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Boman, Kurt
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Hägglund, L., Boman, K. & Brännström, M. (2018). A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nursing Open
Open this publication in new window or tab >>A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older
2018 (English)In: Nursing Open, E-ISSN 2054-1058Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims and objectives

This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older.

Background

Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF.

Design

A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (= 25) or control (= 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self-rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (= 10) in the Tai Chi training group.

Results

No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow-up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort.

Conclusion

Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.

Keywords
chronic heart failure; elderly; group training; mixed methods; Tai Chi
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145128 (URN)10.1002/nop2.127 (DOI)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-06-09
Hellström Ängerud, K., Boman, K. & Brännström, M. (2018). Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scandinavian Journal of Caring Sciences, 32(1), 346-353
Open this publication in new window or tab >>Areas for quality improvements in heart failure care: quality of care from the family members' perspective
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 346-353Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care.

OBJECTIVE: To describe family members' perceptions of quality of HF care in an outpatient setting.

METHODS: A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV.

RESULTS: Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members.

CONCLUSION: Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
heart failure, Quality from patients' Perspective questionnaire, family members' perspective, quality of care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139041 (URN)10.1111/scs.12468 (DOI)000426524200035 ()28543624 (PubMedID)
Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-06-09Bibliographically approved
Greve, A. M., Bang, C. N., Boman, K., Egstrup, K., Forman, J. L., Kesäniemi, Y. A., . . . Wachtell, K. (2018). Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study). American Journal of Cardiology, 121(6), 739-745
Open this publication in new window or tab >>Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study)
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2018 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 121, no 6, p. 739-745Article in journal (Refereed) Published
Abstract [en]

Observational studies indicate that low-density lipoprotein (LDL) cholesterol acts as a primary contributor to an active process leading to aortic stenosis (AS) development. However, randomized clinical trials have failed to demonstrate an effect of lipid lowering on impeding AS progression. This study explored if pretreatment LDL levels and AS severity altered the efficacy of lipid-lowering therapy. The study goal was evaluated in the analysis of surviving patients with baseline data in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial of 1,873 asymptomatic patients with mild-to-moderate AS. Serially measured peak aortic jet velocity was the primary effect estimate. Linear mixed model analysis adjusted by baseline peak jet velocity and pretreatment LDL levels was used to assess effect modifications of treatment. Data were available in 1,579 (84%) patients. In adjusted analyses, lower baseline peak aortic jet velocity and higher pretreatment LDL levels increased the effect of randomized treatment (p >= 0.04 for interaction). As such, treatment impeded progression of AS in the highest quartile of LDL among patients with mild AS at baseline (0.06 m/s per year slower progression vs placebo in peak aortic jet velocity, 95% confidence interval 0.01 to 0.11, p = 0.03), but not in the 3 other quartiles of LDL. Conversely, among patients with moderate AS, there was no detectable effect of treatment in any of the pretreatment LDL quartiles (all p In conclusion, in a non prespecified post hoc analysis, the efficacy of lipid-lowering therapy on impeding AS progression increased with higher pretreatment LDL and lower peak aortic jet velocity (SEAS study: NCT00092677). 

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146569 (URN)10.1016/j.amjcard.2017.12.011 (DOI)000428102100012 ()29361285 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-06-09Bibliographically approved
Boman, K., Thormark Fröst, F., Bergman, A.-C. R. & Olofsson, M. (2018). NTproBNP and ST2 as predictors for all-cause and cardiovascular mortality in elderly patients with symptoms suggestive for heart failure. Biomarkers, 23(4), 373-379
Open this publication in new window or tab >>NTproBNP and ST2 as predictors for all-cause and cardiovascular mortality in elderly patients with symptoms suggestive for heart failure
2018 (English)In: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 23, no 4, p. 373-379Article in journal (Refereed) Published
Abstract [en]

Background: A new biomarker, suppression of tumorigenicity 2 (ST2) has been introduced as a marker for fibrosis and hypertrophy. Its clinical value in comparison with N-terminal pro-hormone of brain natriuretic peptide /Amino-terminal pro-B-type natriuretic peptide (NTproBNP) in predicting mortality in elderly patients with symptoms of heart failure (HF) is still unclear.

Aim: To evaluate the prognostic value for all-cause- and cardiovascular mortality of ST2 or NTproBNP and the combination of these biomarkers.

Patients and methods: One hundred seventy patients patients with clinical symptoms of HF (77 (45%) were with verified HF) were recruited from one selected primary health care center (PHC) in Sweden and echocardiography was performed in all patients. Blood samples were obtained from 159 patients and stored frozen at -70 degrees C. NTproBNP was analyzed at a central core laboratory using a clinically available immunoassay. ST2 was analyzed with Critical Diagnostics Presage ST2 ELISA immunoassay.

