82 results found
Singhal A, Riley J, Cowie M, 2023, Benefits and challenges of telemedicine for heart failure consultations: a qualitative study, BMC Health Services Research, Vol: 23, ISSN: 1472-6963
Background:Prior to the Covid-19 pandemic, heart failure (HF) disease management programmes were predominantly delivered in-person, with telemedicine being uncommon. Covid-19 resulted in a rapid shift to “remote-by-default” clinic appointments in many organisations. We evaluated clinician and patient experiences of teleconsultations for HF.Methods:From 16th March 2020, all HF appointments at a specialist centre in the UK were telemedicine-by-default through a mixture of telephone and video consultations, with rare in-person appointments. HF clinicians and patients with HF were invited to participate in semi-structured interviews about their experiences. A purposive sampling technique was used. Interviews were conducted using Microsoft Teams®, recorded and transcribed verbatim. Narrative data were explored by thematic analysis. Clinicians and patients were interviewed until themes saturated.Results:Eight clinicians and eight patients with HF were interviewed before themes saturated. Five overarching themes emerged: 1) Time utilisation – telemedicine consultations saved patients time travelling to and waiting for appointments. Clinicians perceived them to be more efficient, but more administrative time was involved. 2) Clinical assessment – without physical examination, clinicians relied more on history, observations and test results; video calls were perceived as superior to telephone calls for remote assessment. Patients confident in self-monitoring tended to be more comfortable with telemedicine. 3) Communication and rapport – clinicians experienced difficulty establishing rapport with new patients by telephone, though video was better. Patients generally did not perceive that remote consultation affected their rapport with clinicians. 4) Technology – connection issues occasionally disrupted video consultations, but overall patients and clinicians found the technology easy to use. 5) Choice and flexibility – both patien
Singhal A, Riley JP, Cowie MR, 2021, Clinician experiences of 1 year of telemedicine heart failure clinics: The VIDEO-HF study, Publisher: WILEY, Pages: 302-302, ISSN: 1388-9842
Singhal A, Riley J, Cowie M, 2021, CLINICIAN EXPERIENCES OF 1 YEAR OF TELEMEDICINE HEART FAILURE CLINICS: THE VIDEO-HF STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A90-A90, ISSN: 1355-6037
McCambridge J, Keane C, Walshe M, et al., 2020, The prehospital patient pathway and experience of care with acute heart failure: a comparison of two health care systems, ESC Heart Failure, Vol: 8, Pages: 1076-1084, ISSN: 2055-5822
AimsThis study aimed to analyse community management of patients during the symptomatic period prior to admission with acute decompensated heart failure (ADHF).Methods and resultsWe conducted a prospective, two-centre, two-country observational study evaluating care pathways and patient experience in patients admitted to hospital with ADHF. Quantitative and qualitative data were gathered from patients, carers, and general practitioners (GPs). From the Irish centre, 114 patients enrolled, and from the English centre, 50 patients. Symptom duration longer than 72 h prior to hospitalization was noted among 70.4% (76) Irish and 80% (40) English patients, with no significant difference between those with a new diagnosis of HF [de novo HF (dnHF)] and those with known HF [established HF (eHF)] in either cohort. For the majority, dyspnoea was the dominant symptom; however, 63.3% (31) of these Irish patients and 47.2% (17) of these English patients did not recognize this as an HF symptom, with no significant difference between dnHF and eHF patients. Of the 46.5% (53) of Irish and 38% (19) of English patients reviewed exclusively by GPs before hospitalization, numbers prescribed diuretics were low (11.3%, six; and 15.8%, three, respectively); eHF patients were no more likely to receive diuretics than dnHF patients. Barriers to care highlighted by GPs included inadequate access to basic diagnostics, specialist support and up-to-date patient information, and lack of GP comfort in managing HF.ConclusionThe aforementioned findings, consistent across both health care jurisdictions, show a clear potential to intervene earlier and more effectively in ADHF or to prevent the need for hospitalization.
