Skip Navigation

European Journal of Heart Failure 2007 9(11):1095-1103; doi:10.1016/j.ejheart.2007.08.001
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (11)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Lainscak, M.
Right arrow Articles by Swedberg, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lainscak, M.
Right arrow Articles by Swedberg, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2007 European Society of Cardiology

Recall of lifestyle advice in patients recently hospitalised with heart failure: A EuroHeart Failure Survey analysis

Mitja Lainscaka,*, John G.F. Clelandb, Mattie J. Lenzenc, Samantha Nabbb, Irena Keberd, Ferenc Follathe, Michel Komajdaf and Karl Swedbergg

a Department of Internal Medicine, General Hospital Murska Sobota Murska Sobota, Slovenia
b Department of Cardiology, University of Hull Kingston upon Hull, UK
c Department of Cardiology, Erasmus Medical Center, Thoraxcenter Rotterdam, The Netherlands
d Department of Vascular diseases, University Medical Centre Ljubljana, Slovenia
e University Hospital Zürich Zürich, Switzerland
f Department of Cardiology, Hôpital Pitié Salpétrière Paris, France
g Department of Medicine, Sahlgrenska University HospitalÖstra Göteborg, Sweden

* Corresponding author. Department of Internal Medicine, General Hospital Murska Sobota, Dr. Vrbnjaka 6, SI-9000 Murska Sobota, Slovenia. Tel.: +386 31379533; fax: +386 25221007. E-mail address: mitja.lainscak{at}guest.arnes.si


   Abstract
Top
 Abstract
1. Introduction
 2. Methods
 3. Results
 4. Discussion
 References
 
Background: There are limited data on recall and implementation of lifestyle advice in patients with heart failure (HF).

Aim: To investigate what advice patients with HF recall being given, and whether they report following the advice they remember.

Methods and results: 3261 patients with suspected HF participating in the EuroHeart Failure Survey were interviewed by a health professional 12weeks after hospital discharge. Patients recalled receiving 46% of pre-specified items of advice and 67% reported that they followed these completely. Both recall (53%) and implementation (71%) was best in patients with left ventricular systolic dysfunction (LVSD). In multivariate analysis, younger age, male sex, patient awareness of the condition and patients reporting that they received a clear explanation of the diagnosis by a health professional, all factors associated with having LVSD, were the strongest predictors of recall.

Conclusions: Recall of and adherence to advice by patients with HF in this large European cross-sectional survey was disappointing. Responsibility for patient education lies with health professionals who should ensure that patients receive and understand advice, and are able to recall and follow it. A greater awareness of the issues surrounding lifestyle advice and more evidence supporting its value could improve patient care.

Key Words: EuroHeart Failure Survey • Heart failure • Lifestyle advice • Management • Non-pharmacological measures

Received December 28, 2006; Revised June 3, 2007; Accepted August 15, 2007


   1. Introduction
Top
 Abstract
 1. Introduction
2. Methods
 3. Results
 4. Discussion
 References
 
Heart failure (HF) is a common and serious condition [1]. Guidelines on HF stress the importance of lifestyle advice, although there is a paucity of evidence that such recommendations improve symptoms or prognosis [2]. Most lifestyle advice was developed in an era before effective drug therapy existed, and there are limited data from randomised controlled trials [3-5]. Nonetheless, many patients seek advice about lifestyle and it is likely that professional advice is beneficial to the patient because it may help them gain some feeling of control over their condition. Indeed, several trials have shown better adherence to self-management strategies and improved quality of life when patients receive lifestyle advice [6].

There are few data on the recall of advice about lifestyle amongst patients with heart failure. Furthermore, there is little information about whether patients follow the advice they recall and even less on whether they do what they say they do. The EuroHeart Failure Survey included questions about the patients' recall of lifestyle and other advice and whether the patient considered they followed it, a key step towards implementation of the advice. This provided an opportunity to obtain insights into the management of HF from the point of view of a large number of patients from different European countries.


   2. Methods
Top
 Abstract
 1. Introduction
 2. Methods
3. Results
 4. Discussion
 References
 
2.1. Study design and patients
Details on design and the selection criteria of the EuroHeart Failure Survey have been published [7,8]. In brief, between March 2000 and May 2001, over a 6 week period in each participating institution, 46,788 unselected discharges or deaths for any reason in cardiology, general internal medicine, cardiovascular surgery, and geriatrics departments of 115 hospitals from 24 European countries were screened to see if they met at least one of four inclusion criteria:

  1. a clinical diagnosis of heart failure during the index admission,
  2. a recorded diagnosis of heart failure during the last 3 years,
  3. treatment with loop diuretic for any cause other than renal failure within 24 h prior to discharge or death,
  4. pharmacological treatment for heart failure or ventricular dysfunction within 24 h prior to discharge or death.

Overall, 10,701 patients fulfilled one or more of the inclusion criteria and were enrolled. Surviving patients were invited to attend an interview 12 weeks after discharge from the hospital. For the purpose of this analysis we included all 3261 patients attending the interview (performed by a junior fellow, resident or a nurse, and reviewed by a senior doctor) and divided them into four groups based on the assessment of left ventricular function (LVF) and whether the interviewer thought that the diagnosis of heart failure was definite, probable or less certain (Fig. 1):

  1. LVSD—left ventricular systolic dysfunction,
  2. PLVF—preserved left ventricular function and definite or probable HF,
  3. LVF?HF+—unknown LVF and definite or probable clinical diagnosis of HF,
  4. LVF?HF–—unknown LVF and less certain clinical diagnosis of HF.


Figure 01
View larger version (27K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 1 Study design and patient selection. LVSD—left ventricular systolic dysfunction; PLVF—preserved left ventricular function; LVF?HF+—unknown left ventricular function and definite/probable clinical diagnosis of heart failure; LVF?HF–—unknown left ventricular function and less certain clinical diagnosis of heart failure.

 
In all participating countries an ethics committee approved the survey protocol. All patients gave their written consent prior to the interview.

2.2. Data collection
Data on co-morbid conditions, hospital stay, previous HF hospitalisations, left ventricular ejection fraction (LVEF) (if available), and predisposing factors for the index hospitalisation were collected from the patient's medical records on enrolment. During the interview, investigators obtained information on NYHA class and recall of lifestyle and other advice (dichotomous answer: yes/no). If the patient recalled advice, they were asked to specify the level (increase level/maintain current level/decrease level) and their response to given advice (followed completely/followed partially/ignored). Information on personal circumstances (living alone or not, in their own home or not, retired or employed) was also gathered. Patients were asked if they were aware that they had a heart condition and whether they thought the statement "Heart failure means the heart's pumping action is reduced. This may cause breathlessness and ankle swelling. This may or may not apply to you." applied to them. Additionally, we enquired whether they thought their clinical condition had been adequately explained to them. The interviewer then classified the clinical diagnosis of HF as definite, probable, possible, doubtful, absent or unknown in the light of all the evidence available.

2.3. Statistical analysis
Continuous variables are presented as mean value±standard deviation. Categorical variables are presented as absolute number and percentages.

To evaluate the differences between the group of patients who reported receiving >4 items (i.e. above median) of advice to those who recalled ≤4 items of advice the Student's t-test, chi-square test, and Mann-Whitney U-test were used as appropriate.

Multivariable logistic regression analysis was applied to investigate the relationship between clinically relevant variables and recall of advice. The following variables were entered into a regression model: age, sex, speciality at discharge, categorisation by presence of LVSD and HF as noted above, knowledge that a heart condition was present, LVEF<40%, living alone, pharmacological treatment, a clinical report of dementia, which and how many of the survey inclusion criteria the patient fulfilled and the final evaluation of how secure the diagnosis of HF was felt to be at interview and in the light of all the available data. We report odds ratios and corresponding 95% confidence intervals. All calculations were performed using SPSS 12.0 software package. For all tests a p value of 0.05 or less (two-sided) was considered statistically significant.


