Abstracts
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Netherlands, we retrospectively reviewed hospital discharge letters for all patients, admitted on the CCU in the month March between 1985 and 2007 (every second year). Relevant information on diagnosis and therapeutic intervention of 1116 individual patients was used for this overview. Results: The mean age (SD) was 60 (±13) years and showed no changes over time. Additionally, the length of stay in the CCU (3 days) remained stable. The length of total hospital stay gradually decreased from 12 to 6 days. The number of patients with stable angina decreased from 25% to b5%, while patients with acute coronary syndromes showed a steep increase. In the first decade we observed an increase in invasive hemodynamic monitoring (from 16% to 23%), followed by a decrease to 8% over the last 4 years. The use of an Intra-Aortic Balloon Pump (IABP) increased from 2% to 8%, and mechanical ventilation from 5% to 17%. Since the introduction of the Coolgard® in 2004 on the CCU, this intervention was used in 5% of all admissions. Furthermore, we observed the rice and fall of thrombolytic therapy in patients with acute myocardial infarction, and from 1995 onwards, a steep increase in primary Percutaneous Coronary Interventions (0% to 84%). Mortality varied over the last two decades between 6% and 10%. Discussion/conclusion: The overview clearly demonstrates that analyzing patient discharge letters over a certain time period provides interesting information on changes in cardiovascular care. Furthermore, we did not only show the successful implementation of invasive techniques like an IABP, respirator and coolgard, but also the rise and fall of thrombolitic therapy. It is important to note that these developments have consequences for the educational level of nurses, including continues nursing education.
doi:10.1016/j.ejcnurse.2008.01.086
increased collaboration between the specialized heart-failure nurse and the general practitioner resulted in state-of-the-art medication treatment. We also examined the congruence between cardiologists' pharmacological prescriptions at discharge and medication treatment of the general practitioners in HF-patients. Methods: Data were used from the Swiss Interdisciplinary Management Program for chronic Heart Failure pilot study (SWIM-HF), a randomized controlled pilot trial conducted between 2003 and 2005 at a Swiss University Hospital. HFmedication prescriptions of 42 patients were obtained from medical records, health insurance data and patients' hospital discharge letter to the general practitioners. Thirty-two participants completed a self-report follow-up questionnaire about their medication at 3 months; 9 patients were lost to follow-up because of deaths or readmission to the hospital and one patient dropped out. Results: The prescription behaviour of the cardiologists at discharge was largely in accordance to the international guidelines, as shown by the high percentage of prescribed ACEI or ARB (88.1%) and beta-blockers (83.3%) in the whole sample. Diuretics were prescribed to 88.1% of the patients at discharge. At 3 months follow-up, prevalence of ACEI, ARB and betablocker prescription was not significantly different between groups. However beta-blocker up-titration was significantly better in the intervention group than the control group (p = 0.45). Among control group patients, congruence between the recommended and actual prescription after 3 months was moderate: only 60% of the patients received the recommended combination of ACEI/ARBs and beta-blockers, a decrease of 16% compared to the cardiologists' baseline prescriptions. After 3 months the entire control group was on diuretics, which was an increase of 10.5%, while diuretic prescription in the intervention group even decreased in 3.3% of the patients. Conclusion: This pilot study suggests that collaboration between general practitioners, cardiologists and HF nurses may enhance adherence to the medication treatment guidelines. There is room for improvement in reaching treatment according to international guidelines in HF patients, particularly in the prescription and up-titration of ACEIs, ARBs and beta-blockers, as well as in prescription of diuretics, which should not be the first-choice drug.