Burns DJP, Arora J, Okunade O, et al., 2020, International Consortium for Health Outcomes Measurement (ICHOM): Standardized Patient-Centered Outcomes Measurement Set for Heart Failure Patients, JACC-HEART FAILURE, Vol: 8, Pages: 212-222, ISSN: 2213-1779
Mccambridge JJ, Keane C, Walshe M, et al., 2019, The care pathway prior to hospitalisation with acute decompensated heart failure: a comparison between two healthcare systems, Publisher: WILEY, Pages: 442-442, ISSN: 1388-9842
Brahmbhatt D, Evans L, Riley J, et al., 2018, Mapping the processes involved in remote monitoring of heart failure patients at a specialist NHS cardiology clinic, Heart Rhythm Congress
Kernan R, Lennon E, Gallagher J, et al., 2018, Evaluating the patient and carers perspective of the heart failure pathway following an admission with an acute decompensation of heart failure, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 1201-1201, ISSN: 0195-668X
Harjola V-P, Parissis J, Brunner-La Rocca H-P, et al., 2018, Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)., Eur J Heart Fail, Vol: 20, Pages: 1081-1099
This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.
Mc Cambridge J, Keane C, Walshe M, et al., 2018, Inpatient management of acute decompensated heart failure (ADHF) under general medical teams remains suboptimal despite specialist input, Publisher: WILEY, Pages: 121-121, ISSN: 1388-9842
Kernan RR, Lennon E, Gallagher J, et al., 2018, Evaluating the patient and carers perspective of the heart failure pathway following an admission with an acute decompensation of heart failure, Publisher: WILEY, Pages: 304-304, ISSN: 1388-9842
Seferović PM, Petrie MC, Filippatos GS, et al., 2018, Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology., Eur J Heart Fail, Vol: 20, Pages: 853-872
The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium-glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.
Lucas R, FangWang S, Riley J, et al., 2018, Patient experience in clinical trials: results of a survey, European Journal of Heart Failure, Vol: 20, Pages: 612-614, ISSN: 1388-9842
Corra U, Agostoni PG, Anker SD, et al., 2018, Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 20, Pages: 3-15, ISSN: 1388-9842
Lennon E, Kernan R, Gallagher J, et al., 2017, A STUDY TO EVALUATE THE PHARMACIST'S PERSPECTIVE OF THE HEART FAILURE PATIENT PATHWAY, Publisher: SPRINGER LONDON LTD, Pages: S476-S477, ISSN: 0021-1265
Kernan R, Lennon E, Gallagher J, et al., 2017, "EVALUATING THE PATIENT'S PERSPECTIVE OF THE HEART FAILURE PATHAY FOLLOWING AND ADMISSION WITH AN ACUTE DECOMPENSATION OF HEART FAILURE", Publisher: SPRINGER LONDON LTD, Pages: S478-S478, ISSN: 0021-1265
Riley JP, 2017, Patient information websites: how do we assess their usefulness?, Eur J Heart Fail, Vol: 19, Pages: 1455-1456
Mc Cambridge J, Keane C, Walshe M, et al., 2017, Missed opportunity to minimise risk of admission with acute decompensated heart failure (ADHF) during pre-hospital phase of care, Publisher: WILEY, Pages: 522-522, ISSN: 1388-9842
Mc Cambridge J, Keane C, Walshe M, et al., 2017, Twenty percent of patients with acute decompensated heart failure (ADHF) do not receive appropriate treatment in the emergency department (ED), Publisher: WILEY, Pages: 385-385, ISSN: 1388-9842
Riley J, Keane C, Walshe M, et al., 2017, The patient view of hospitalisation with acute heart failure. Results from a qualitative study of the acute heart failure pathway., Publisher: WILEY, Pages: 207-207, ISSN: 1388-9842
Ponikowski ADGDTP, Voors AA, Anker SD, et al., 2016, 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure, Revista Espanola de Cardiologia, Vol: 69, Pages: 1167.-1167., ISSN: 0300-8932
Ponikowski P, Voors AA, Anker SD, et al., 2016, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, European Heart Journal, Vol: 37, Pages: 2129-2200, ISSN: 1522-9645
Keane C, Riley JP, McDonald K, et al., 2016, HOSPITALISATION WITH ACUTE HEART FAILURE: THE PATIENT'S VIEW: RESULTS FROM A QUALITATIVE STUDY OF THE ACUTE HEART FAILURE PATHWAY, Annual Scientific Meeting and AGM of the Irish-Cardiac-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A9-A10, ISSN: 1355-6037
Riley JP, Astin F, Crespo-Leiro MG, et al., 2016, Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum, European Journal of Heart Failure, Vol: 18, Pages: 736-743, ISSN: 1879-0844
