Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (11 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2012)

Background: As the final stage of many types of heart disease, heart failure (HF) is a prevalent chronic condition and a costly public health issue. Patients with this highly symptomatic syndrome experience shortness of breath, fatigue, edema, and orthopnea. Mortality in HF is high and functional status is low.

Aims: This study aimed to examine function and symptoms in hospitalized HF patients and determine whether function and/or symptoms predicted cardiac event-free survival within 90 days after discharge. Cardiac events were defined as cardiac rehospitalization, heart transplantation, or death.

Methods: A convenience sample of 32 inpatients with primary or secondary HF diagnoses were enrolled. Symptoms were assessed with yes/no questions at two points in time during hospitalization and function was determined with tools including NYHA Classification and the Katz Index of Activities of Daily Living (ADLs), as well as by the direct performance measure of Short Physical Performance Battery (SPPB). Survival was analyzed via univariate Cox proportional-hazards regression with time to first post-discharge cardiac event as the outcome variable.

Results: Mean age was 58.2 ±13.6 years. Patient ADL function was nearly independent (5.6±1.1) while mean SPPB showed moderate functional limitation (6.4±3.1). All patients reported at least one symptom at the study outset. Within 90 days, 40.6% patients had a cardiac event. Results showed that each increase in NYHA Classification assessed 1.0 days (median) before discharge was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting shortness of breath 1.0 days (median) before discharge had a 4.0-fold greater risk of cardiac events (95% CI 1.2-13.2). Risk of cardiac events was 9.7 times higher among patients reporting fatigue at this time (95% CI 1.2-75.1) and 12.8 times higher among those reporting orthopnea (95% CI 1.7-99.7).

Conclusion: Quick, simple assessments of function and symptoms that can easily be done at the bedside by physicians or nurses may be a meaningful way to predict short-term cardiac outcomes in hospitalized HF patients.

    Cover page: Simple Measures of Function and Symptoms in Hospitalized Heart Failure Patients Predict Short-Term Cardiac Event-Free Survival
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2012)

    Background

    Heart failure (HF) is a terrible and costly disease with high morbidity and mortality rates. However, patients who die from heart failure are often not prepared for their own death, and physicians are unable to assist them by predicting when they might die. Previous studies have indicated that predicting mortality is challenging, time-consuming and often inaccurate. The current study is novel because it examines short-term mortality after hospital discharge in patients with HF using easily accessible clinical characteristics including previous medical history, mental status and functional status.

    Aim

    In this prospective, cohort study we examined the patient characteristics of 386 patients with HF at an academic urban medical center, to identify patients at risk for dying within 30 and 90 days after hospital discharge.

    Methods and Results

    Using multiple logistic regression, patients with preserved systolic function (p<.04 ) and with no history of coronary artery disease (p<.05) were at high risk of death within 30 days after discharge. Consultation with Palliative Care services was the most powerful predictor of mortality at 30 and 90 days after discharge. No clinical or demographic variables correlated highly with Palliative Care consultations.

    Conclusions

    Patients who received consultations from Palliative Care services were the most likely to die at 30 and 90 days after hospital discharge. Clinicians accurately identify patients with HF who are at highest risk of dying in the near term using non-quantifiable attributes.

      Cover page: Palliative Care as a Predictor of Mortality in Heart Failure Patients
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2023)
      BACKGROUND: Heart failure (HF) prevalence has risen for more than a decade. Effective patient and family education strategies for HF are needed on a global scale. One widely used method of education is the teach-back method, where learners are provided information, then their understanding assessed by teaching it back to the educator. PURPOSE: This state-of-the-art review article seeks to examine the evidence focusing on the teach-back method of patient education and patient outcomes. Specifically, this article describes (1) the teach-back process, (2) teach-backs effect on patient outcomes, (3) teach-back in the context of family care partners, and (4) recommendations for future research and practice. CONCLUSIONS: Study investigators report the use of teach-back, but few describe how teach-back was utilized. Study designs vary widely, with few having a comparison group, making conclusions across studies challenging. The effect of teach-back on patient outcomes is mixed. Some studies showed fewer HF readmissions after education using teach-back, but different times of measurement obscure understanding of longitudinal effects. Heart failure knowledge improved across most studies after teach-back interventions; however, results related to HF self-care were mixed. Despite family care partner involvement in several studies, how they were included in teach-back or the associated effects are unclear. CLINICAL IMPLICATIONS: Future clinical trials that evaluate the effect of teach-back education on patient outcomes, such as short- and long-term readmission rates, biomarkers, and psychological measures, are needed, as patient education is the foundation for self-care and health-related behaviors.
        Cover page: A State-of-the-Art Review of Teach-Back for Patients and Families With Heart Failure: How Far Have We Come?
        • Thesis
        • Peer Reviewed
        UC San Francisco Electronic Theses and Dissertations (2014)

        The Effect of Hypovitaminosis D on Risk for Cardiovascular Disease

        Patricia G. Weyland, MS, RN, FNP-BC, CDE, PhD (c)

        Abstract

        Background: Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus.

        Objective: This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk.

        Method: We evaluated journal articles in light of Hill's criteria for causality in a biological system.

        Results: The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer.

        Conclusion: All relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor.

