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  • 1.
    Andreae, Christina
    Linköpings universitet, Medicinska fakulteten, Sweden.
    Appetite in patients with heart failure: Assessment, prevalence and related factors2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Appetite is an important component in nutrition for maintaining the food intake needed by the body. Decreased appetite is a common clinical problem in patients with heart failure. It has a negative impact on food intake and possibly on malnutrition and health outcomes. There is a lack of evidence on how to assess appetite in heart failure. Furthermore, there are knowledge gaps about factors associated with appetite and which role appetite plays for health status in heart failure.   Aim: The overall aim of the thesis was to investigate appetite in patients with heart failure. Four studies were conducted with the goal to evaluate the psychometric properties of the Council on Nutrition Appetite Questionnaire (CNAQ) (I) and to explore the prevalence of decreased appetite and related factors associated with appetite in patients with heart failure (II-IV).   Methods: A multicenter study was conducted in three outpatient heart failure clinics in the center of Sweden during 2009-2012. Data were collected through a baseline measurement (I-IV) and an 18-month follow-up (IV). The first study was a psychometric evaluation study (I), while the other studies had an observational cross-sectional design (II-III) and an observational prospective design (IV). One hundred and eighty-six patients diagnosed with heart failure and experiencing heart failure symptoms participated at baseline. At the 18-month follow-up study (IV), one hundred and sixteen participants from the baseline participated. Data were collected from medical records (pharmacological treatment, comorbidity, left ventricle ejection fraction, time of diagnosis), self-reported questionnaires (demographic background data, appetite, symptoms of depression, health status, sleep, self-reported physical activity), objective measurements (anthropometric assessment of body size, blood samples, six minutes’ walk test, and physical activity measured with an actigraph) and clinical assessment (New York Heart Association (NYHA) functional classification, and cognitive assessment). The main outcome variables included appetite (I, II and IV) and health status (III). Descriptive and inferential statistics were used in the studies (I-IV).   Results: The majority of the participants had moderate heart failure symptoms, i.e., NYHA class II (n=114, 61%). Most of the participants were men (n=130, 70%). Mean age was 70,7 years, (SD=11,0), and mean BMI was 28.7 (SD=5.3). The CNAQ showed acceptable psychometric properties for assessing appetite in patients with heart failure (I). This thesis shows that 38% of the participants experienced an appetite level that put them at risk of weight loss (I). It was shown that factors such as biological, medical, psychological (II) and physical activity/exercise capacity (IV) are associated with appetite. Also, appetite was associated with impaired health status. However, this association was found to be moderated by symptoms of depression (III). Neither appetite nor physical activity changed during the 18-month follow-up (IV).   Conclusion: Decreased appetite is a serious phenomenon that needs attention in the care of patients with heart failure. Health care professionals can now use a validated and simple appetite instrument to assess appetite in heart failure. In addition, attention should be paid to elderly patients and those who have symptoms of depression, sleep problems, impaired cognitive function and impaired physical activity, as well as to patients on suboptimal medical treatment. Higher appetite was shown to contribute to a better health status, but this was only evident in patients without symptoms of depression. Therefore, special attention should be paid to symptoms of depression, as this risk factor affected the association between appetite and health status. This thesis enhances the understanding of the magnitude of the problem with decreased appetite in heart failure both in numbers and factors. New priorities in nutrition care and new ideas can be established, both in practice and in research, in order to improve a nutrition care that is vital for patients with heart failure.  

  • 2.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden..
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Res Sect, Sweden..
    Evangelista, Lorraine
    Univ Calif Irvine, CA USA..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Univ Calif Irvine, CA USA..
    The relationship between physical activity and appetite in patients with heart failure: A prospective observational study2019In: European Journal of Cardiovascular Nursing, Vol. 18, no 5, p. 410-417Article in journal (Refereed)
    Abstract [en]

    Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II-IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps (p = 0.019) and the six-minute walk test (p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps (p = 0.001) and metabolic equivalent daily averages (p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.

