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Konrad C, Lossnitzer N, Boehlen FH, Haefeli WE, Holleczek B, Brenner H, Schoettker B, Wild B. Coping resources of heart failure patients - a comparison with cancer patients and individuals having no chronic condition results from the esther study. Heart Lung 2020; 49:829-835. [PMID: 33011461 DOI: 10.1016/j.hrtlng.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart failure (HF) and cancer patients share similarities in symptom burden and depression prevalence. Coping resources, such as optimism have been associated with improved health-related quality of life (HRQoL) and mental health. OBJECTIVES To investigate a wide range of resources in a large population-based sample of HF patients; to compare resources between three groups: HF patients, cancer patients, and individuals having no chronic condition. METHODS This cross-sectional analysis was performed among n = 2761 subjects who participated in home visits during the 11-year follow-up of the epidemiological ESTHER study. Resources were assessed by trained medical doctors through a questionnaire that lists 26 items. One-way analyses of covariance (ANCOVAs) controlled for sociodemographic variables and depression were performed to compare resources between groups. RESULTS Family and self-efficacy were the most frequently reported resources in all groups. HF patients reported optimism significantly less frequently as a resource in comparison to cancer patients (p=.031). HF patients showed significantly lower levels of resource factor 3 (positive attitude), compared to cancer patients (p=.006), and not chronically ill participants (p=.037). CONCLUSIONS Family and self-efficacy seem to be the most important resources, regardless of diagnosis. HF patients appear to have significantly lower levels of resources concerning positive attitude, compared to cancer patients, and not chronically ill individuals. We suggest the development of psychosocial interventions to enhance optimism in HF.
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Affiliation(s)
- Cinara Konrad
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Nicole Lossnitzer
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Friederike H Boehlen
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Saarland Cancer Registry, Saarbruecken, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schoettker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Germany
| | - Beate Wild
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Lossnitzer N, Feisst M, Wild B, Katus HA, Schultz JH, Frankenstein L, Stock C. Cross-lagged analyses of the bidirectional relationship between depression and markers of chronic heart failure. Depress Anxiety 2020; 37:898-907. [PMID: 32542951 DOI: 10.1002/da.23041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/06/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depression is common in patients with chronic heart failure (CHF) and is a predictor of rehospitalization and mortality. However, the complex bidirectional relationships between these two conditions are barely understood. We investigated the course of depression and markers of CHF (New York Heart Association [NYHA] functional class, N-terminal-prohormone B-type natriuretic peptide [NT-proBNP], and left ventricular ejection fraction [LVEF]) in a longitudinal study over a period of 2 years, using three assessment points. METHODS Data of n = 446 patients with documented CHF were analyzed using structural equation modeling. Specifically, a Bayesian cross-lagged structural equation model was applied. RESULTS Our study revealed that an aggravation of depression predicted an increase in NYHA functional class (significant cross-lagged effect γh = 0.103, 95% confidence interval [CI] [0.017; 0.194]), whereas an increase in NYHA functional class did not predict an aggravation of depression (γd = 0.002 95% CI [-0.057; 0.194]). This association was found only for NYHA functional class and depression-not for NT-proBNP and LVEF. CONCLUSIONS Experiencing depression and associated symptoms, such as lack of energy and fatigue, may lead to a further decrease of functional capacity, and consequently to a higher NYHA functional class in CHF patients. As NYHA functional class is associated with higher mortality, this may be a critical development for affected patients. Further studies are required to investigate whether or not this association could be an essential key that explains the pathway from depression to increased mortality in heart failure patients.