   3. Results
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
4. Discussion
 References
 
3.1. Patient characteristics
Patients with LVSD were younger, more often men and were more likely to have a history of smoking and to have had a myocardial infarction. They were also more likely to be receiving angiotensin converting enzyme inhibitors and beta-blockers. In contrast, patients with PLVF were more likely to have arterial hypertension and atrial fibrillation. NYHA class and duration of index admission were similar amongst groups (Table 1).


View this table:
[in this window]
[in a new window]

  		Table 1 Patient characteristics recorded at baseline and at the post-discharge interview

 
Patients with documented left ventricular systolic dysfunction or a clinical diagnosis of HF usually reported that they were aware of having a heart condition (91%) and that the description of HF applied to them (78%). Patients who had an assessment of LV function were more likely to report that they had received a clear explanation of their condition from health professionals (Table 1).

3.2. Lifestyle and other advice
Altogether, patients recalled 15,005 items of advice (46% of 32,610 possible items) and, when recalled, reported to follow them completely in 10,012 (67%) instances. Advice on diet and exercise were the most frequently recalled and influenza vaccination and avoiding non-steroidal anti-inflammatory drugs the least frequently recalled. Patients with documented LVSD were most likely to recall receiving advice and more likely to say that they followed it, while patients who had no assessment of cardiac function were least likely to recall or follow advice—Table 2. Advice related specifically to the management of heart failure, including regular weighing, reducing salt intake or avoiding non-steroidal anti-inflammatory drugs was recalled by 48%, 43%, and 17% of patients, respectively. Both recall (59%, 48%, and 21%) and implementation amongst those with recall (75%, 65%, and 87%) were again highest among patients with LVSD.


View this table:
[in this window]
[in a new window]

  		Table 2 Lifestyle and other advice recalled and followed

 
The median number of recalled items of advice was four (Table 3). Younger men with lower LVEF, who were more often cared for by cardiologists and received more treatment with angiotensin converting enzyme inhibitors and beta-blockers were most likely to recall advice. After applying the predefined multivariable analysis model, younger age, male sex, awareness of heart condition and report of a clear explanation, but not LVSD, were predictors of recall of >4 items of advice (Fig. 2a). In the same model, younger age, male sex, clear explanation, LVEF <40% and treatment with beta blocker and spironolactone predicted the recall of advice to check weight regularly (Fig. 2b). Similar factors predicted the recall of most individual items of advice (Table 4).


View this table:
[in this window]
[in a new window]

  		Table 3 Patients reporting receiving >4 items of advice compared to those with ≤4 recalled items of advice

 


Figure 02
View larger version (14K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 2 Prediction of recall of >4 items of advice (a) and regular weighing (b). Lines represent 95% confidence intervals with corresponding odds ratios. Age <65 years was reference age.

 


View this table:
[in this window]
[in a new window]

  		Table 4 Prediction of advice, expressed as odds ratio (95% confidence intervals)

 

   4. Discussion
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
References
 
This is the first large survey of heart failure to investigate patients' recall of health advice. Although not unexpected, the amount of advice recalled by the patients and the proportion who said they followed it is disappointing. Even fewer patients are likely to have actually followed the advice in everyday life, although we had no resources to address this issue. Patients were hospitalised for an average of 11 days, which gave ample opportunity to provide advice in accordance with clinical guidelines. It is possible that patients had been given advice, but had forgotten it. If this is true, it still indicates inadequate care, since being able to recall and implement advice is an essential part of health education.

The prognosis of heart failure is improving in clinical trials and in clinical practice [9]. This reflects both increased implementation of advances in pharmacological and device therapy and withdrawal of harmful therapies [10]. However, trials that have studied the implementation of specialist services, including telemonitoring [11], suggest that increased patient support may improve outcomes further. A possible explanation for this is improved lifestyle modification, uptake of health advice and improved concordance between what the doctor prescribes and the patient ingests. Trials show that patients who are adherent to advice to take their treatment have a better outcome [12]. Patients' knowledge of their condition, another marker of advice received, may also predict a better prognosis [13].