  • 3.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Franzén Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Evangelista, Lorraine
    Sweden Lorraine Evangelista, RN, Prof, University of California, Irvine, CA, USA..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    The associations between physical activity and appetite in patients with heart failure: a prospective observational study2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Physical activity and appetite both play a crucial role for health outcomes and quality of life in patients with heart failure. Nevertheless, both of these key functions are frequently decreased in patients with heart failure. Whilst most attention focuses independently on the physical activity levels, the associations with appetite has been insufficiently investigated. The aim was therefore to explore the associations between physical activity and appetite in community dwelling heart failure patients. Methods: This prospective observational study consisted of 186 patients with symptomatic heart failure of whom 56 (30%) were women and 130 (70%) were men. Mean age was 70.7 (SD=11 years), the majority had NYHA-class II, 114 (63%). Objective and subjective methods were used to measure physical activity include a wearable actigraph (SenceWear) for 4 days and six minutes’ walk test. The actigraph calculate total energy expenditure, active energy expenditure, number of steps and METs daily average index. Patients also stated their physical activity level on a numeric rating scale. A self-reported questionnaire, the Council on Nutrition Appetite Questionnaire was used to assess appetite. Simple linear regression was conducted to explore the associations between physical activity and appetite at baseline and at 18-month follow-up. Results: In general, the levels of physical activity in this sample was low and appetite was poor. There was a significant association between objective physical activity measures and appetite at baseline ranging between (p=<0.001-0.041). The number of steps and walking distance had the strongest association, each explaining 6% and 7% of the total variance in appetite. At the 18-month follow-up, all objective and subjective physical activity measures were associated with appetite (p=0.001-0.035) with the number of steps being most strongly associated (p=<0.001) explaining 14% of the total variation in appetite. Conclusions: Patients with heart failure who are more physically active experiences better appetite. These findings underscore the importance of placing greater attention on both physical activity and appetite in clinical practice as these factors has implications for patient’s health outcomes. Further longitudinally oriented studies are needed to determine whether there is a causal relationship between physical activity and appetite in heart failure populations. Keywords: Appetite, Heart Failure, Physical activity

  • 4.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Franzén Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    The assosciation between depressive symptoms and appetite among patients with chronic heart failure2012Conference paper (Refereed)
  • 5.
    Andreae, Christina
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University , Linköping , Sweden;Centre for Clinical Research Sörmland, Uppsala University , Eskilstuna , Sweden.
    Lennie, Terry A
    College of Nursing, University of Kentucky, Lexington, USA.
    Chung, Misook L
    College of Nursing, University of Kentucky, Lexington, USA.
    Diet variety mediates the relationship between appetite and micronutrient intake in patients with heart failure2022In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 00, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Aims Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease the desire to eat a varied dietleading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrientintake have not been investigated in patients with heart failure (HF). The purpose of the study was to determine whether therelationship between appetite and micronutrient insufficiency was mediated through diet variety.

    Methodsand results A total of 238 patients with HF, mean age 61 ± 12.1; 68% male, and 45% NYHA class III/IV were included in this secondaryanalysis. Data collection consisted of a 4-day food diary and self-reported appetite on a 10-point visual analogue scale.Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet.Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for cov-ariates age, gender, NYHA class, and body mass index showed that diet variety mediated the relationship between appetiteand micronutrient insufficiencies [indirect effect = −0.0828, 95% confidence interval (CI): −0.1585 to −0.0150]. There was nodirect effect of appetite on micronutrient insufficiency (c ́ = −0.1802; 95% CI = −0.3715 to.0111).

    Conclusions Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake inpatients with HF. More research is needed to validate these associations in patients with HF.