doi:10.1016/j.ejcnurse.2008.01.087
1387 Effectiveness of a nurse intervention on the congruence of general practitioner to cardiologist's medication recommendation in heart failure after hospital discharge S. Jaggi, R. Mahrer-Imhof, A. Rossi, N. Zigan, S. De Geest, M. Leventhal, H.P. Brunner, E. Froelicher, K. Denhaerynck Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
1388 Purpose: Disease Management Programs for heart failure (HF) patients focusing on pharmacological treatment have been proven effective in reducing mortality and hospital readmission. The aim of this pilot study was to investigate whether a nurse-led patient education program with an How to succeed in health promotion Helle Broberg a, Vivi Nielsen a , Astrid Lauberg b a Patient Education in the Heart Failure Clinic, Aalborg University Hospital, Denmark
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Abstracts
The Department of Cardiology, Aalborg University Hospital, Denmark In 2004 the Heart Failure Clinic (HFC) was founded in order to improve rehabilitation for patients with chronic heart failure. Nurses experienced that some patients needed further specialist information and education. Since 2004 the nurse staffed HFC has been offering individual teaching, guidance and support to patients with chronic heart failure. In 2007 a patient questionnaire was conducted in order to evaluate the teaching program from the patients' point of view. Purpose: The aim of this study was to unfold to what extend the intentions for the HFC were obtained regarding satisfaction with the teaching program including perception of understanding difficulties with life in a new life situation and discussing effects of healthy lifestyles. Furthermore it was determined from a patient perspective whether national indicators for education of heart failure patients were obtained. The intention was to identify relevant themes for future education and adjusting education in coordination with patients needs. Methods: Data was collected in a period of 6 months from 44 questionnaires allowing patients to elaborate on their answers. Facts were processed with quantitatively methods and the comments were analysed qualitatively. Results: 89% said that they have been educated in heart failure. 52% say that they are “extremely satisfied” and 37% were “satisfied” with education about disease and symptoms and how to respond to changes in their condition. On the question of how patients assessed their own capacity to deal with heart disease after having received education 23% answered “very good”, 61% said “good”, 9% said “neutral” and only 2% said “poor”, which shows that the majority of the patients feel capable of managing themselves when any change in their condition occur. Conclusion: The majority of the patients (89%) felt capable of managing themselves when change in their condition occurred. It is also shown that education in the HFC rated by patients comes up to standard, which by national indicators states that 80% of all heart failure patients must receive structured education. It can therefore be concluded that patients with a chronic heart failure condition are very satisfied with the education in the HFC. From comments which suggested themes of importance as “understanding”, “meeting professionals in a caring atmosphere” and “confidence in being able to” it was concluded that maintaining the level of education in the
clinic is vital and it also showed potential for developing methods in order to further empower patients.
doi:10.1016/j.ejcnurse.2008.01.088
1389 Female sexual dysfunction (F.S.D.) in women with essential hypertension Varezina Zoulia, Aleksandra Aggelopoulou, Ioanna Mpiskini, Maria Sarakatsianou, Theodora Michalopoulou, Georgia Triantafyllou First Department of Cardiology, Coronary Care Unit Hippokration Hospital, Athens Medical School, Greece
Purpose: Female sexual dysfunction (FSD) is increasingly attracting more scientific and public interest, and represents a poorly investigated issue in women with essential hypertension. The purpose of our review was to present the definition, the epidemiology and the methodology used to evaluate the presence of FSD. Methods: The study population consisted of consecutive, sexually active women attending an outpatient hypertension clinic. FSD was defined as the persistent or recurrent decrease of sexual desire, the impairment of sexual act, as well as the presence of sexual impotence and pain after sexual contact. The Female Sexual Function Index (FSFI questionnaire) was used to evaluate FSD. Results: Preliminary data exhibited a wide range of FSD prevalence. Based on standardized FSFI, sexual dysfunction was found in 42.1% of hypertensive women compared with 19.4% of normotensive women. Systolic blood pressure levels were significantly related to FSFI score. Successful control of hypertension was related to lower prevalence of FSD. Increasing age, increasing systolic blood pressure and beta-blocker administration were significant predictors of sexual dysfunction in this patient population. Conclusions: FSD is more prevalent in women with essential hypertension compared with women with normal blood pressure, and its prevalence declines with adequate blood pressure control. Adequate control of hypertension with medication not affecting sexual function can have a great impact on the quality of life of hypertensive patients. Physicians should recognize and properly manage FSD in hypertensive women.
doi:10.1016/j.ejcnurse.2008.01.089