Results: We studied 159 patients (mean age 778.3years, 70% women). During ten years of follow up 78 patients had died, out of which 50 deaths were for cardiovascular reasons. Continuous NTproBNP and ST2 were both significantly associated with all-cause mortality (1.0001; 1.00001-1.0002, p=0.04 and 1.03; 1.003-1.06, p=0.03), NTproBNP but not ST2 remained significant for cardiovascular mortality after adjustments (1.0001; 1.00001-1.0002, p=0.03 and 1.01; 0.77-1.06, p=0.53), respectively. NTproBNP above median (>328ng/L) compared to below median was significantly associated with all-cause mortality(HR: 4.0; CI :2.46-6.61; p<0.001) and cardiovascular mortality (HR: 6.1; CI: 3.11-11.95; p<0.001). Corresponding analysis for ST2 above median (25.6ng/L) was not significantly associated neither with all-cause mortality (HR; 1.4; CI: 0.89-2.77) nor cardiovascular mortality (HR: 1.3; CI: 0.73-2.23) and no significant interaction of NTproBNP and ST2 (OR: 1.1; CI: 0.42-3.12) was found.

Conclusion: In elderly patients with symptoms of heart failure ST2 was not superior to NTproBNP to predict all cause or cardiovascular mortality. Furthermore, it is unclear if the combination of ST2 and NTproBNP will improve long-term prognostication beyond what is achieved by NTproBNP alone.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
NTproBNP, ST2, elderly, heart failure, morbidity, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-148038 (URN)10.1080/1354750X.2018.1431692 (DOI)000431689700009 ()29355441 (PubMedID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-06-09Bibliographically approved
Hodges, G. W., Bang, C. N., Eugen-Olsen, J., Olsen, M. H., Boman, K., Ray, S., . . . Wachtell, K. (2018). SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis. Open heart, 5(1), Article ID e000743.
Open this publication in new window or tab >>SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis
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2018 (English)In: Open heart, ISSN 0168-2601, E-ISSN 2053-3624, Vol. 5, no 1, article id e000743Article in journal (Refereed) Published
Abstract [en]

Background We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery.

Methods Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period.

Results Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively.

Conclusion Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146446 (URN)10.1136/openhrt-2017-000743 (DOI)000427076500032 ()29387432 (PubMedID)
Available from: 2018-05-03 Created: 2018-05-03 Last updated: 2018-06-09Bibliographically approved
Norberg, E.-B., Löfgren, B., Boman, K., Wennberg, P. & Brännström, M. (2017). A client-centred programme focusing energy conservation for people with heart failure. Scandinavian Journal of Occupational Therapy, 24(6), 455-467
Open this publication in new window or tab >>A client-centred programme focusing energy conservation for people with heart failure
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2017 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 6, p. 455-467Article in journal (Refereed) Published
Abstract [en]

AIM: The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF).

METHODS: The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed.

RESULTS: The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice.

CONCLUSIONS: This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.

Keywords
Activities of daily living, case study, energy conservation, goal achievement, intervention
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-130408 (URN)10.1080/11038128.2016.1272631 (DOI)000407390500008 ()28052703 (PubMedID)
Available from: 2017-01-19 Created: 2017-01-19 Last updated: 2018-06-09Bibliographically approved
Olofsson, M., Boman, K., Lindmark, K., Wikstrom, G., Bergman, G. J., Tornblom, M., . . . Stalhammar, J. (2017). A description of characteristics of very elderly patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden. European Journal of Heart Failure, 19(Supplement: 1), 362-362, Article ID Meeting Abstract: 1519.
Open this publication in new window or tab >>A description of characteristics of very elderly patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Supplement: 1, p. 362-362, article id Meeting Abstract: 1519Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136995 (URN)000401005301176 ()
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-06-09Bibliographically approved
Boman, K., Olofsson, M., Bergman, A.-C. R. & Brännström, M. (2017). Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: a substudy of the PREFER trial. European journal of internal medicine, 46, 35-40
Open this publication in new window or tab >>Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: a substudy of the PREFER trial
2017 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 46, p. 35-40Article in journal (Refereed) Published
Abstract [en]

Background: To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality.

Methods: A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality.