  • 6.
    Andreae, Christina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden..
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping..
    Chung, Misook L
    College of Nursing, University of Kentucky, Lexington, USA..
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery..
    Årestedt, Kristofer
    Linnaeus University, Kalmar, Kalmar County Hospital, Kalmar Sweden..
    Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure2018In: Journal of Cardiovascular Nursing, Vol. 33, no 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status. OBJECTIVE: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association. METHODS: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status. RESULTS: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001). CONCLUSIONS: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

  • 7.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Chung, Misook
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA..
    Lennie, Terry
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Depressive symptoms as a moderator and mediator of the relationship between physical activity, appetite and perceived health among patients with heart failure2015Conference paper (Other academic)
    Abstract [en]

    Purpose: Depressive symptoms have been shown to directly influence perceived health among persons with heart failure (HF). Decreased physical activity and appetite may also be predictive of poor perceived health.The purposes of this study were to determine whether appetite and physical activity predicted perceived health, and to determine whether depressive symptoms mediated or moderated their relationship with perceived health. Methods: A total of 184 patients with mild to severe HF were included. Appetite, depressive symptoms and perceived health were measured by self-report questionnaires (Council on Nutrition Appetite Questionnaire, Patient Health Questionnaire and EuroQol 5D index). Physical activity was measured by SenceWearTM for 6 days. A separate series of multiple linear regression analyses were run to determine whether depressive symptoms mediated or moderated the relationship between physical activity and perceived health, and between appetite and perceived health. Results: Higher physical activity predicted better perceived health (ß=0.202, p=.006) but the strength of the association decreased (ß=0.13, p=.048) when depressive symptoms were included in the model. There was a significant mediation effect for depressive symptoms on perceived health (sobel=2.03, p=.041) (Fig 1). Appetite was a significant predictor of perceived health. Examination of this association among those with and without depressive symptoms, however showed positive association between appetite and perceived health remained only for patients without depressive symptoms demonstrating a moderating effect (p<.001) (Fig 2). Conclusion: Identifying and treating depression simultaneously while addressing appetite and physical activity may be key to improving perceived health among persons with HF.

  • 8.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Hjelm, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Factors influencing nutritional status in chronic heart failure2011Conference paper (Refereed)
  • 9.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Sawatzky, Richard
    Trinity Western University, Canada; Providence Health Care Research Institute, Canada..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure2015In: Journal of Cardiac Failure, Vol. 21, no 12, p. 954-958Article in journal (Refereed)
    Abstract [en]

    Background: Decreased appetite in heart failure (HF) may lead to undemutrition which could negatively influence prognosis. Appetite is a complex clinical issue that is often best measured with the use of self-report instruments. However, there is a lack of self-rated appetite instruments. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are validated instruments developed primarily for elderly people. Yet, the psychometric properties have not been evaluated in HF populations. The aim of the present study was to evaluate the psychometric properties of CNAQ and SNAQ in patients with HE Methods and Results: A total of 186 outpatients with reduced ejection fraction and New York Heart Association (NYHA) functional classifications II-IV were included (median age 72 y; 70% men). Data were collected with the use of a questionnaire that included the CNAQ and SNAQ. The psychometric evaluation included data quality, factor structure, construct validity, known-group validity, and internal consistency. Unidimensionality was supported by means of parallel analysis and confirmatory factor analyses (CFAs). The CFA results indicated sufficient model fit. Both construct validity and known-group validity were supported. Internal consistency reliability was acceptable, with ordinal coefficient alpha estimates of 0.82 for CNAQ and 0.77 for SNAQ. Conclusions: CNAQ and SNAQ demonstrated sound psychometric properties and can be used to measure appetite in patients with HF.

  • 10.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Caring for appetite among patients with chronic heart failure - the extent of appetite and associated factors in outpatient clinic settings2013Conference paper (Refereed)
  • 11.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Factors associated with appetite among patients with symptomatic heart failure2014Conference paper (Refereed)
  • 12.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Årestedt, Kristofer
    Institutionen för hälso- och vårdvetenskap, Linnéuniversitetet, Kalmar, Sweden..
    Predictors for appetite among patients with chronic heart failure2013Conference paper (Refereed)
  • 13.
    Andreae, Christina
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Uppsala University, Sweden..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Linnaeus University, Sweden..
    Prevalence and associated factors for decreased appetite among patients with stable heart failure2016In: Journal of Clinical Nursing, Vol. 25, no 11-12, p. 1703-1712Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. DesignObservational, cross-sectional study. MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