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Affiliation(s)
- Nicole Lossnitzer
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Hutchinson RN, Gutheil C, Wessler BS, Prevatt H, Sawyer DB, Han PKJ. What is Quality End-of-Life Care for Patients With Heart Failure? A Qualitative Study With Physicians. J Am Heart Assoc 2020; 9:e016505. [PMID: 32862771 PMCID: PMC7727006 DOI: 10.1161/jaha.120.016505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Advanced heart failure (AHF) carries a morbidity and mortality that are similar or worse than many advanced cancers. Despite this, there are no accepted quality metrics for end‐of‐life (EOL) care for patients with AHF. Methods and Results As a first step toward identifying quality measures, we performed a qualitative study with 23 physicians who care for patients with AHF. Individual, in‐depth, semistructured interviews explored physicians' perceptions of characteristics of high‐quality EOL care and the barriers encountered. Interviews were analyzed using software‐assisted line‐by‐line coding in order to identify emergent themes. Although some elements and barriers of high‐quality EOL care for AHF were similar to those described for other diseases, we identified several unique features. We found a competing desire to avoid overly aggressive care at EOL alongside a need to ensure that life‐prolonging interventions were exhausted. We also identified several barriers related to identifying EOL including greater prognostic uncertainty, inadequate recognition of AHF as a terminal disease and dependence of symptom control on disease‐modifying therapies. Conclusions Our findings support quality metrics that prioritize receipt of goal‐concordant care over utilization measures as well as a need for more inclusive payment models that appropriately reflect the dual nature of many AHF therapies.
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Affiliation(s)
- Rebecca N. Hutchinson
- Division of Palliative MedicineMaine Medical CenterPortlandME
- Center for Outcomes Research and EvaluationMaine Medical CenterPortlandME
| | - Caitlin Gutheil
- Center for Outcomes Research and EvaluationMaine Medical CenterPortlandME
| | | | - Hayley Prevatt
- Center for Outcomes Research and EvaluationMaine Medical CenterPortlandME
| | | | - Paul K. J. Han
- Center for Outcomes Research and EvaluationMaine Medical CenterPortlandME
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Hu Y, Jiang J, Xu L, Wang C, Wang P, Yang B, Tao M. Symptom clusters and quality of life among patients with chronic heart failure: A cross-sectional study. Jpn J Nurs Sci 2020; 18:e12366. [PMID: 32857469 DOI: 10.1111/jjns.12366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/28/2022]
Abstract
AIM This study aimed to identify symptom clusters among patients with chronic heart failure (HF) and examine their independent relationships with quality of life (QoL). METHODS A descriptive cross-sectional design was adopted, and 201 Chinese participants were recruited. Their symptom profiles and QoL were assessed using the Memorial Symptom Assessment Scale-Heart Failure and Minnesota Living with Heart Failure Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Pearson's correlation analysis and multiple regression analysis were conducted to examine their independent relationships with QoL. RESULTS Six distinct symptom clusters were identified: the fatigue, dyspneic, discomfort, congestive, ischemic, and emotional symptom clusters. These six symptom clusters accounted for 57.508% of the variance in patient symptom experiences and were positively related to their overall QoL. Moreover, the fatigue (β = .317, p < .001), dyspneic (β = .228, p < .001), congestive (β = .363, p < .001), and emotional (β = .200, p < .001) symptom clusters independently predicted QoL. CONCLUSION The six symptom clusters that were identified in this study and the relationships that they shared with QoL are expected to inform future approaches to symptom management. Interventions that target these symptom clusters will improve the QoL of patients with HF.