The characteristics of patients in this survey appeared similar to those in other hospital discharge survey populations and in clinical practice. Many patients had PLVF but clinical trials and guidelines have focussed mainly on patients with LVSD [2]. Patients with LVSD were more often younger men with ischaemic heart disease, who were aware they had a heart problem; they felt their condition had been explained to them and, as expected, received more appropriate pharmacological therapy. In contrast, patients with a clinical diagnosis of HF who did not have LVSD on imaging were older and had more co-morbidities. There are therefore multiple explanations for the differences in the better recall of advice amongst patients with LVSD, including patient characteristics and the certainty of the diagnosis by the health professionals. It is likely that when time is taken to advise patients about their diagnosis and drug therapy, a discussion about lifestyle changes will also take place.

There are relatively few data on patient counselling and implementation of advice; however, the available data agree with the results of this survey in showing poor recall [14-17]. A retrospective study of the medical records of 522 patients from 7 academic medical centres, reported that advice about exercise was documented in 83% of cases and about dietary sodium intake in 75% but that advice on weight monitoring was documented in only 11% [14]. Findings were similar in a survey of 2411 patients' records, where provision of advice was documented on salt intake in 84%, low fat diet in 69%, increasing physical activity in 33%, regular weighing in 21%, and fluid restriction in 23% [15]. Two or more items of advice were documented in 62% of patient records. Documenting whether patients receive advice might help explain rates of recall, but a patients' ability to recall advice is more important. In a telephone survey, 781 out-patients were asked about their knowledge and self-management of heart failure [16]. Patients' recall of advice about regular exercise (86%), salt intake (86%), daily weighing (58%), and fluid intake (47%) was higher than reported in other surveys. However, only half of the patients who owned a set of scales weighed themselves daily. A smaller prospective German study found that 51% of patients recalled receiving advice on regular weighing and 41% actually weighed themselves regularly one year after discharge [17]. Interestingly, in our survey recall of advice was greater amongst men than women, which already has been reported previously [15]. Whether this is true or reflects a greater likelihood of men to give a socially desirable answer is not known. In order to understand why the recall and implementation of advice is poor, qualitative studies are required. In a recent pilot study of 15 patients who received advice in a specialised nurse-led clinic [18], the consolidation, and implementation of advice differed between patients. It was, however, unclear whether patients had forgotten about the received advice or had chosen not to follow it. The authors concluded that it is insufficient merely to inform the patients about self-care behaviour; instead, information has to be adapted to the actual needs and circumstances of the individual patient.

Although there is a consensus amongst experts about dietary sodium intake and regular weight monitoring [19,20], health professionals often fail to deliver advice to patients and their relatives in a way they can understand and remember [20]. This may reflect the lack of robust clinical trial data to show that what is being advised really is in the patients' interest, which reduces its value from the perspective of the health professional. More evidence would produce greater consensus and increase the awareness of and value placed on lifestyle advice. Measures to ensure implementation of the advice that is given should also be found. Patients, appropriately, consider doctors and nurses [16,17], as those they should turn to for advice. Specialised heart failure clinics help to educate doctors and nurses, and encourage them to develop communication skills and educational packages; this creates a sense of direction and purpose for patients. It is not surprising that patients actually retain more information when enrolled in such programmes when compared to usual care [13].

4.1. Limitations
This survey is likely to have over-estimated the recall of advice for several reasons. Only 35% of surviving patients attended for interview. Patients who attended for interview were more likely to be younger, less socially disadvantaged, better informed and more motivated. The recall and uptake of advice amongst patients who did not attend for interview may have been much poorer. The centres taking part in this survey may also have been more aware of heart failure and may have had better systems in place to manage it. Implementation of advice using modern technology [21] may be more effective.

