Masoud Shafazand - Academia.edu (original) (raw)
Papers by Masoud Shafazand
Patients with worsening chronic heart failure who present to a hospital emergency department requ... more Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care
Aim: To investigate gender-specifi c trends in long-term mortality in patients hospitalised for i... more Aim: To investigate gender-specifi c trends in long-term mortality in patients hospitalised for ischaemic and non-ischaemic heart failure (HF) and explore temporal trends in the risk of HF complicating acute myocardial infarction (AMI). Another aim is to characterise patients with chronic heart failure (CHF) that seek an emergency department (ED) because of their deteriorating condition and evaluate the feasibility of home care (HC) in comparison with conventional care (CC) in patients with worsening CHF. Patients and methods: In Papers I and II, data from the national hospital discharge and causespecifi c death registers were linked through the personal identity number. The hospital discharge register has been in operation since the 1960s and has operated on a nationwide basis since 1987. Between April 2004 and May 2006, patients seeking care for dyspnoea were identifi ed at the ED
European Journal of Cardiovascular Nursing, 2011
Background Despite advancement in care and extensive research, patients with chronic heart failur... more Background Despite advancement in care and extensive research, patients with chronic heart failure experience episodic deterioration, high symptom burden, affected functional capacity and recurrent hospital admissions. Aim & Metods In a cross sectional study we sought to explore the reasons for hospitalisation in patients with deteriorated Chronic Heart Failure. Results The vast majority of patients with worsening Chronic Heart Failure seeking the emergency department required hospital care, predominantly because of co-morbidities. Reason for hospital admission proportion Pneumonia/respiratory disease 35.4% Need to monitor cardiac rhythm 15.6% Communication problem (such as dementia, stroke and aphasia) 22.3% Pulmonary oedema 11.3% Myocardial infarction 6.2% Anaemia* 5.2% Pathologic blood chemistry other than haemoglobin** 3.7% Hypotension 2.1% *S-Haemoglobinb 20 g/L ** S-Creatinine>250 ?mol/L, S-Potassium>5.5 mmol/L or 0.05 ?g/L, Creatine kinase-MB>5 ?g/L, ASAT and ALAT > three times above the normal value Conclusion Patients with severe chronic illness like CHF with symptomatic deterioration could be attended with focus on symptom relieve and without additional emergency room investigations before hospital admission.
BMC Research Notes, 2012
Background: Chronic heart failure (CHF) is a major public health problem characterised by progres... more Background: Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method: Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/ Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results: Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion: The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
European Heart Journal, 2008
Int J Integrated Care, 2008
International journal of integrated care
Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, ... more Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, poor quality of life, frequent hospital admissions and need of specialist care. Lack of alternative care results in involuntary hospitalisation. Aim In a pilot study evaluate home care (HC) versus conventional care (CC) in relation to medical safety, health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Method Thirty-one patients with deteriorating CHF were randomised to HC or CC when seeking medical attention at hospital. Patients in the HC group were discharged from the hospital and were followed-up in their homes by a specialist nurse. Patients in the control group were treated in hospital with usual care. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Health-related quality of life assessed by EuroQol-5D VAS, Standard Gamble technique, SF-36 and Kansas City cardiomyopathy Questionnaire. All health care r...
European Journal of Heart Failure Supplements, 2008
International journal of integrated care
Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, ... more Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, poor quality of life, frequent hospital admissions and need of specialist care. Lack of alternative care results in involuntary hospitalisation. Aim In a pilot study evaluate home care (HC) versus conventional care (CC) in relation to medical safety, health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Method Thirty-one patients with deteriorating CHF were randomised to HC or CC when seeking medical attention at hospital. Patients in the HC group were discharged from the hospital and were followed-up in their homes by a specialist nurse. Patients in the control group were treated in hospital with usual care. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Health-related quality of life assessed by EuroQol-5D VAS, Standard Gamble technique, SF-36 and Kansas City cardiomyopathy Questionnaire. All health care r...
European Journal of Heart Failure, 2011
To investigate temporal trends in the risk of heart failure (HF) complicating acute myocardial in... more To investigate temporal trends in the risk of heart failure (HF) complicating acute myocardial infarction (AMI) and to determine whether these trends differ by gender or age. The national Swedish hospital discharge and death registries from 1993 to 2004 were used to calculate age- and gender-specific trends for a first episode of HF within 3 years in 175 216 patients aged 35-84 and hospitalized with a first AMI. Overall, 14.4% of patients aged 35-64 and 31.5% of those aged 65-84 with AMI in 1993-1995 had a hospital diagnosis of HF within 3 years (including the index admission). Corresponding figures for patients with AMI from 2002 to 2004 were 11.5 and 28.0%, respectively. In multivariable analyses, the risk of HF decreased by 4% per year. Having had a stroke before admission increased HF risk by 37%, diabetes increased the risk by 76% and atrial fibrillation by 80%. Patients with any kind of valvular disease had a more than doubled risk. Women had a 6% higher incidence of HF than men, whereas men with an index admission for AMI who did not develop HF had higher mortality than women. In this national sample, we observed a steady decrease in the risk of being hospitalized with HF after an AMI. However, the 3-year risk of HF remains high, with nearly one-third of AMI patients aged 65-84 developing HF within 3 years.
European Journal of Heart Failure, 2008
Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital a... more Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. Aim: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Methods: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Results: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p = 0.05). Conclusion: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.
European Journal of Cardiovascular Nursing, 2007
Background: Patients with chronic heart failure (CHF) have frequent episodes of exacerbation lead... more Background: Patients with chronic heart failure (CHF) have frequent episodes of exacerbation leading to recurrent hospitalization. Aims: To explore factors related to patients seeking care for worsening CHF. Methods: Eighty-eight patients diagnosed with a deteriorating CHF condition were interviewed. Data were analysed using content analysis. Results: Overall, 51 (58%) patients sought emergency care because of their symptoms while 37 (42%) were either sent by relatives or referred from outpatient clinics. Delay in seeking care was explained by 62 (71%) patients as a "wait and see" strategy, 9 (10%) were reluctant to use the health care system and 10 (11%) felt that it was futile to seek care. Fifty percent of the patients were uncertain about their current deteriorating status. Only 4 patients reported their symptoms to be related to heart failure. Conclusions: Although symptoms were the dominant reason for seeking emergency care, only a few patients related their symptoms to worsening CHF, which might be an important factor for not seeking emergency care earlier. Patient education programs should make efforts to improve understanding of symptom recognition.
BMC Research Notes, 2012
Background: Chronic heart failure (CHF) is a major public health problem characterised by progres... more Background: Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method: Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/ Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results: Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion: The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
European Heart Journal, 2008
Patients with worsening chronic heart failure who present to a hospital emergency department requ... more Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care
Aim: To investigate gender-specifi c trends in long-term mortality in patients hospitalised for i... more Aim: To investigate gender-specifi c trends in long-term mortality in patients hospitalised for ischaemic and non-ischaemic heart failure (HF) and explore temporal trends in the risk of HF complicating acute myocardial infarction (AMI). Another aim is to characterise patients with chronic heart failure (CHF) that seek an emergency department (ED) because of their deteriorating condition and evaluate the feasibility of home care (HC) in comparison with conventional care (CC) in patients with worsening CHF. Patients and methods: In Papers I and II, data from the national hospital discharge and causespecifi c death registers were linked through the personal identity number. The hospital discharge register has been in operation since the 1960s and has operated on a nationwide basis since 1987. Between April 2004 and May 2006, patients seeking care for dyspnoea were identifi ed at the ED
European Journal of Cardiovascular Nursing, 2011
Background Despite advancement in care and extensive research, patients with chronic heart failur... more Background Despite advancement in care and extensive research, patients with chronic heart failure experience episodic deterioration, high symptom burden, affected functional capacity and recurrent hospital admissions. Aim & Metods In a cross sectional study we sought to explore the reasons for hospitalisation in patients with deteriorated Chronic Heart Failure. Results The vast majority of patients with worsening Chronic Heart Failure seeking the emergency department required hospital care, predominantly because of co-morbidities. Reason for hospital admission proportion Pneumonia/respiratory disease 35.4% Need to monitor cardiac rhythm 15.6% Communication problem (such as dementia, stroke and aphasia) 22.3% Pulmonary oedema 11.3% Myocardial infarction 6.2% Anaemia* 5.2% Pathologic blood chemistry other than haemoglobin** 3.7% Hypotension 2.1% *S-Haemoglobinb 20 g/L ** S-Creatinine>250 ?mol/L, S-Potassium>5.5 mmol/L or 0.05 ?g/L, Creatine kinase-MB>5 ?g/L, ASAT and ALAT > three times above the normal value Conclusion Patients with severe chronic illness like CHF with symptomatic deterioration could be attended with focus on symptom relieve and without additional emergency room investigations before hospital admission.
BMC Research Notes, 2012
Background: Chronic heart failure (CHF) is a major public health problem characterised by progres... more Background: Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method: Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/ Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results: Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion: The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
European Heart Journal, 2008
Int J Integrated Care, 2008
International journal of integrated care
Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, ... more Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, poor quality of life, frequent hospital admissions and need of specialist care. Lack of alternative care results in involuntary hospitalisation. Aim In a pilot study evaluate home care (HC) versus conventional care (CC) in relation to medical safety, health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Method Thirty-one patients with deteriorating CHF were randomised to HC or CC when seeking medical attention at hospital. Patients in the HC group were discharged from the hospital and were followed-up in their homes by a specialist nurse. Patients in the control group were treated in hospital with usual care. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Health-related quality of life assessed by EuroQol-5D VAS, Standard Gamble technique, SF-36 and Kansas City cardiomyopathy Questionnaire. All health care r...
European Journal of Heart Failure Supplements, 2008
International journal of integrated care
Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, ... more Background Worsening chronic heart failure (CHF) is largely characterised by disabling symptoms, poor quality of life, frequent hospital admissions and need of specialist care. Lack of alternative care results in involuntary hospitalisation. Aim In a pilot study evaluate home care (HC) versus conventional care (CC) in relation to medical safety, health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Method Thirty-one patients with deteriorating CHF were randomised to HC or CC when seeking medical attention at hospital. Patients in the HC group were discharged from the hospital and were followed-up in their homes by a specialist nurse. Patients in the control group were treated in hospital with usual care. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Health-related quality of life assessed by EuroQol-5D VAS, Standard Gamble technique, SF-36 and Kansas City cardiomyopathy Questionnaire. All health care r...
European Journal of Heart Failure, 2011
To investigate temporal trends in the risk of heart failure (HF) complicating acute myocardial in... more To investigate temporal trends in the risk of heart failure (HF) complicating acute myocardial infarction (AMI) and to determine whether these trends differ by gender or age. The national Swedish hospital discharge and death registries from 1993 to 2004 were used to calculate age- and gender-specific trends for a first episode of HF within 3 years in 175 216 patients aged 35-84 and hospitalized with a first AMI. Overall, 14.4% of patients aged 35-64 and 31.5% of those aged 65-84 with AMI in 1993-1995 had a hospital diagnosis of HF within 3 years (including the index admission). Corresponding figures for patients with AMI from 2002 to 2004 were 11.5 and 28.0%, respectively. In multivariable analyses, the risk of HF decreased by 4% per year. Having had a stroke before admission increased HF risk by 37%, diabetes increased the risk by 76% and atrial fibrillation by 80%. Patients with any kind of valvular disease had a more than doubled risk. Women had a 6% higher incidence of HF than men, whereas men with an index admission for AMI who did not develop HF had higher mortality than women. In this national sample, we observed a steady decrease in the risk of being hospitalized with HF after an AMI. However, the 3-year risk of HF remains high, with nearly one-third of AMI patients aged 65-84 developing HF within 3 years.
European Journal of Heart Failure, 2008
Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital a... more Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. Aim: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Methods: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Results: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p = 0.05). Conclusion: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.
European Journal of Cardiovascular Nursing, 2007
Background: Patients with chronic heart failure (CHF) have frequent episodes of exacerbation lead... more Background: Patients with chronic heart failure (CHF) have frequent episodes of exacerbation leading to recurrent hospitalization. Aims: To explore factors related to patients seeking care for worsening CHF. Methods: Eighty-eight patients diagnosed with a deteriorating CHF condition were interviewed. Data were analysed using content analysis. Results: Overall, 51 (58%) patients sought emergency care because of their symptoms while 37 (42%) were either sent by relatives or referred from outpatient clinics. Delay in seeking care was explained by 62 (71%) patients as a "wait and see" strategy, 9 (10%) were reluctant to use the health care system and 10 (11%) felt that it was futile to seek care. Fifty percent of the patients were uncertain about their current deteriorating status. Only 4 patients reported their symptoms to be related to heart failure. Conclusions: Although symptoms were the dominant reason for seeking emergency care, only a few patients related their symptoms to worsening CHF, which might be an important factor for not seeking emergency care earlier. Patient education programs should make efforts to improve understanding of symptom recognition.
BMC Research Notes, 2012
Background: Chronic heart failure (CHF) is a major public health problem characterised by progres... more Background: Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method: Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/ Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results: Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion: The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
European Heart Journal, 2008