RESUMO
INTRODUCTION: Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARDPCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARDPCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI. METHODS AND ANALYSIS: This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries. ETHICS AND DISSEMINATION: Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations. TRIAL REGISTRATION NUMBER: NCT03810612.
Assuntos
Reabilitação Cardíaca/economia , Reabilitação Cardíaca/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Letramento em Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/métodos , Idoso , Estudos de Coortes , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Dinamarca , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Letramento em Saúde/métodos , Humanos , Masculino , Noruega , Estudos Prospectivos , Projetos de Pesquisa , Resultado do TratamentoRESUMO
European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.
Assuntos
Cardiologia/normas , Doenças Cardiovasculares/prevenção & controle , Serviços Preventivos de Saúde/normas , Cardiologia/economia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Consenso , Análise Custo-Benefício , Custos de Cuidados de Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Serviços Preventivos de Saúde/economia , Prognóstico , Fatores de Proteção , Medição de RiscoRESUMO
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease associated with breathlessness, inability to exercise, frequent infections, hospitalisation and reduced quality of life. Pulmonary rehabilitation (PR), providing supervised exercise and education, is an effective and cost-effective treatment for COPD but is significantly underused. Interventions to improve referral and uptake have been tested and some positive results reported. However, interventions are diverse and no clear recommendations for practice can be made. This study aims to understand the challenges to referral and uptake in primary care, where most referrals originate, and to develop a flexible toolkit of resources to support referral and uptake to PR in primary care in the UK. METHODS AND ANALYSIS: This is a mixed methods study informed by normalisation process theory and burden of treatment theory. In the first phase, general practitioners, practice nurses and PR providers will be invited to complete an online survey to inform a broad exploration of the topic areas. In phase 2 interviews and focus groups will be conducted with patients, healthcare professionals (HCP) in primary care, PR providers and commissioners to gain an in-depth understanding of the issues and needs. Toolkit development in phase 3 will draw together the learning from phases 1 and 2 and employ an iterative development process to build the toolkit jointly with patients and HCPs. It will be tested in primary care for usability and acceptability. ETHICS AND DISSEMINATION: The study has ethical and Health Research Authority approval (Research Ethics Committee reference number 17/EE/0136). It is registered with the International Standard Registered Clinical/Social Study Number (ISRCTN) registry (trial ID: ISRCTN20669629, assignment date 20 March 2018, trial start date 1 April 2016). Dissemination will be aimed at patients, carers/families, service providers, commissioners and national interest groups. Methods will include conferences, presentations, academic publications and plain English reports and will be supported by the British Lung Foundation. TRIAL REGISTRATION NUMBER: ISRCTN20669629 ; Pre-results.
Assuntos
Exercício Físico , Educação de Pacientes como Assunto , Doença Pulmonar Obstrutiva Crônica/reabilitação , Análise Custo-Benefício , Grupos Focais , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Qualidade de Vida , Encaminhamento e Consulta , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Diabetes is a common co-morbidity for patients with heart failure. Diabetes as a co-morbidity means that inpatient care should focus on both conditions to maximize the treatment regimen. However, this pressing issue is not widely researched and so it is unclear whether the acute care management needs of these patients are being met. AIMS: (1) To assess the differences in the number of hospital readmissions between patients with heart failure and patients with heart failure-diabetes; (2) to assess the use of integrated care approach for patients with heart failure-diabetes during the index heart failure-related admission; (3) to explore patient experiences of admissions. METHODS: A mixed methods design was used: we identified heart failure-related admissions between 1 April 2011 and 31 March 2012 in two hospitals, then reviewed medical records and interviewed 14 patients. RESULTS: Over a 12 month period patients with heart failure-diabetes ( n=172) had more heart failure-related Accident and Emergency attendance episodes (incident rate ratio 1.24, p<0.01) and hospital readmissions (incident rate ratio 1.23, p=0.01) than patients with heart failure ( n=370). We reviewed 72 medical records which met inclusion criteria (adults with heart failure-diabetes, ejection fraction <45%): during admission most of them were reviewed by heart failure specialists but less than one-third were reviewed by diabetes specialists. The interview respondents addressed the need for better integration and co-ordination of care. CONCLUSIONS: This is one of the first UK studies to assess the integration of inpatient care for those with heart failure and multi-morbidities. The findings suggest that maximal care management during admission should be explored as a way of reducing the frequent readmissions and improving patient outcomes.
Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino UnidoRESUMO
Worldwide, each year more than 7 million people experience myocardial infarction, in which one-year mortality rates are now in the range of 10%, but vary with patient characteristics. The consequences are even more dramatic: among patients who survive, 20% suffer a second cardiovascular event in the first year and approximately 50% of major coronary events occur in those with a previous hospital discharge diagnosis of ischaemic heart disease. The people behind these numbers spur this call for action. Prevention after myocardial infarction is crucial to reduce risk and suffering. Evidence-based interventions include optimal medical treatment with anti-platelets and statins, achievement of blood pressure, lipid and blood glucose targets, and appropriate lifestyle changes. The European Society of Cardiology and its constituent bodies are determined to embrace this challenge by developing a consensus document in which the existing gaps for secondary prevention strategies are reviewed. Effective interventions in relation to the patients, healthcare providers and healthcare systems are proposed and discussed. Finally, innovative strategies in hospital as well as in outpatient and long-term settings are endorsed.
Assuntos
Atenção à Saúde/organização & administração , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/prevenção & controle , Prevenção Secundária/normas , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Reabilitação Cardíaca/métodos , Efeitos Psicossociais da Doença , Exercício Físico/fisiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Mortalidade/tendências , Infarto do Miocárdio/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Fatores de Risco , Comportamento de Redução do Risco , Prevenção Secundária/métodosAssuntos
Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/prevenção & controle , Adulto , Fatores Etários , Idoso , Anti-Hipertensivos/uso terapêutico , Biomarcadores/metabolismo , Reabilitação Cardíaca/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etnologia , Análise Custo-Benefício , Angiopatias Diabéticas/prevenção & controle , Diagnóstico por Imagem/métodos , Dieta Saudável , Exercício Físico/fisiologia , Medicina Geral/métodos , Promoção da Saúde/métodos , Estilo de Vida Saudável , Humanos , Hiperlipidemias/prevenção & controle , Hipertensão , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas , Linhagem , Padrões de Prática Médica/normas , Medição de Risco , Fatores Sexuais , Abandono do Hábito de Fumar , Fatores SocioeconômicosAssuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Cardiomiopatias Diabéticas/epidemiologia , Cardiomiopatias Diabéticas/prevenção & controle , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Progressão da Doença , Dislipidemias/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Hipoglicemiantes/uso terapêutico , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Gestão de RiscosAssuntos
Hipertensão/terapia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Encefalopatias/diagnóstico , Encefalopatias/etiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/prevenção & controle , Anticoncepcionais Orais/efeitos adversos , Atenção à Saúde , Complicações do Diabetes/complicações , Dieta , Interações Medicamentosas , Quimioterapia Combinada , Ecocardiografia , Eletrocardiografia , Exercício Físico/fisiologia , Feminino , Cardiopatias/prevenção & controle , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hiperglicemia/prevenção & controle , Hipertensão/diagnóstico , Hipertensão Induzida pela Gravidez/diagnóstico , Masculino , Informática Médica , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Assistência Perioperatória/métodos , Exame Físico/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Gravidez , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Apneia Obstrutiva do Sono/complicações , Abandono do Hábito de Fumar , Redução de Peso , Adulto JovemAssuntos
Doenças Cardiovasculares/prevenção & controle , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Biomarcadores , Pressão Sanguínea/fisiologia , Cardiologia , Fármacos Cardiovasculares/uso terapêutico , Doença Crônica/prevenção & controle , Atenção à Saúde , Diabetes Mellitus Tipo 2/prevenção & controle , Angiopatias Diabéticas/prevenção & controle , Diagnóstico por Imagem , Dieta , Combinação de Medicamentos , Diagnóstico Precoce , Registros Eletrônicos de Saúde , Medicina Baseada em Evidências , Exercício Físico/fisiologia , Feminino , Medicina Geral , Promoção da Saúde , Hospitalização , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/prevenção & controle , Hipertensão/complicações , Hipertensão/prevenção & controle , Estilo de Vida , Lipídeos/sangue , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Obesidade/complicações , Obesidade/prevenção & controle , Seleção de Pacientes , Papel do Médico , Atenção Primária à Saúde/organização & administração , Prognóstico , Medição de Risco , Comportamento de Redução do Risco , Autocuidado , Fumar/efeitos adversos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Fatores Socioeconômicos , Estresse Psicológico/complicações , Estresse Psicológico/prevenção & controleRESUMO
Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease--primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking--continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Saúde Global , Promoção da Saúde , Necessidades e Demandas de Serviços de Saúde , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Países em Desenvolvimento , Feminino , Transição Epidemiológica , Humanos , Estilo de Vida , Masculino , Obesidade/epidemiologia , Obesidade/prevenção & controle , Prevalência , Fatores de Risco , Distribuição por Sexo , Fumar/epidemiologia , Prevenção do Hábito de FumarRESUMO
Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease-primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking-continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.