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Affiliation(s)
- Yinyi Hu
- School of Nursing, Zunyi Medical University, Zunyi, China.,Department of Nursing, Fourth People's Hospital of Guiyang, Guiyang, China
| | - Jiaoming Jiang
- School of Nursing, Zunyi Medical University, Zunyi, China
| | - Liyuan Xu
- School of Nursing, Zunyi Medical University, Zunyi, China
| | - Cui Wang
- Department of Pediatric Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Pengxiao Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Biwen Yang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ming Tao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Albuquerque de Almeida F, Al MJ, Koymans R, Riistama J, Pauws S, Severens JL. Impact of hospitalisation on health-related quality of life in patients with chronic heart failure. Health Qual Life Outcomes 2020; 18:262. [PMID: 32746842 PMCID: PMC7397623 DOI: 10.1186/s12955-020-01508-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empirical identification of the direct impact of hospitalisation in the change in utility could provide an interpretation for some of the unexplained variance in quality of life responses in clinical practice and clinical trials and provide assistance to researchers in assessing the impact of a hospitalisation in the context of economic evaluations. This study had the goal of determining the impact of nonfatal hospitalisations on the quality of life of a cohort of patients previously diagnosed with heart failure by using their quality of life measurements before and after hospitalisation. METHODS The impact of hospitalisation on health-related quality of life was estimated by calculating the difference in utility measured using the EQ-5D-3L in patients that were hospitalised and had records of utility before and after hospitalisation. The variation in differences between the utilities pre and post hospitalisation was explained through two multiple linear regression models using (1) the individual patient characteristics and (2) the hospitalisation characteristics as explanatory variables. RESULTS The mean difference between health-related quality of life measurement pre and post hospitalisation was found to be 0.020 [95% CI: - 0.020, 0.059] when measured with the EQ-5D index, while there was a mean decrease of - 0.012 [95% CI: - 0.043, 0.020] in the utility measured with the visual analogue scale. Differences in utility variation according to the primary cause for hospitalisation were found. Regression models showed a statistically significant impact of body mass index and serum creatinine in the index utility differences and of serum creatinine for utilities measured with the visual analogue scale. CONCLUSIONS Knowing the impact of hospitalisation on health-related quality of life is particularly relevant for informing cost-effectiveness studies designed to assess health technologies aimed at reducing hospital admissions. Through using patient-level data it was possible to estimate the variation in utilities before and after the average hospitalisation and for hospitalisations due to the most common causes for hospital admission. These estimates for (dis) utility could be used in the calculations of effectiveness on economic evaluations, especially when discrete event simulations are the employed modelling technique.
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Affiliation(s)
| | - Maiwenn J. Al
- ESHPM – Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- iMTA – Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ron Koymans
- Professional Health Services and Solutions, Philips Research Europe, Eindhoven, The Netherlands
| | - Jarno Riistama
- Chronic Disease Management, Philips Research Europe, Eindhoven, The Netherlands
| | - Steffen Pauws
- Chronic Disease Management, Philips Research Europe, Eindhoven, The Netherlands
| | - Johan L. Severens
- ESHPM – Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- iMTA – Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Changes in Social Support and Relational Mutuality as Moderators in the Association Between Heart Failure Patient Functioning and Caregiver Burden. J Cardiovasc Nurs 2020; 36:212-220. [PMID: 32740225 DOI: 10.1097/jcn.0000000000000726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Caregivers to patients with heart failure (HF) may experience substantial burden in their roles, yet little is known about factors that exacerbate caregiver burden over time. OBJECTIVES We test the moderating role of changes in caregivers' social support and patient-caregiver relationship mutuality in the association between HF patient functioning and caregiver burden. METHODS Data were analyzed using Stata 13.1 for 100 HF primary caregivers, the majority of whom were female (81%), living with the patient (87%), and married or partnered to the patient (70%). Patients reported on dyspnea, disability level, and symptom severity, and caregivers reported on patient-caregiver mutuality, social support, and perceived caregiver burden at both baseline and a 12-month follow-up. RESULTS Regression analyses using the Structural Equation Modeling framework revealed that declines in caregiver-patient mutuality over the 12 months of the study amplified the association between patient functioning (ie, dyspnea, symptom severity, and disability) and caregiver burden. Change in social support did not significantly moderate the association between any of the patient functioning variables and caregiver burden. CONCLUSIONS Caregivers' relationships with their care recipient shape how they respond to and interpret the demands of caregiving, and relationships experiencing negative changes over time contribute to caregiver burden. Promoting and sustaining positive social relationships within the caregiver-patient dyad is thus a promising avenue for interventions aimed at reducing the burden experienced by caregivers to patients with HF.
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Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review. Drugs Context 2020; 9:2020-5-4. [PMID: 32788920 PMCID: PMC7398616 DOI: 10.7573/dic.2020-5-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: 'antidepressant*' and 'heart failure.' Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. RESULTS Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. CONCLUSION Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.
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Affiliation(s)
- Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emile Tadros
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Veronica Cortez
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Desiree Triay
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda Olanisa
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nathalie Herrera
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sophia Hanna
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asher Kimchi
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michele Hamilton
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine, Los Angeles, CA, USA
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Identifying critical psychotherapy targets in serious cardiac conditions: The importance of addressing coping with symptoms, healthcare navigation, and social support. Palliat Support Care 2020; 17:531-535. [PMID: 30702055 DOI: 10.1017/s1478951518001037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy. METHOD During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits. RESULT A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%). SIGNIFICANCE OF RESULTS Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.
