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  • 1.
    Holst, Marie
    Malmö högskola, Faculty of Health and Society (HS).
    Self-care behaviour and daily life experiences in patients with chronic heart failure2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic heart failure (CHF) is a progressive, complex, clinical syndrome resultingfrom structural and/or functional cardiac disorders that impair systolic and/or diastolicventricular function. The dominating clinical symptoms are shortness of breath, fatigue,exercise intolerance and peripheral oedema. This considerably affects physical,psychological and social functions of the individual, often making normal daily lifeactivity difficult. The treatment for CHF is both pharmacological and nonpharmacological.Patient education, support and counselling are important parts of thenon-pharmacological treatment and aims among other things to improve self-care behaviourand adherence to the treatment.Thirst is, in clinical practise, a common reason for complaint in patients with CHF.One factor that can cause or aggravate thirst is the recommendation to be restrictivewith fluid intake. In international guidelines for CHF treatment, a fluid restriction of1,5-2L/day is often recommended. However, neither is this recommendation based onscientific evidence, nor has it been investigated if and how such a recommendationaffects the patients’ physical and mental health. The overall aim of this thesis was todescribe and evaluate self-care behaviour and to describe daily life experiences in patientswith CHF, with special reference to fluid intake.The aims of Study I were to: (1) describe self-care with special regard to daily selfweighingand salt and fluid restriction in patients with heart failure in primary healthcare, during one year of monthly telephone follow-up after a single session education,(2) to describe gender differences in regard to self-care and (3) to investigate if selfcarewas associated with health-related quality of life. The study was a subgroupanalysis of the interventional group from a larger randomised trial. No changes werefound in self-care behaviour throughout the study period. The intervention had no effecton quality of life and no associations were found between quality of life and selfcarebehaviour. There were no statistically significant differences between the genders.Study II was a randomised, cross-over trial with the aim to compare the effects of arestrictive to those of a liberal fluid prescription, on quality of life, physical capacity,thirst and hospital admissions, in patients who had improved from NYHA class (III-)IV CHF to a stable condition, without clinical signs of significant fluid overload.There were no significant differences in end-of-intervention between the two fluidprescriptions in quality of life, physical capacity or hospital admission. In sense ofthirst and difficulties to adhere to the fluid prescription there were significant between-intervention differences in end-of-intervention in favour of the liberal prescription.Study III was a secondary analysis of the data from study II with the aim to describethe self-reported fluid intake and its effects on body weight, signs and symptomsof CHF, quality of life, physical capacity and thirst in patients with stabilisedCHF. The efficacy variables were analysed in relation to the median fluid intake of19ml/kg bodyweight/day. Patients with an above median fluid intake experiencedsignificantly less thirst and difficulties to adhere to the fluid prescription.Study IV was an interview study with the aim to describe how persons with CHFexperience and manage daily life. The interviews were analysed with manifest andlatent content analysis. The experience of living with CHF is illuminated by thethemes Hindering and Facilitating Forces. The distribution between these themes wasequal which can be interpreted as despite the difficulties patients with CHF have, theyare capable to create a good life for themselves.The results of this thesis confirm the results from other studies regarding self-carebehaviour and the experiences of living with CHF. It is the first study showing that itseems beneficial and safe to recommend a liberal fluid prescription, based on bodyweight, in stabilised patients with CHF. A liberal fluid intake has favourable effectson thirst and difficulties to adhere to the fluid prescription without any detectable effectson quality of life, physical capacity or morbidity. A larger self-reported fluid intakewas not associated with any measurable negative effects on signs and symptomsof CHF, diuretic use, or physical capacity. Thus, a more liberal fluid intake may beadvisable in patients with CHF who have been stabilised from an initial unstableclinical state.

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