The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study Edita Lycholip,1,2 Ina Thon Aamodt,3,4 Irene Lie,3 Toma Šimbelytė,5 Roma Puronaitė,2,6,7 Hans Hillege,8 Arjen de Vries,8 Imke Kraai,9 Anna Stromberg,10 Tiny Jaarsma,11 Jelena Čelutkienė1,2 1Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 2Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; 3Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway; 4Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 5Clinic of Internal Medicine, Centre of Family and Internal Medicine, Vilnius University Santaros Clinics, Vilnius University, Vilnius, Lithuania; 6Centre of Informatics and Development, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; 7Institute of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania; 8Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 9PRA Health Sciences – Early Development Services, Groningen, the Netherlands; 10Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden; 11Department of Social and Welfare Studies, Linkoping University, Norrkoping, Sweden Introduction: Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited. Aims: This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. Methods: In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69±11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). Results: The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p

Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.

Patients discharged after hospitalization for acute heart failure (AHF) are frequently readmitted due to an incomplete decongestion, which is difficult to assess clinically. Recently, it has been shown that the use of a highly sensitive, non-invasive device measuring lung impedance (LI) reduces hospitalizations for heart failure (HF); it has also been shown that this device reduces the cardiovascular and all-cause mortality of stable HF patients when used in long-term out-patient follow-ups. The aim of these case series is to demonstrate the potential additive role of non-invasive home LI monitoring in the early post-discharge period. We present a case series of three patients who had performed daily LI measurements at home using the edema guard monitor (EGM) during 30 d after an episode of AHF. All patients had a history of chronic ischemic HF with a reduced ejection fraction and were hospitalized for 6–17 d. LI measurements were successfully made at home by patients with the help of their caregivers. The patients were carefully followed up by HF specialists who reacted to the values of LI measurements, blood pressure, heart rate and clinical symptoms. LI reduction was a more frequent trigger to medication adjustments compared to changes in symptoms or vital signs. Besides, LI dynamics closely tracked the use and dose of diuretics. Our case series suggests non-invasive home LI monitoring with EGM to be a reliable and potentially useful tool for the early detection of congestion or dehydration and thus for the further successful stabilization of a HF patient after a worsening episode.

Heart failure (HF) is an increasing cause of cardiovascular morbidity and mortality. However, the lay public awareness about HF is shown to be inferior to the knowledge of myocardial infarction or stroke. The vast majority of HF patients lack basic comprehension of HF and self-care, which translates into suboptimal treatment outcomes. Therefore this study aimed to establish the present level of knowledge about HF of the lay public and to evaluate the effects of a single public lecture for the consideration of implementing further steps to raise public awareness. Design and methods: We performed a cross sectional survey study using an anonymous questionnaire designed by the German Competence Network Heart Failure (CNHF). Respondents were selected randomly and fulfilled the questionnaire free-willingly prior to and after a standardized lecture on HF. The CNHF questionnaire consisted of two sets of questions focusing on individual characteristics of the respondent and HF-related knowledge. The gathered data were verified by a standardized procedure in Wurzburg, Germany. Results: Among 1025 respondents 60% were females: 15% of the participants had occupational experience in the medical field. The majority (79%) of the study population had heard about HF previously. Typical complaints and symptoms of HF were correctly identified as ‘shortness of breath’ by 69%, ‘swelling of feet’ by 56%, ‘fatigue’ by 56%, and ‘weakness’ by 54% survey participants. The lecture resulted in 22% (from 26% to 48%) increase of correct identification of the combination all three HF symptoms (shortness of breath, swelling of feet and tiredness). The lecture significantly increased the proportion of correct answers for most of the questions. Particularly notable gains were observed in respondents without prior medical experience. Conclusion: The study population’s initial awareness of HF was insufficient. Standardized lecture improved the short-term knowledge about HF symptoms and nature of the disease. Regular educational activities increasing the HF awareness of general population and HF patients can increase the overall HF treatment success.

Background and Objectives: Cardiovascular risk prediction models (RPMs) are widely used to guide statin initiation in primary prevention, yet the extent to which different models produce concordant treatment decisions in the same population remains insufficiently characterized. We compared statin eligibility across nine commonly used RPMs: SCORE2, PREVENT, PCE, ASSIGN, FRS-hCHD, AusCVDRisk, MESA, QRISK3, and RRS. Materials and Methods: We performed a cross-sectional analysis of 11,174 adults aged 40–65 years with metabolic syndrome enrolled in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR) and evaluated them at a single tertiary center during 2006–2023. Statin eligibility was determined for each RPM using guideline-mapped treatment thresholds. Pairwise agreement was assessed using Cohen’s κ, Gwet’s AC1, Positive and Negative Percent Agreement (PPA/NPA), the Jaccard index, and McNemar testing. Analyses were repeated by sex. Consensus eligibility was defined as treatment recommended by at least k of nine models. Results: Eligibility varied more than twenty-fold, from 67.39% (7530/11,174) with SCORE2 to 3.03% (339/11,174) with AusCVDRisk; intermediate estimates included PREVENT at 44.83%, QRISK3 at 39.00%, and PCE at 37.97%. Overall pairwise agreement was modest: κ ranged from 0.03 (SCORE2 vs. AusCVDRisk) to 0.67 (QRISK3 vs. ASSIGN), with a median κ of 0.38 (IQR: 0.19–0.51). Median AC1 was 0.58 (IQR 0.37–0.68). Agreement was stronger for non-eligibility than for eligibility (median NPA: 0.82 vs. median PPA: 0.53). Consensus eligibility declined from 73.5% at k = 1 to 45.1% at k = 3, 30.0% at k = 5, and 1.87% at k = 9, with the greatest sex divergence at intermediate stringency. Conclusions: In this real-world cohort with elevated cardiometabolic risk, statin eligibility was highly dependent on RPM choice and showed only modest inter-model concordance. Increasing consensus stringency rapidly reduced eligibility, indicating that RPM selection and embedded thresholds substantially influence statin treatment decisions in primary prevention.