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Adherence to guidelines in patients with chronic heart failure in primary health care
Örebro University, School of Medical Sciences. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.ORCID iD: 0000-0001-6261-6925
Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden.
2017 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 336-343Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.

DESIGN: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.

SETTING: Three primary health care centres in Sweden.

SUBJECTS: Patients with a CHF diagnosis registered in their medical record.

MAIN OUTCOME MEASURES: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9).

RESULTS: The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.

CONCLUSION: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

Place, publisher, year, edition, pages
Taylor & Francis, 2017. Vol. 35, no 4, p. 336-343
Keywords [en]
Guideline adherence; chronic heart failure; primary health care; pharmacological treatment; diagnostic assessment; self-care behaviour
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-63017DOI: 10.1080/02813432.2017.1397253ISI: 000416735200006PubMedID: 29105550Scopus ID: 2-s2.0-85033499303OAI: oai:DiVA.org:oru-63017DiVA, id: diva2:1163509
Note

Funding Agency:

County Council of Värmland, Sweden

Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2024-01-02Bibliographically approved
In thesis
1. Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
Open this publication in new window or tab >>Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this compilation thesis was to explore different aspects of the management of patients with chronic obstructive pulmonary disease (COPD) and heart disease in primary health care: guideline adherence in chronic heart failure (CHF) management (I); comparing patients with COPD and heart failure, and factors associated with the pa-tients’ exercise self-efficacy (II); and the influence of comorbid heart disease in COPD over time (III–IV).

Materials and methods: Cross-sectional data from primary health care: 155 patients with heart failure (I) and 150 with COPD and/or heart failure (II). Longitudinal data from patients with COPD from 2005 through 2012 (III) and 2019 (IV), based on questionnaires, medical records, and national registers.

Results: (I) Over 80% of the heart failure patients had received relevant laboratory tests and echocardiography. Recommended medication was given to most of the patients, but only a few achieved target doses. Contact with a hospital heart failure clinic was associated with better self-care behavior. (II) Patients with COPD or heart failure had similar exercise self-efficacy, symptoms, functional capacity, and health status. Exercise self-efficacy was associated with symptoms, but not with the diag-nosed disease. (III) COPD with comorbid heart disease was associated with a lower health status and higher level of dyspnea but did not accelerate the worsening over time. (IV) Comorbid heart disease was associated with increased hospitalization and mortality, not for respiratory disease, but mainly for cardiovascular and other causes.

Conclusions: Adherence to guidelines for CHF in primary health care is suboptimal, particularly regarding medication target dosage and patient education. It seems more relevant to consider the symptom level than the specific diagnosis when forming self-management groups to increase exercise self-efficacy. In COPD management in primary health care, it is important to recognize and treat heart disease.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 269
Keywords
COPD, chronic heart failure, heart disease, patient outcomes, exercise self-efficacy, comorbidity, primary health care, cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-101233 (URN)9789175294681 (ISBN)
Public defence
2022-11-11, Samlingssalen, Centralsjukhuset i Karlstad, Rosenborgsgatan 9, Karlstad, 13:15 (English)
Opponent
Supervisors
Available from: 2022-09-14 Created: 2022-09-14 Last updated: 2024-01-03Bibliographically approved

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