Allida, S.M., Hayward, C.S. & Newton, P.J. 2018, 'Thirst in heart failure: what do we know so far?', Current Opinion in Supportive and Palliative Care, vol. 12, no. 1, pp. 4-9.View/Download from: Publisher's site
Thirst is a common and burdensome symptom of heart failure, which impacts adversely on quality of life. To date, there is limited research on the prevalence of thirst, the factors associated with thirst and interventions to help manage thirst in heart failure. This review summarizes key empirical research developments of thirst.Recent research shows that the heart failure syndrome, medications, self-care practice such as fluid restriction and anxiety contributes greatly to increased thirst in patients with heart failure. In addition, predictors such as being younger, male patient, with high symptom burden and serum urea is also associated with thirst. There are no intervention studies to manage thirst, only reports of various strategies recommended to heart failure patients in clinical practice.Despite the burden of thirst in heart failure patients, strategies to relieve thirst remains insufficiently addressed in literature. Further research to improve the understanding of the severity of thirst and its relationship to possible factors associated with thirst is required in order to develop future interventions to either prevent or alleviate troublesome thirst in patients with heart failure.
Shehab, S., Allida, S.M., Davidson, P.M., Newton, P.J., Robson, D., Jansz, P.C. & Hayward, C.S. 2017, 'Right Ventricular Failure Post LVAD Implantation Corrected with Biventricular Support: An In Vitro Model.', ASAIO Journal, vol. 63, no. 1, pp. 41-47.View/Download from: UTS OPUS or Publisher's site
Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
Shehab, S., Macdonald, P.S., Keogh, A.M., Kotlyar, E., Jabbour, A., Robson, D., Newton, P.J., Rao, S., Wang, L., Allida, S., Connellan, M., Granger, E., Dhital, K., Spratt, P., Jansz, P.C. & Hayward, C.S. 2016, 'Long-term biventricular HeartWare ventricular assist device support-Case series of right atrial and right ventricular implantation outcomes.', Journal of Heart and Lung Transplantation, vol. 35, no. 4, pp. 466-473.View/Download from: UTS OPUS or Publisher's site
There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation.Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed.Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 ± 11 years, and mean body mass index was 26 ± 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient.Critically ill patients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort.
Shehab, S., Newton, P.J., Allida, S., Jansz, P. & Hayward, S.C. 2016, 'Biventricular mechanical support devices – clinical perspectives', Expert Review of Medical Devices, vol. 13, no. 4, pp. 353-365.View/Download from: Publisher's site
Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S., Shehab, S. & Newton, P.J. 2016, 'A survey of views and opinions of health professionals managing thirst in chronic heart failure.', Contemporary nurse, vol. 52, no. 2-3, pp. 244-252.View/Download from: UTS OPUS or Publisher's site
Thirst is a common and burdensome symptom of chronic heart failure (CHF) which affects adherence to self-care practices specifically fluid restriction. Despite this, there is no standard clinical practice for managing the symptom of thirst.The aim is to identify the current strategies recommended by health professionals to help relieve thirst in CHF patients and their perceived usefulness of these strategies.A survey was distributed to attendees of the 8th Annual Scientific Meeting of Australasian Cardiovascular Nursing College.There were 42 of 70 respondents to the survey. The majority (33 of 40; 82.5%) had recommended various strategies to alleviate thirst. The most recommended strategy was ice chips (36 of 38; 94.7%). Overall, the respondents reported 'some use' in all of the strategies.Information from this survey may help in the incorporation of thirst-relieving strategies into evidence-based guidelines; further improving the quality of care of patients.
Allida, S.M., Inglis, S.C., Davidson, P.M., Lal, S., Hayward, C.S. & Newton, P.J. 2015, 'Thirst in chronic heart failure: a review.', Journal of clinical nursing, vol. 24, no. 7-8, pp. 916-926.View/Download from: UTS OPUS or Publisher's site
This review will (1) explore factors related to thirst in chronic heart failure and (2) describe interventions to alleviate thirst in chronic heart failure patients.Thirst is a common and troublesome symptom of chronic heart failure. Despite the burden and prevalence of this symptom, there are limited strategies to assist in its management.This is a review of literature on the burden of thirst, contributors to thirst and potential management strategies of thirst in patients with chronic heart failure.Medline, Cumulative Index for Nursing and Allied Health, PubMed and Scopus were searched using the key words thirst, chronic heart failure, angiotensin II, fluid restriction and intervention. Of the 165 citations yielded, nine studies (n = 9) were included. The eligibility criteria included participants with confirmed diagnosis of chronic heart failure, randomised controlled studies or any studies with thirst as primary or secondary outcome, in humans and in English. There was no limit to the years searched.Factors related to thirst in chronic heart failure were condition; prolonged neurohormonal activation, treatment; pharmacological interventions and fluid restriction and emotion. No intervention studies were found in chronic heart failure patients. Interventions such as artificial saliva and chewing gum have been investigated for their effectiveness as a thirst reliever in haemodialysis patients.Thirst is a frequent and troublesome symptom for individuals with chronic heart failure. It is highly likely that this contributes to poor adherence with fluid restrictions. Chewing gum can help alleviate thirst, but investigation in people with heart failure is needed.Increasing awareness of thirst and interventions to relieve it in clinical practice is likely to improve the quality of care for people with chronic heart failure.
Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S. & Newton, P.J. 2014, 'Measurement of thirst in chronic heart failure- a review.', Contemporary nurse, vol. 48, no. 1, pp. 5134-5152.View/Download from: Publisher's site
Abstract Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF. Methods: Medline, PubMed, CINAHL, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies. Results: The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full- text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients (Visual Analogue Scale, Numeric Rating Scale and Thirst Distress Scale). Conclusion: Thirst in CHF is measured in a non- systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital.
Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S. & Newton, P.J. 2014, 'Measurement of thirst in chronic heart failure - A review.', Contemporary Nurse, vol. 48, no. 1, pp. 2-9.View/Download from: UTS OPUS or Publisher's site
Abstract Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF.Medline, PubMed, Cumulative Index for Nursing and Allied Health, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies.The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full-text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients [Visual Analogue Scale (VAS), Numeric Rating Scale and Thirst Distress Scale].Thirst in CHF is measured in a non-systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital.