.0% (n=24) had one or more cardiovascular diseases, while 80.0% (n=32) had one or more cardiovascular risk factors. Existing cardiovascular disease and cardiovascular risk factors increase the risk of more severe disease and worse clinical outcomes in patients with COVID-19. Many cardiovascular risk factors are modifiable, so it is important to consider preventative education strategies designed to reduce modifiable risk factors to improve outcomes for patients with COVID-19.
COVID-19 引发了急诊医疗服务的重大变革。国际数据表明,COVID-19 与原有心血管疾病和心血管风险因素患者的发病率和死亡率增加有关。本研究旨在探讨一家爱尔兰医院中已存在的心血管疾病和/或心血管风险因素与 COVID-19 疾病严重程度和结果之间的关联。这项回顾性研究从生物资源数据库中获得了都柏林一家大型医院确诊 COVID-19 感染患者(n=649)的数据。研究收集了患者的人口统计学特征、心血管疾病、心血管疾病风险因素和心血管疾病用药等数据。采用世界卫生组织的进展量表来评估每位患者感染 COVID-19 的严重程度。交叉分析用于分析变量之间的关联,P值≤0.05表示显著性。与无心血管疾病的患者相比,有心血管疾病的患者死亡率高出六倍(18.6% 对 3.1%)。与无心血管风险因素的患者相比,具有一种或多种心血管风险因素的患者中,具有中度(53.4%)或重度(19.1%)COVID-19 的比例更高,死亡率(10.7%)也更高。在死于 COVID-19 的患者(40 人)中,60.0%(24 人)患有一种或多种心血管疾病,而 80.0%(32 人)有一种或多种心血管风险因素。现有的心血管疾病和心血管风险因素会增加 COVID-19 患者病情加重和临床预后恶化的风险。许多心血管风险因素是可以改变的,因此必须考虑旨在减少可改变风险因素的预防教育策略,以改善 COVID-19 患者的预后。
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引用次数: 0
Patient-reported experiences of cardiac rehabilitation services and the Country Heart Attack Prevention model of care 患者对心脏康复服务和国家心脏病预防护理模式的体验报告
Pub Date : 2024-01-25 DOI: 10.12968/bjca.2023.0061
L. Gebremichael, A. Beleigoli, Jonathon W Foote, N. Bulamu, Joyce S. Ramos, Robyn A Clark
Patient-centred care is the delivery of a high-quality healthcare service that appropriately responds to the needs and preferences of patients. Addressing participants' needs and preferences in healthcare services is essential to improving patients' experiences and clinical outcomes. This article aimed to evaluate patient-reported experiences of standard cardiac rehabilitation programmes and the Country Heart Attack Prevention model of care, as well as design and standardise patient-reported experience measures. This was a cross-sectional study with a multi-method analysis. Participants (n=818) ≥18 years old with cardiovascular disease who attended cardiac rehabilitation programmes across all modes of delivery before (1 January 2017 to 30 June 2021), during (1 July 2021 to 30 June 2022) and after implementation of the Country Heart Attack Prevention model (1 July 2022 to 30 December 2022) responded to the patient satisfaction surveys. Participant data from before and after implementation of the model were categorised as ‘not exposed’, while those who received cardiac rehabilitation during this period were categorised as ‘exposed’. A total of 170 participants provided qualitative feedback. Summary t-test was used to compare the means of the quantitative responses, and thematic analysis was used to generate themes from the qualitative feedback. The overall patient-reported satisfaction scores for those not exposed (n=685) and exposed (n=133) to the Country Heart Attack Prevention model of care were 77.1% and 85.9%, respectively (mean difference=−8.8; 95% confidence interval=−10.2, −7.4; P≤0.05). Themes for positive feedback included education and information, communication and friendly advice. Themes for improvement included follow-up duration, more face-to-face contact and waiting time. Overall patient-reported satisfaction scores were significantly higher for participants who were exposed to the Country Heart Attack Prevention model of care compared with those who were not exposed. Addressing feedback on areas for improvement in cardiac rehabilitation services can promote attendance, completion and improved health outcomes of patients.
以患者为中心的医疗服务是指提供高质量的医疗服务,适当满足患者的需求和偏好。在医疗保健服务中满足参与者的需求和偏好对于改善患者的体验和临床结果至关重要。本文旨在评估患者对标准心脏康复计划和国家心脏病预防护理模式的体验报告,并设计和标准化患者体验报告测量方法。这是一项采用多种方法分析的横断面研究。在 "国家心脏病发作预防模式 "实施前(2017 年 1 月 1 日至 2021 年 6 月 30 日)、实施期间(2021 年 7 月 1 日至 2022 年 6 月 30 日)和实施后(2022 年 7 月 1 日至 2022 年 12 月 30 日),年龄≥18 岁的心血管疾病患者(n=818)参加了各种模式的心脏康复项目,并对患者满意度调查做出了答复。模式实施前和实施后的参与者数据被归类为 "未暴露",而在此期间接受心脏康复治疗的参与者被归类为 "暴露"。共有 170 名参与者提供了定性反馈。采用摘要 t 检验比较定量反馈的平均值,并采用主题分析从定性反馈中生成主题。未接触过(人数=685)和接触过(人数=133)国家心脏病预防护理模式的患者报告的总体满意度分别为77.1%和85.9%(平均差异=-8.8;95%置信区间=-10.2,-7.4;P≤0.05)。积极反馈的主题包括教育和信息、沟通和友好建议。需要改进的主题包括随访时间、更多面对面接触和等待时间。与未接触过 "国家心脏病预防 "护理模式的人相比,接触过该模式的参与者的患者报告的总体满意度得分明显更高。对心脏康复服务中需要改进的地方进行反馈,可以促进患者参加、完成康复训练并改善其健康状况。
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引用次数: 0
International nurse collaborations to improve cardiometabolic health: a professional visit report 国际护士合作改善心脏代谢健康:专业访问报告
Pub Date : 2024-01-19 DOI: 10.12968/bjca.2023.0098
Janice Richardson
Janice Richardson describes her professional visit to the Dasman Diabetes Institute in Kuwait to provide support for a collaborative research project, known as KUDOS, exploring the relationship between excess liver fat and diabetes in different age groups.
珍妮丝-理查森(Janice Richardson)介绍了她对科威特达斯曼糖尿病研究所(Dasman Diabetes Institute)的专业访问,这次访问是为了为一个名为 "KUDOS "的合作研究项目提供支持,该项目探索不同年龄段人群肝脏脂肪过多与糖尿病之间的关系。
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引用次数: 0
期刊
British Journal of Cardiac Nursing
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