  • 14.
    Andreae, Christina
    et al.
    Uppsala universitet, Centrum för klinisk forskning i Sörmland (CKFD), Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden .
    Tingström, Pia
    Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Nilsson, Staffan
    Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden.;Primary Hlth Care Ctr Vikbolandet, Vikbolandet, Sweden..
    Jaarsma, Tiny
    Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden.;Univ Med Ctr Utrecht, Julius Ctr, Utrecht, Netherlands..
    Karlsson, Nadine
    Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Köhler, Anita Kärner
    Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting?: A long-term prospective, randomised, parallel single randomised trial (COR-PRIM)2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 2, article id e065230Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).

    Design: A prospective, randomised, parallel single centre trial.

    Settings: Primary care settings in Sweden.

    Participants: 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.

    Intervention: Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.

    Primary and secondary outcomes: Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.

    Results: The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.

    Conclusion: One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.

  • 15.
    Andreae, Christina
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    van der Wal, Martje H. L.
    Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands..
    van Veldhuisen, Dirk J.
    Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands..
    Yang, Bei
    Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden..
    Strömberg, Anna
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden..
    Jaarsma, Tiny
    Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands..
    Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life2021In: Journal of Cardiovascular Nursing, Vol. 36, no 6, p. 539-545Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital. OBJECTIVE: The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite. METHODS: Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life. RESULTS: A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates. CONCLUSIONS: Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

  • 16.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Evangelista, L.
    University of California at Irvine, Program in Nursing Science, Irvine, United States of America..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    The relationship between physical activity and appetite in heart failure – A cross sectional study2017In: European Journal of Heart Failure, Vol. 19, no S1, p. 135-135, article id P533Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity and appetite are important for maintaining physical health. Yet, sedentary lifestyle and poor appetite are frequently observed in the heart failure (HF) population. However, the relationships between these phenomena are not yet clearly understood.  Purpose: To investigate the relationship between physical activity and appetite in patients with stable HF. Methods: In this cross sectional study, a consecutive sample of 186 patients with confirmed HF with NYHA class II-IV (median age 72y, 70% men, NYHA class II 61%) participated in the study. Patients were recruited from three HF outpatient clinics in central Sweden. Physical activity measures included total energy expenditure (TEE), active energy expenditure (AEE) above 3 METs, average daily METs and number of steps per day during four days using a validated multi-sensor wearable armband (SenseWear®, Body Monitoring System). Patients also self-reported their physical activity on a ten point numeric rating scale, from extremely low (1) to extremely high (10). Self-reported appetite was measured by Council on Nutrition Appetite Questionnaire (CNAQ), an 8-item instrument (score range 8-40) where CNAQ ≤28 indicate poor appetite. Associations between physical activity and appetite were analyzed by Spearman correlation while differences in physical activity between poor vs good appetite were analyzed using Mann Whitney U test. Results: There was a significant positive relationship between physical activity and appetite assessed by TEE (rs=.184, p=.012), AEE of moderate intensity >3 METs (rs=.262, p=.000), number of steps (rs=.292, p=.000), average METs intensity (rs=.249, p=.001), and self- reported physical activity (rs=.191, p =.009). Levels of physical activity in the low appetite group differed significantly from the group with better appetite, this was seen in all physical dimensions, TEE (U=3225, z=-2.26, p=.024), AEE (U=2902, z=-3.178, p=.001), number of steps (U=2706, z=-3.734, p=.000), average METs intensity (U=3128, z=-2.541, p=.011), levels of self-reported physical activity (U=3185, z=-2.47, p=.013). Conclusion: This study shows that physical activity is associated with appetite and that levels of physical activity differs between patients with poor and good appetite. These findings has implications for both research and practice and underlines the importance in monitoring both physical activity and appetite. Further research is needed to determine whether interventions targeting physical activity also improve appetite and vice versa in the HF population.