Results: Seventy-two patients (51 males, 21 females), aged 79.2±9.1years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r=0.37; p=0.001), anxiety (r=0.25; p=0.04), and reduced well-being (r=0.26; p=0.03) in the ESAS; mobility (r=0.33; p=0.005), pain/discomfort (r=0.27; p=0.02), and visual analogue scale of health state (r=-0.28; p=0.02) in the EQ-5D; and physical limitation (r=-0.27; p=0.02), symptom stability; (r=-0.43; p<0.001); (r=-0.25; p=0.033), social limitation;(r=-0.26; p=0.03), overall summary score; (r=-0.24, p=0.046) and clinical summary score; (r=-0.27; p=0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05-8.50, p=0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality.

Conclusion: Anaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2017
Keywords
Anaemia, Heart failure, Iron deficiency, Palliative care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139876 (URN)10.1016/j.ejim.2017.08.027 (DOI)000417096400027 ()28899603 (PubMedID)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2018-06-09Bibliographically approved
Bang, C. N., Greve, A. M., Rossebø, A. B., Ray, S., Egstrup, K., Boman, K., . . . Wachtell, K. (2017). Antihypertensive treatment with β-blockade in patients with asymptomatic aortic stenosis and association with cardiovascular events. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(12), Article ID e006709.
Open this publication in new window or tab >>Antihypertensive treatment with β-blockade in patients with asymptomatic aortic stenosis and association with cardiovascular events
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 12, article id e006709Article in journal (Refereed) Published
Abstract [en]

Background: Patients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a beta-blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is associated with increased risk of cardiovascular events in patients with asymptomatic mild to moderate AS.

Methods and results: We did a post hoc analysis of 1873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity-matched Cox regression and competing risk analyses were used to assess risk ratios for all-cause mortality, sudden cardiac death, and cardiovascular death. A total of 932 (50%) patients received Bbl at baseline. During a median follow-up of 4.3 +/- 0.9 years, 545 underwent aortic valve replacement, and 205 died; of those, 101 were cardiovascular deaths, including 40 sudden cardiovascular deaths. In adjusted analyses, Bbl use was associated with lower risk of all-cause mortality (hazard ratio 0.5, 95% confidence interval 0.3-0.7, P<0.001), cardiovascular death (hazard ratio 0.4, 95% confidence interval 0.2-0.7, P<0.001), and sudden cardiac death (hazard ratio 0.2, 95% confidence interval 0.1-0.6, P=0.004). This was confirmed in competing risk analyses (all P<0.004). No interaction was detected with AS severity (all P>0.1).

Conclusions: In post hoc analyses Bbl therapy did not increase the risk of all-cause mortality, sudden cardiac death, or cardiovascular death in patients with asymptomatic mild to moderate AS. A prospective study may be warranted to determine if Bbl therapy is in fact beneficial.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017
Keywords
aortic valve stenosis, arrhythmia (heart rhythm disorders), atrial fibrillation, beta-blocker, high blood essure, hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-144421 (URN)10.1161/JAHA.117.006709 (DOI)000418951100020 ()
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2018-06-09Bibliographically approved
Hellström Ängerud, K., Boman, K., Ekman, I. & Brännström, M. (2017). Areas for quality improvements in heart failure care: quality of care from the patient's perspective. Scandinavian Journal of Caring Sciences, 31(4), 830-838
Open this publication in new window or tab >>Areas for quality improvements in heart failure care: quality of care from the patient's perspective
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 830-838Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Heart failure is a serious condition with high mortality and a high symptom burden. Most patients with heart failure will be taken care of in primary care but the knowledge of how the quality of care is perceived by patients with heart failure is limited.

OBJECTIVE: The aim was to explore how patients with heart failure report quality of care, in an outpatient setting.

METHODS: Seventy-one patients with a confirmed diagnosis of heart failure and who were cared for in an outpatient setting were included in this cross-sectional study. Quality of care was assessed with a short form of the Quality from the Patient's Perspective questionnaire. The items measured four dimensions, and each item consists of both perceived reality of the received care and its subjective importance.

RESULTS: Inadequate quality was identified in three out of four dimensions and in items without dimension affiliation. In total, inadequate quality was identified in 19 out of 25 items. Patients reported the highest level of perceived reality in 'my family member was treated well' and the lowest perceived reality in 'effective treatment for loss of appetite'. Effective treatment for shortness of breath was of the highest subjective importance for the patients.

CONCLUSION: Important areas for improvement in the quality of care for patients with heart failure in an outpatient setting were identified, such as symptom alleviation, information, participation and access to care.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2017
Keywords
heart failure, heart failure care, patient perspective, patient satisfaction, quality of care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-142365 (URN)10.1111/scs.12404 (DOI)000416413000021 ()27859523 (PubMedID)
Available from: 2017-11-28 Created: 2017-11-28 Last updated: 2018-06-09Bibliographically approved
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