          Cover page: The Evidence for Hypovitaminosis D as a Cause of Cardiovascular Disease
          • Thesis
          • Peer Reviewed
          UC San Francisco Electronic Theses and Dissertations (2011)

          Background: Heart failure (HF) is a chronic and costly condition that affects approximately 5.8 million people in the United States with an additional 670,000 diagnosed each year. With a 30-day hospital readmission rate of 21%, the importance of determining effective means of preventing readmissions is imperative. Despite published guidelines emphasizing the importance of education in preventing readmissions, the most effective means of educating hospitalized patients with HF about their self-care remains unknown.

          Objective: The objective of this study was to determine if hospitalized HF patients educated with the teach-back method retain self-care educational information and whether it is associated with fewer hospital readmissions.

          Methods: A prospective cohort study design was utilized and included 276 patients hospitalized with HF over a 13-month period. Patients were educated and evaluated using the teach-back method as part of usual care. Data were collected related to their ability to recall educational information while hospitalized and during follow-up approximately seven days after hospital discharge. Readmissions were confirmed through follow-up phone calls and review of electronic medical records.

          Results: Patients correctly answered three out of four or 75% of self-care teach-back questions 84.4% of the time while hospitalized and 77.1% of the time during follow-up phone call. More time spent teaching was significantly associated with correctly answered questions (p<0.001). Patients answering teach-back questions correctly while hospitalized and during follow-up had non-significant (p=0.775 and p=0.609) reductions in all-cause 30-day hospital readmission rates but a trend toward significance (p=0.15) was found in patients who had readmissions for HF.

          Conclusions: The teach-back method is an effective method and tool to assess learning in hospitalized HF patients. Patients whose education is over a longer period retain significantly more information than those with briefer teaching. Correctly answering HF specific teach-back questions is not associated with reductions in 30-day hospital readmission rates. Future studies that include patients randomized to receive usual care or teach-back education to compare readmissions, deaths, and knowledge acquisition would provide an educational comparison between the groups.

            Cover page: Inpatient Education of Heart Failure Patients: Do Patients Retain Knowledge and Does it Help in Preventing Readmissions?
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2014)
            Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2-13.2; 1.2-75.1; 1.7-99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.
              Cover page: Simple Measures of Function and Symptoms in Hospitalized Heart Failure Patients Predict Short-Term Cardiac Event-Free Survival
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2014)

              Background

              Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC).

              Methods

              Project Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back.

              Results

              Participants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC.

              Conclusion

              The intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF.
                Cover page: A Culturally Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart Failure: A Pilot Randomized Controlled Trial
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2015)
                BACKGROUND: The objective of this study was to evaluate the effect of a disease management intervention on rehospitalization rates in hospitalized heart failure (HF) patients. METHODS: Patients treated with the TEACH-HF intervention that included Teaching and Education, prompt follow-up Appointments, Consultation for support services, and Home follow-up phone calls (TEACH-HF) from January 2010 to January 2012 constituted the intervention group (n = 548). Patients treated from January 2007 to January 2008 constituted the usual care group (n = 485). RESULTS: Group baseline characteristics were similar with 30-day readmission rates significantly different (19% usual care vs. 12% for the intervention respectively (P = 0.003)). Patients in the usual care group were 1.5 times more likely to be hospitalized (95% CI: 1.2 - 1.9; P = 0.001) compared to the intervention group. A savings of 641 bed days with potential revenue of $640,000 occurred after TEACH-HF. CONCLUSIONS: The TEACH-HF intervention was associated with significantly fewer hospital readmissions and savings in bed days.
                  Cover page: A Strategy to Reduce Heart Failure Readmissions and Inpatient Costs.
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2024)
                  INTRODUCTION: Patients experience high symptom burden during critical care hospitalization and mechanical ventilation. Medications are of limited effectiveness and are associated with increased morbidity such as delirium and long-term cognitive and psychological impairments. Music-based interventions have been used for pain and anxiety management in critical care but remain understudied in terms of music selection and range of symptoms. This study aimed to describe the ways in which a diverse sample of critically ill adults used personalized music listening and their perceptions of the effects of music listening on symptom experience after critical injury. METHODS: Semi-structured interviews (N = 14) of adult patients, families and friends who were provided with personalized music in an urban, academic, neurotrauma intensive care unit were collected and analyzed with grounded theory methodology. Open coding of transcripts, field notes and memos was performed using Atlas.ti.9.1. Recruitment and data collection were deemed complete once thematic saturation was achieved. RESULTS: We identified 6 uses of personalized music listening in critical care: 1) Restoring consciousness; 2) Maintaining cognition; 3) Humanizing the hospital experience; 4) Providing a source of connection; 5) Improving psychological wellbeing; and 6) Resolving the problems of silence. Patients used music to address psychological experiences of loneliness, fear, confusion, and loss of control. Personalized music helped patients maintain their identity and process their trauma. Additional benefits of music included experiencing pleasure, hope, resilience, and feelings of normalcy. Patients disliked being sedated and used music to wake up. Findings also highlighted the problem of the lack of meaningful stimulation in critical care. CONCLUSION: Critically injured adults used personalized music to achieve psychological and cognitive homeostasis during critical care hospitalization. These results can inform future studies designed to explore the use of music-based interventions to prevent and treat the cognitive and emotional morbidity of critical care.
                    Cover page: Personalized music for cognitive and psychological symptom management during mechanical ventilation in critical care: A qualitative analysis.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2017)

                    Background

                    Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use.

                    Methods and results

                    This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model.

                    Conclusions

                    In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes.

                    Clinical trial registration

                    URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.
                      Cover page: Symptom Diary Use and Improved Survival for Patients With Heart Failure
                      Top