  • 17.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Evangelista, Lorraine L
    Sue and Bill Gross School of Nursing, University of California, Irvine, CA,..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Physical activity and appetite in patients with stable heart failure – A cross sectional study2017Conference paper (Refereed)
  • 18.
    Andreae, Christina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten..
    Evangelista, Lorraine
    Sue and Bill Gross School of Nursing, University of California, Irvine, CA..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Sedentary lifestyle is associated with poor appetite in patients with heart failure.2017Conference paper (Refereed)
  • 19.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund Gustin, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. The Arctic University of Norway Narvik Norway.
    Toivanen, Susanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jaarsma, Tiny
    Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden;Julius Center University Medical Center Utrecht Utrecht Netherlands.
    Andreae, Christina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden.
    Struggling in the dehumanized world of COVID—An exploratory mixed‐methods study of frontline healthcare workers' experiences2024In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore healthcare workers' experiences of the changed caring reality during the COVID-19 pandemic in Sweden.DesignAn online fully mixed-methods design.MethodsA web-based self-reported questionnaire with fixed and open-ended answers collected data from March to April 2021, analysed in three steps. First, free-text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta-inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting.

    Results

    Meta-inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality, comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post-traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy.

    Conclusions

    Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID-19 pandemic and to prevent mental health illness in future crisis.

  • 20.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Toivanen, Susanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Andreae, Christina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jaarsma, Tiny
    Struggling with frightening experiences in a transformed reality: A mixed methods study of healthcare workers’ experiences during the pandemic.2023Conference paper (Other academic)
    Abstract [en]

    Background: The COVID-19 pandemic continues to impact health care workers’ (HCWs’) mental health. Research show that psychological distress and hard challenges abide with strong commitment to contribute. Yet, in-depth understanding of HCWs’ experiences of the changed caring reality during the pandemic is missing. Mixed methods research (MMR) accommodates several features apart from employing either quantitative or qualitative methods. This presentation focuses on examples from the 13-step mixed method by Leech and Onwuegbuzie.

    Methods: 97 HCWs in one hard-hit region in Sweden answered a web-based questionnaire measuring symptoms of stress (using DSM-5 criteria for post-traumatic stress syndrome, PTSD) in relation to perceived sense of coherence (SOC-scale) and self-compassion (SCS) as well as HCWs’ experiences. First, qualitative data (experiences of the pandemic) was analyzed by qualitative content analysis, then quantitative data (associations between PTSD and SOC/SCS) were analyzed with linear regression adjusted for covariates. Thirdly, a synthesis, the meta-inference of qualitative and quantitative data, explained a new comprehensive understanding. 

    Results: By analyzing the categories and subcategories from the qualitative analysis in relation to symtoms of stress and SOC/SCS, a synthesis emerged. This was undertaken by merging and comparing the findings and discussing the new comprehensive understanding. Finally, to fully outline the mixed methods approach, qualitative and quantitative data were synthesized into a new comprehensive whole, a meta inference. 

    Conclusion: This study moves away from dichotomic traditions between qualitative or quantitative approaches. By broadening the methodological departure this study may provide a new comprehensive understanding and contribute to enhance quality in MMR. 

  • 21.
    Franzén Årestedt, Kristofer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Andreae, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US..
    Initial psychometric evaluation of the council of nutrition apetite queestionnaire (QNAC)2012Conference paper (Refereed)
  • 22.
    Hendriks, Jeroen
    et al.
    Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia..
    Andreae, Christina
    Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden..
    Ågren, Susanna
    Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden..
    Eriksson, Helene
    Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden..
    Hjelm, Carina
    Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden..
    Walfridsson, Ulla
    Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden..
    Ski, Chantal F.
    School of Nursing and Midwifery, Queen's University Belfast, UK..
    Thyl’en, Ingela
    Department of Cardiology, Linköping University, Sweden..
    Jaarsma, Tiny
    Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden..
    Cardiac disease and stroke: Practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied ProfessionsIn: European Journal of Cardiovascular NursingArticle in journal (Refereed)
    Abstract [en]

    Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.

