Clinical InvestigationFactors Associated With Patient Delay in Seeking Care After Worsening Symptoms in Heart Failure Patients
Section snippets
Methods
This descriptive cross-sectional study on patient delay is a secondary analysis of COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure). COACH was a randomized, multicenter, controlled study in which 1,023 hospitalized HF patients were included between November 2002 and February 2005 (registered at trialregister.nl, no. NTC98675639).18, 19 Patients were included in the study during an admission for HF (New York Heart Association [NYHA] functional class
Characteristics of the Study Population
A total of 1,023 patients participated in COACH. Of these patients, 112 had a patient delay time of 0 hours and, at the same time, were in NYHA functional class IV at admission and were therefore excluded from analyses. Those patients did not significantly differ in age, gender, and left ventricular ejection fraction (LVEF) from the 911 patients included in this substudy. The mean age of the study population (n = 911) was 71 ± 12 years, and 62% were male. The mean length of HF symptoms was 32 ±
Discussion
Although delay in HF patients was assessed in earlier studies, those studies assessed the time from worsening symptoms to arrival at the hospital. The scope of the present study was on patient delay, reflecting the time from worsening symptoms to actually contacting a health care provider. The most important findings of this study were that a history of MI or stroke was independently associated with short patient delay. We also found that male gender, more HF knowledge, and the presence of
Conclusion and Implications
Patients with a history of a serious, life-threatening event, such as MI or stroke, contacted a health care provider earlier in case of worsening HF symptoms, compared with those without such events. More HF knowledge, male gender, and more HF symptoms were also independently associated with long patient delay in all patients and those with a history of HF. Although these results might suggest a profile of HF patients vulnerable to long delay in seeking care after worsening symptoms, further
Disclosures
None.
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Cited by (31)
Symptom Status Questionnaire – Heart Failure – Brazilian Version: cross-cultural adaptation and content validation
2021, Heart and LungCitation Excerpt :Brazil has similar numbers of HF-related hospitalizations and deaths, with over 880,000 hospitalizations and 98,000 deaths from the disease since 2016.2 In patients with HF, persistent symptoms even after therapeutic optimization are prevalent,3–6 indicate poor prognosis,7 and are common causes for hospitalization.7–10 In addition, HF symptoms are associated with impaired functional capacity and limited performance of activities of daily living11 and are the most important predictors of quality of life,7,12 which is considerably poorer than that of age- and gender-matched elders.13
Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study
2015, Heart and LungCitation Excerpt :Such cognitively impaired patients with HF are 30% more likely to have poor self-care,8–10 medication adherence,11,12 and quality of life.13–15 Additionally, such patients delay seeking medical care for HF symptoms,16–18 and have higher mortality rates.19 Although multiple cognitive intervention studies in older adults have demonstrated improvements in cognition,20,21 there is scant research on interventions to improve cognitive function among patients with HF,22 which could potentially improve self-care.
Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort
2014, International Journal of CardiologyCitation Excerpt :Significantly, as in our previous trials [3,16], group survival curves deviate at the point of application of the pivotal home visit at 7–14 days post-discharge. This phenomenon suggests immediate benefits in terms of detecting and managing residual/de novo clinical instability in a patient population in whom delay to treatment is common [24]. As suggested by the survival data presented in Fig. 1 and Appendix IV, whatever difference home-based management makes initially, it is probably reinforced with further home visits in survivors and persists over the longer-term.
Supported by the Netherlands Heart Foundation (grant 2000Z003).
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