Biomedical subjects

L S Evangelista

Publications and source records attributed to L S Evangelista.

7 recordsLinked to original sources

PubMed2001

Hemodynamic benefits of treatment modalities for hypertrophic cardiomyopathy: a case study.

Hypertrophic cardiomyopathy is a primary disease of the cardiac muscle characterized by a hypertrophied and nondilated left ventricle in the absence of other cardiac or systemic disease. The disorder occurs twice as often in men than in women and is relatively more common in young adults. Early treatment of symptoms may improve hemodynamic benefits and prevent complications, including sudden death. This case illustrates various treatment modalities used to manage symptoms and describes the challenges in effectively maintaining hemodynamic stability.

Aged↗

PubMed2000

Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans.

Multiple hospital readmissions for heart failure (HF) are progressively increasing and may be related to continued tobacco and alcohol use. To study this relation, we conducted a retrospective chart audit of all veterans discharged with HF at a large Veterans Administration (VA) facility from 1997 to 1998. Using a multivariate logistic regression model, the smoking and alcohol use of patients who required > 1 HF admission within 1 year were compared with those who did not. Demographic, clinical, and psychosocial variables were also included in the model. Of 753 patients admitted with HF during the review period (mean age 69.1 years, 99% men), 220 patients (29.2%) were readmitted to the hospital at least once (range 1 to 8 readmissions, mean 1.79 +/- 0.27) after the index admission. In a multivariate analysis, current smoking (odds ratio [OR] 1.82; confidence interval [CI] 1.17 to 2.82) and current alcohol use (OR 5.92; CI 3.83 to 9.13) were independent predictors of readmissions. Other predictors included living alone (OR 2.09; CI 1.42 to 3.09), HF associated with ischemic etiology (OR 3.99; CI 2.58 to 6.18), higher New York Heart Association class (OR 2.57; CI 1.86 to 3.55), and care provided by a primary care physician compared with a cardiologist (OR 2.41; CI 1.57 to 3.67). This study confirms that noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for multiple hospital readmissions among patients with HF. Consequently, evaluation of noncompliance to smoking and alcohol consumption with targeted interventions in this population may be a key component for the reduction of multiple hospital readmissions.

Adult↗

PubMed2000

Treatment-seeking delays in heart failure patients.

BACKGROUND: Patients having cardiac symptoms often delay for hours before seeking treatment. Delay time is usually defined as the amount of time between the patient's first awareness of symptoms and arrival at the hospital. Excessive delays in seeking medical care for heart failure (HF) symptoms may influence patient outcomes. However, the treatment-seeking patterns of HF patients are not well understood. METHODS: We obtained data through a retrospective chart audit to describe the treatment-seeking behaviors of 753 HF patients, at a Veterans Administration facility, and to identify predictors of delay in seeking medical care for HF symptoms. Using univariate and multivariate analyses, we assessed relationships among delay time, presenting symptoms, and patient characteristics. RESULTS: The mean delay time was 2.93 +/- 0.68 days. The most common symptoms on admission were dyspnea (76%), edema (66%), fatigue (37%), and angina (25%). Variables negatively affecting delay time included presence of dyspnea and edema (odds ratio [OR], 2.10 and 1.82; confidence interval [CI], 1.38 to 3.19 and 1.17 to 2.82, respectively), care by a primary care physician (OR, 2.04; CI, 1.45 to 2.88), and higher New York Heart Association (NYHA) Class (OR, 1.96; CI, 1.47 to 2.61). Variables positively affecting delay time were the presence of chest pain (OR, 0.42; CI, 0.29 to 0.62) and a history of previous admission for HF (OR, 0.42; CI, 0.28 to 0.62). CONCLUSIONS: Delays in seeking treatment for HF symptoms are significantly high. This study supports the need for interventions that will increase early symptom recognition and management on the part of patients and their families.

Adult↗

PubMed2000

A closer look at compliance research in heart failure patients in the last decade.

Compliance with a complex healthcare regimen is required of most patients with heart failure. Noncompliance with even some aspects of the recommended treatment can lead to repeated and preventable hospitalizations, or even death. This paper reviews the extent of noncompliance for general health-seeking behavior and recommended lifestyle modifications in the general population, as well as the research on compliance conducted specifically in patients with heart failure. Research findings are reviewed in three areas: the extent and predictors of compliance, the relationship of compliance and clinical outcomes, and interventions designed to increase compliance in heart failure patients. Based on research findings to date, strategies to enhance compliance are offered.

Heart Failure↗

PubMedDate not supplied

Gender differences in health perceptions and meaning in persons living with heart failure.

OBJECTIVE: The goal of this study was to determine whether gender differences exist in health perceptions, psychosocial adjustment to illness, and concerns related to illness in patients with heart failure (HF). DESIGN: Thirty-two patients (50% women) from a single outpatient HF clinic were asked to complete standardized tools to assess health perceptions and psychosocial adjustment to illness. Open-ended questions were used to obtain data on concerns related to HF. RESULTS: The women had higher health perceptions than men did; they also demonstrated better psychosocial adjustment to illness. The qualitative data further suggest that women ascribed more positive meanings to their illness than men did. CONCLUSION: The current study underscored the importance of gender differences in health perceptions related to HF. Patient teaching and counseling can be tailored to address the gender-specific concerns of men and women suffering with this condition to improve patient outcomes.

Adult↗

PubMedDate not supplied

Relationship between psychosocial variables and compliance in patients with heart failure.

OBJECTIVE: The purpose of this study was to describe the socio-demographic, psychosocial, and social support variables that predict compliance to treatment regimens in HF patients. DESIGN AND SETTING: Semistructured interviews were conducted on 82 patients at an outpatient heart failure clinic to gather data related to compliance behaviors. Five standardized instruments were used to gather data on patients' psychosocial health status and perceived social support. RESULTS: The overall compliance rate was 85.13 (10.01%). Higher levels of compliance (> 90%) were noted for follow-up appointments, medications, smoking, and alcohol cessation. Poor compliance was observed with dietary and exercise recommendations (71% and 53%, respectively). In a multivariate model, higher education, higher mental and physical health status and neuroticism independently contributed to 24% of the variance in overall compliance. CONCLUSION: The study supports that HF patients had poor compliance with dietary and exercise regimens. Since following a dietary and exercise regimen has been demonstrated to reduce morbidity in this population, strategies to increase compliance should be rigorously pursued [corrected].

Adult↗

PubMedDate not supplied

Compliance: a concept analysis.

Compliance has a myriad of definitions. Understanding it as a phenomenon is complicated by the different perspectives of different disciplines. Nurses need to define compliance in a manner that best fits the philosophy of the nursing discipline. This article makes a distinction between the ordinary use and the scientific use of the term compliance. Nurses are challenged to embrace an interactive, transactional process in order to form a partnership with clients, which allows for client choice and control in decision making about carrying out the prescribed behavior.

Decision Making↗