  • 23.
    Hjelm, Carina
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science and Department of Cardiothoracic Surgery, Linköping University, Sweden.
    Andreae, Christina
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden and Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    Isaksson, Rose-Marie
    Department of Medical and Health Sciences, Division of Nursing Science and Department of Cardiothoracic Surgery, Linköping University, Sweden.
    From insecurity to perceived control over the heart failure disease: A qualitative analysis2019In: Nursing & Care Open Access Journal, Vol. 6, no 3, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The objective in our study was to explore chronic heart failure patients’ perceived control over their heart disease. Background: Higher levels of perceived control over one’s chronic heart disease are associated with lower levels of psychological distress and a higher quality of life. Design: The study has an explorative and descriptive design using a directed manifest qualitative content analysis according to Marring. Methods: The analysis was based on nine interviews with four men and five women aged between 62-85 years, diagnosed with chronic heart failure. The study followed consolidated criteria for reporting qualitative research (COREQ). Results: Five categories emerged in the analysis, mirroring a step-by-step process. The first step, insecurity, was followed by evaluation, management and adjustment. The patients finally reached a higher level of perceived control over their lives in relation to their heart disease. Conclusions: Most of the patients stated that they could assess and manage symptoms and had adapted to their condition, which increased their level of perceived control. Relevance to clinical practice: These findings suggest that managing symptoms is important for strengthen the patients with chronic heart failure. The findings can help health care professionals in communication with the patient planning for self-care actions.

  • 24.
    Khatib, Rani
    et al.
    Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK..
    Lee, Geraldine A.
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London SE1 8WA, UK..
    Marques-Sule, Elena
    Department of Physiotherapy, University of Valencia, Valencia 46010, Spain..
    Arnesdatter Hopstock, Laila
    Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway..
    O’Donnell, Sharon
    School of nursing and Midfwifery, 24 D'Olier St, University of Dublin, Trinity College, Dublin 2, Ireland..
    Svavarsdóttir, Margrét Hrönn
    School of Health Science, Department of Nursing, University of Akureyri, Solborg V/Nordurslod, 600 Akureyri, Iceland..
    Andreae, Christina
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden..
    Vellone, Ercole
    Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy..
    Goossens, Eva
    Academic Center for Nursing and Midwifery, Departement of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 box 7001, 3000 Leuven, Belgium..
    Strömberg, Anna
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.
    Kjellström, Barbro
    Department of Medicine, Cardiology Unit, Karolinska Institute, 171 77 Stockholm, Sweden.
    Jaarsma, Tiny
    Department of Nursing Science Julius Center, University Medical Center 100, 3584 CG Utrecht, The Netherlands..
    Stewart, Chloe
    Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK..
    Evaluating the extent of patient-centred care in a selection of ESC guidelines2020In: European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 6, p. 55-61Article in journal (Refereed)
    Abstract [en]

    AbstractAims Patient-centred care (PCC) is the cornerstone for healthcare professionals to promote high quality care for patients with cardiovascular conditions. It is defined as ’Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions’. PCC can improve patient outcomes and allow patients and healthcare professionals to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC). Methods and results Using a narrative literature review and expert consensus, the Science Committee within the Association of Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed, with committee members independently evaluating five PCC aspects: patient voice and involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients’ needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared. The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the ’multidisciplinary involvement’ category. Conclusion Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing, or formulating recommendations. Future development of guidelines should ensure better incorporation of patients’ perspective, in particular, and other PCC aspects highlighted in this study.