Assuntos
Doenças Cardiovasculares/enfermagem , Doenças Cardiovasculares/prevenção & controle , Educação em Saúde/tendências , Papel do Profissional de Enfermagem , Prevenção Primária/organização & administração , Especialidades de Enfermagem/tendências , Doenças Cardiovasculares/epidemiologia , Efeitos Psicossociais da Doença , Saúde Global , Humanos , Comunicação Interdisciplinar , Fatores de RiscoRESUMO
AIMS AND OBJECTIVES: To explore patients' responses to developing and managing cystic fibrosis-related diabetes and to contrast their views with those of individuals with type 1 diabetes mellitus. BACKGROUND: The incidence of diabetes among people with cystic fibrosis has increased with improvement in life expectancy. However, little is known about how patients respond to and manage cystic fibrosis-related diabetes, and how this compares with people living with type 1 diabetes mellitus. DESIGN: Qualitative research was undertaken in order to fully explore meanings and views. METHODS: Semi-structured telephone or face-to-face interviews were conducted with patients who had cystic fibrosis-related diabetes or type 1 diabetes mellitus, during which, they discussed diagnosis and management of diabetes. Framework analysis was employed to identify themes and to consider similarities and differences between the two groups. RESULTS: Eleven cystic fibrosis-related diabetes and 12 type 1 diabetes mellitus patients were interviewed in 2006. Patients with cystic fibrosis-related diabetes described their diabetes diagnosis as a progression of their primary illness, management of which was important owing to the benefits it brought to their cystic fibrosis. Those with type 1 diabetes mellitus were more likely to report feeling psychologically low because of diabetes and to list long-term complications as a key factor motivating self-management. Both groups struggled to balance the demands of diabetes with other life and health obligations, and experienced isolation because of diabetes. Conclusions. Variation in perceptions recalled during interviews stemmed from diabetes being part of an existing life-threatening chronic illness in people with cystic fibrosis-related diabetes. Similarities and differences in attitudes and management practices were found, with less urgency regarding glucose monitoring and fewer information resources available for those with cystic fibrosis-related diabetes. RELEVANCE TO CLINICAL PRACTICE: Both groups need support for optimal diabetes management and access to appropriate resources outside specialist clinics. Web-based technologies could prove useful for those with cystic fibrosis-related diabetes as face-to-face interaction may be prevented owing to the risk of cross-infection.
Assuntos
Adaptação Psicológica , Fibrose Cística/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus/psicologia , Motivação , Isolamento Social , Atividades Cotidianas/psicologia , Adulto , Atitude Frente a Saúde , Fibrose Cística/complicações , Diabetes Mellitus/etiologia , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus Tipo 1/prevenção & controle , Inglaterra , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Internet , Relações Interpessoais , Masculino , Pesquisa Metodológica em Enfermagem , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Autocuidado/psicologia , Autoimagem , Apoio Social , Inquéritos e QuestionáriosRESUMO
Percutaneous coronary intervention (PCI) remains a major therapeutic option for the treatment of chronic coronary artery disease. In the COURAGE trial, 2287 patients with chronic coronary disease were randomized between PCI with medical management and medical management alone. Embedded within the COURAGE trial is a detailed economic analysis being conducted in three health care systems: the US Veterans Administration (VA), Canada, and the US non-VA. Resource use and costs are being collected for each system and overall. Survival is assessed internally in the trial with mean follow-up of 4.5 years. Long-term mean survival will be estimated by projecting survival beyond the trial period by extrapolating the in-trial hazard rates. Utility is being assessed at baseline and at 1, 3, and 6 months and annually thereafter, using a computer-administered standard gamble. Quality-adjusted life years are calculated by multiplying survival by utility. The incremental cost-effectiveness ratio of PCI will be defined as the additional cost of PCI divided by the gain in life years and quality-adjusted life years. The 95% confidence regions of efficacy and costs will be determined by bootstrap over a range of acceptability thresholds, which will then be displayed in the cost-effectiveness plane and as a cost-effectiveness acceptability curve. A multilevel regression model will assess cost-effectiveness from a net benefit perspective. These approaches should provide the most detailed assessment available of the cost-effectiveness of PCI for coronary artery disease.
Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Doença das Coronárias/tratamento farmacológico , Humanos , Guias de Prática Clínica como AssuntoRESUMO
This article provided an overview of the current state of knowledge related to cardiovascular disease in elders. Some depth has been provided related to CHD and HF, two common diagnoses in older persons. The most striking finding is that although trials are increasingly including older cohorts of patients, research specifically testing known therapies in older patients is essential. In particular, research testing the safety, efficacy, and acceptability of therapies in the oldest old is greatly needed.