Recent advances in care and management of heart failure have improved outcome, largely as a result of the developing evidence basis for medications, implantable devices and the organization of heart failure follow-up. Such developments have also increased the complexity of delivering and coordinating care. This has led to a change to the way in which heart failure services are organized and to the traditional role of the heart failure nurse. Nurses in many countries now provide a range of services that include providing care for patients with acute and with chronic heart failure, working in and across different sectors of care (inpatient, outpatient, community care, the home and remotely), organising care services around the face-to-face and the remote collection of patient data, and liaising with a wide variety of health-care providers and professionals. To support such advances the nurse requires a skill set that goes beyond that of their initial education and training. The range of nurses' roles across Europe is varied. So too is the nature of their educational preparation. This heart failure nurse curriculum aims to provide a framework for use in countries of the European Society of Cardiology. Its modular approach enables the key knowledge, skills, and behaviours for the nurse working in different care settings to be outlined and so facilitate nursing staff to play a fuller role within the heart failure team.
Ponikowski P, Voors AA, Anker SD, et al., 2016, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC., European Journal of Heart Failure, ISSN: 1879-0844
Demir S, Ozer Z, Riley J, 2016, Health status in patients with advanced heart failure: the role of illness uncertainty, Publisher: SAGE PUBLICATIONS LTD, Pages: S22-S22, ISSN: 1474-5151
Harjola V-P, Mebazaa A, Celutkiene J, et al., 2016, Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology, European Journal of Heart Failure, Vol: 18, Pages: 226-241, ISSN: 1879-0844
Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.
Chatwin M, Hawkins G, Panicchia L, et al., 2016, Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)., Thorax, Vol: 71, Pages: 305-311, ISSN: 0040-6376
OBJECTIVE: To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease. DESIGN: Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring. PARTICIPANTS: 68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO2) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team. OUTCOME MEASURES: Primary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford). RESULTS: Median (IQR) number of days to first admission showed no difference between the two groups-77 (114) telemonitoring, 77.5 (61) control (p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring. CONCLUSIONS: Telemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients. TRIAL REGISTRATION NUMBER: NCT02180919 (ClinicalTrials.gov).
Riley JP, 2016, What is the role of the heart failure nurse?, Dialogues in Cardiovascular Medicine, Vol: 21, Pages: 27-34, ISSN: 1272-9949
The specialized role of the heart failure nurse rose to prominence during the 1990s. Studies reported benefits in outcomes in patients receiving follow-up care by a multidisciplinary care team and in which nurses were key players. Since then, the nurse's contribution throughout the journey of the heart failure patient has become widely recognized. In many countries, heart failure nurses are now establishing their role in optimizing outcomes during admission for acute heart failure, routine follow-up and monitoring, and at the end of life. Recent interest in service development for the prevention of heart failure opens up newer avenues for nurses. This paper considers the contribution of the nurse to an effective heart failure service and discusses the value of a "task sharing" approach to care.
Lokker ME, Gwyther L, Riley JP, et al., 2016, The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center., J Cardiovasc Nurs, Vol: 31, Pages: 313-322
BACKGROUND: Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. OBJECTIVE: The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. METHODS: Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. RESULTS: A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). CONCLUSIONS: Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high l
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