  • 25.
    Lee, Geraldine
    et al.
    Kings College London, UK..
    Marques, Elena
    University of Valencia, Spain..
    Vellone, Ercole
    University of Rome, Italy..
    Strömberg, Anna
    Linköping University Hospital, Sweden..
    Hopstock, Laila
    The Arctic University of Norway, Tromsø, Norway..
    Tagney, Jenny
    University Hospitals Bristol NHS Foundation Trust, UK..
    Khatib, Rani
    Leeds University, UK..
    O'Donnell, Sharon
    Trinity College Dublin, Ireland..
    Hronn Svavarsdottir, Margret
    University of Akureyri, Iceland..
    Goossens, Eva
    Leuven University, Belgium..
    Andreae, Christina
    Linköping University, Sweden..
    Post-Doctoral Mentorship Award – have you considered applying?2017In: European Journal of Cardiovascular Nursing, Vol. 16, no 8, p. 658-658Article in journal (Refereed)
  • 26.
    Lennie, Terry A
    et al.
    College of Nursing University of Kentucky Lexington KY..
    Andreae, Christina
    Division of Nursing Science Department of Medical and Health Sciences Linköping University Linköping Sweden..
    Rayens, Mary K
    College of Nursing University of Kentucky Lexington KY..
    Song, Eun Kyeung
    Department of Nursing College of Medicine University of Ulsan Korea..
    Dunbar, Sandra B
    Emory University Atlanta GA..
    Pressler, Susan J
    Indiana University Indianapolis IN..
    Heo, Seongkum
    College of Nursing University of Arkansas for Medical Sciences Little Rock AR..
    Kim, JinShil
    Gachon University College of Nursing Incheon Korea..
    Moser, Debra K
    College of Nursing University of Kentucky Lexington KY..
    Micronutrient Deficiency Independently Predicts Time to Event in Patients with Heart Failure2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 7, no 17, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Dietary micronutrient deficiencies have been shown to predict event‐free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event‐free survival, defined as a combined end point of all‐cause hospitalization and death.

  • 27.
    Wleklik, Marta
    et al.
    Department of Clinical Nursing, Wrocław Medical University, Wroclaw, Poland..
    Lisiak, Magdalena
    Department of Clinical Nursing, Wrocław Medical University, Wroclaw, Poland..
    Andreae, Christina
    Division of Nursing Science, Linköping University, Linköping, Sweden..
    Uchmanowicz, Izabella
    Department of Clinical Nursing, Wrocław Medical University, Wroclaw, Poland..
    Psychometric Evaluation Of Appetite Questionnaires In Elderly Polish Patients With Heart Failure2019In: Patient Preference and Adherence, Vol. 13, p. 1751-1759Article in journal (Refereed)
    Abstract [en]

    Purpose: Loss of appetite is caused by multifaceted disorders and affects an average of 40% of patients with heart failure (HF). The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are designed to assess appetite among older adults. We aimed to assess the psychometric properties of both CNAQ and SNAQ questionnaires in elderly Polish patients with HF. Methods: The study sample involved 103 patients aged amp;gt;= 65 years with HF diagnosed according to the New York Heart Association (NYHA) functional classes II-IV. The study was conducted among hospitalized patients with HF. In the study, the Mini Nutritional Assessment (MNA) questionnaire was used to assess the validity of the questionnaire. The evaluation of the following psychometric values was taken into account: data quality and homogeneity, factor structure, construct validity and internal consistency. Results: Parallel analysis confirmed the unidimensional structure of both CNAQ and SNAQ. The adjusted eigenvalues for CNAQ were 3.50 for the first factor and 0.62 for the second factor, and for SNAQ they were 2.2 and 0.31, respectively. For CNAQ, the desired CFA values were obtained after modification (RMSEA amp;lt;0.06, CFI, TLIamp;gt; 0.95), for SNAQ without modification (RMSEA amp;lt;0.06, CFI, TLIamp;gt; 0.95). The correlation between CNAQ and SNAQ and MNA was strong (rs = 0.8 and rs = 0.81, p amp;lt;0.001, respectively). The internal consistency of the CNAQ and SNAQ tools was 0.88 and 0.86, respectively. Conclusion: The CNAQ and SNAQ questionnaires have positive psychometric properties and can be used to evaluate appetite among elderly Polish patients with HF.

  • 28.
    Wleklik, Marta
    et al.
    Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland.
    Uchmanowicz, Izabella
    Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland.
    Jankovska-Polanska, Beata
    Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland.
    Andreae, Christina
    Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland.
    The role of nutritional status in elderly patients with heart failure2017In: The Journal of Nutrition, Health & Aging, Vol. 22, no 5, p. 581-588Article in journal (Refereed)
    Abstract [en]

    Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients’ prognosis.

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