This study was confined to patients who had had a recent hospitalisation and therefore may represent a more advanced stage of heart failure. However, the patients in a large European survey in primary care [22] were remarkably similar. This is not surprising considering the high rate of hospital admission in patients with HF. Patients recruited from the community and from hospital may not be so different.

Almost 75% of patients felt they had received sufficient information about their medical condition, which is similar to other surveys [17]; however, this is unlikely to reflect clinical practice in general for reasons similar to those described above. Moreover, even when the diagnosis was uncertain, 40% of patients considered that the description of heart failure applied to them and 68% felt that their diagnosis had been clearly explained. This suggests that many patients are content with the advice and information they receive even though it might not be considered satisfactory by a health professional.

4.2. Clinical and future perspectives
This analysis suggests that more effective patient education is required if lifestyle advice is to be beneficial. This would be greatly assisted by more evidence from randomised trials. Whether specialist multi-disciplinary teams, telemonitoring initiatives or targeted educational programmes are most beneficial and cost-effective is uncertain, but all are likely to be better than a lack of any organised approach. The increasing number of heart failure clinics [23] and the development of a HF network under the auspices of the Heart Failure Association may help to improve matters in Europe.


   References
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
 References
 

  1. Cleland J.G.F., Clark A.L. Delivering the cumulative benefits of triple therapy to improve outcomes in heart failure: too many cooks will spoil the broth. J Am Coll Cardiol (2003) 42:1234–1237.[Free Full Text]
  2. Swedberg K., Cleland J., Dargie H., et al. Guidelines for the diagnosis and treatment of chronic heart failure: full text (update 2005). Eur Heart J (2005) 26:1115–1140.[Free Full Text]
  3. Krumholz H.M., Amatruda J., Smith G.L., et al. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol (2002) 39:83–89.[Abstract/Free Full Text]
  4. Kasper E.K., Gerstenblith G., Hefter G., et al. A randomized trial of efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmissions. J Am Coll Cardiol (2002) 39:471–480.[Abstract/Free Full Text]
  5. Jaarsma T., Van Der Wal M.H., Hogenhuis J., et al. Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure. Eur J Heart Fail (2004) 6:227–233.[Abstract/Free Full Text]
  6. Gonseth J., Guallar-Castillon P., Banegas J.R., Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admissions in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J (2004) 25:1570–1595.[Abstract/Free Full Text]
  7. Cleland J.G., Swedberg K., Follath F., et al. The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe; Part 1: patient characteristics and diagnosis. Eur Heart J (2003) 24:442–463.[Abstract/Free Full Text]
  8. Cleland J.G.F., Swedberg K., Cohen-Solal A., et al. The EuroHeart Failure Survey of the EUROHEART Survey Programme: a survey on the quality of care among patients with heart failure in Europe. Eur J Heart Fail (2000) 2:123–132.[Abstract/Free Full Text]
  9. Cleland J.G., Gemmell I., Khand A., Boddy A. Is the prognosis of heart failure improving? Eur J Heart Fail (1999) 1:229–241.[Abstract/Free Full Text]
  10. Yap Y.G., Camm A.J. Lessons from antiarrhythmic trials involving class III antiarrhythmic drugs. Am J Cardiol (1999) 84:83R–89R.[CrossRef][Web of Science][Medline]
  11. Cleland J.G., Louis A.A., Rigby A.S., Janssens U., Balk A.H. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol (2005) 45:1654–1664.[Abstract/Free Full Text]
  12. Granger B.B., Swedberg K., Ekman I., et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled trial. Lancet (2005) 366:2005–2011.[CrossRef][Web of Science][Medline]
  13. Lainscak M., Keber I. Patient's knowledge and beta blocker treatment improve prognosis of patients from the heart failure clinic. Eur J Heart Fail (2006) 8:187–190.[Abstract/Free Full Text]
  14. Nohria A., Chen Y.T., Morton D.J., Walsh R., Vlasses P.H., Krumholz H.M. Quality of care for patients hospitalized with heart failure at academic medical centers. Am Heart J (1999) 137:1028–1034.[CrossRef][Web of Science][Medline]
  15. Goldberg R.J., Farmer C., Spencer F.A., Pezzella S., Meyer T.E. Use of nonpharmacologic treatment approaches in patients with heart failure. Int J Cardiol (2006) 110:348–353.[CrossRef][Web of Science][Medline]
  16. Baker D.W., Brown J., Chan K.S., Dracup K.A., Keller E.B. A telephone survey to measure communication, education, self-management, and health status for patients with heart failure: the Improving Chronic Illness Care Evaluation (ICICE). J Card Fail (2005) 11:36–42.[CrossRef][Web of Science][Medline]
  17. Scherer M., Koschack J., Chenot J.F., Sobek C., Wetzel D., Kochen M.M. Transformation of general measures by patients in heart failure. Dtsch Med Wochenschr (2006) 131:667–671.[CrossRef][Medline]
  18. Lloyd-Williams F., Beaton S., Goldstein P., Mair F., May C., Capewell S. Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study. Chronic Ment Illn (2005) 1:39–47.
  19. Riegel B., Moser D.K., Powell M., Rector T.S., Havranek E.P. Nonpharmacological care by heart failure experts. J Card Fail (2006) 12:149–153.[Web of Science][Medline]
  20. van der Wal M.H.L., Jaarsma T., Moser D.K., Veeger N.J.G.M., van Gilst W.H., van Veldhuisen D.J. Compliance in heart failure patients: the importance of knowledge and beliefs. Eur Heart J (2006) 27:434–440.[Abstract/Free Full Text]
  21. Juilliere Y., Trochu J.N., Jourdain P., et al. Creation of standardized tools for therapeutic education specifically dedicated to chronic heart failure patients: the French I-CARE project. Int J Cardiol (2006) 113:355–363.[CrossRef][Web of Science][Medline]
  22. Cleland J.G., Cohen-Solal A., Aguilar J.C., et al. Improvement programme in evaluation and management; Study Group on Diagnosis of the Working Group on Heart Failure of The European Society of Cardiology. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet (2002) 360:1631–1639.[CrossRef][Web of Science][Medline]
  23. Jaarsma T., Stromberg A., De Geest S., et al. Heart failure management programmes in Europe. Eur J Cardiovasc Nurs (2006) 5:197–205.[CrossRef][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 CirculationHome page
B. Riegel, D. K. Moser, S. D. Anker, L. J. Appel, S. B. Dunbar, K. L. Grady, M. Z. Gurvitz, E. P. Havranek, C. S. Lee, J. Lindenfeld, et al.
State of the Science: Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association
Circulation, September 22, 2009; 120(12): 1141 - 1163.
[Full Text] [PDF]

Home page
 Eur J Heart FailHome page
J. Farkas, S. Nabb, L. Zaletel-Kragelj, J. G.F. Cleland, and M. Lainscak
Self-rated health and mortality in patients with chronic heart failure
Eur J Heart Fail, May 1, 2009; 11(5): 518 - 524.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
M. Lainscak, S. D. Anker, and J. G.F. Cleland
Smoking cessation in heart failure: easier said than done
Eur. Heart J., March 1, 2009; 30(5): 624 - 625.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W.H. W. Tang and G. S. Francis
The Year in Heart Failure
J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1671 - 1678.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J., October 1, 2008; 29(19): 2388 - 2442.
[Full Text] [PDF]

Home page
 Eur J Heart FailHome page
K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
M. A. Denvir and S. J. Leslie
Best practice for chronic heart failure patients--writing guidelines is not enough
Eur. Heart J., July 2, 2008; 29(14): 1706 - 1708.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (11)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Lainscak, M.
Right arrow Articles by Swedberg, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lainscak, M.
Right arrow Articles by Swedberg, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?