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Abstract
BACKGROUND Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF. OBJECTIVE The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status. METHODS A total of 115 patients with HF were included. Data on symptom status (Memorial Symptom Assessment Scale-HF), perceived control (Control Attitudes Scale-Revised), and self-care (Self-Care of Heart Failure Index) were collected. Other covariates included were age, gender, New York Heart Association class, comorbidity burden, and depressive symptoms. Multiple regression analyses were performed to analyze the data. RESULTS Lower perceived control predicted worse symptom status after controlling for covariates (P = .009). Other covariates predictive of worse symptom status were younger age, New York Heart Association class III/IV, and higher levels of depressive symptoms. Higher levels of perceived control were associated with better self-care (P = .044). Better self-care was associated with better symptom status (P = .038). CONCLUSIONS Lower levels of perceived control were independently associated with worse symptom status in patients with HF. Intervention strategies targeting perceived control should be tested to determine whether they could improve symptom status.
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Living with Chronic Heart Failure: Exploring Patient, Informal Caregiver, and Healthcare Professional Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082666. [PMID: 32294975 PMCID: PMC7215740 DOI: 10.3390/ijerph17082666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
Due to the complexity of heart failure (HF) and its treatment process, a high level of patient and informal caregiver engagement is required for management results. We aimed to explore the views of HF patients, informal caregivers, and healthcare professionals about personal experiences, perceived needs, and barriers to optimal HF management. A qualitative study using semi-structured interviews with HF patients (n = 32), their informal caregivers (n = 21), and healthcare professionals (n = 5) was conducted in the outpatient HF clinic in Slovenia in 2018. A content analysis method was used to analyze the data. Negative emotional response to disease and its limitations (especially the inability to continue with work) and changes in family roles were the most prevalent topics regarding the impact of HF on livelihood. Among the most common barriers to HF self-care, were the difficulties in changing lifestyle, financial difficulties due to the disease, traditional cuisine/lack of knowledge regarding a healthy diet and lack of self-confidence regarding physical activity. Despite psychological and social difficulties due to HF being highlighted by patients and informal caregivers, only healthcare professionals emphasized the need to address psychosocial aspects of care in HF management. Established differences could inform the implementation of necessary support mechanisms in HF management.
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61
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Singh GK, Ramjan L, Ferguson C, Davidson PM, Newton PJ. Access and referral to palliative care for patients with chronic heart failure: A qualitative study of healthcare professionals. J Clin Nurs 2020; 29:1576-1589. [PMID: 32141656 DOI: 10.1111/jocn.15222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/28/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Palliative care for individuals with chronic heart failure is recommended for improving patients' symptoms, function and overall quality of life. Despite this mandate, there is limited access and referral to specialist palliative care for individuals with chronic heart failure. OBJECTIVES To explore healthcare professionals' perspectives on access to palliative care for patients with chronic heart failure, focussing on patient, provider and system factors. METHODS Cardiologists, palliative care specialists, heart failure nurses and palliative care nurses in acute and community care settings were interviewed using semi-structured interviews. Purposive and snowball sampling methods were used for recruitment. Interview data were analysed using thematic analysis. The COREQ checklist guided data collection and reporting. RESULTS There were 15 participants in the study, and the majority were female. Participants included palliative medicine physicians, a palliative care nurse consultant, cardiologists, a general practitioner and advanced heart failure nurses. The themes derived from the thematic analysis centred on patient, provider and system factors impacting access and referral to palliative care in the context of chronic heart failure. The patient themes were (a) patient and family preconception of palliative care and (b) patient's clinical profile influences referral. The provider themes were (a) conflict, (b) making decisions and (c) education needs, and the system themes were (a) accessing services and resources and (b) improving the model of care. CONCLUSIONS The patient's clinical profile, education needs of healthcare professionals and improving access to services and resources need to be considered to enhance palliative care access and referral as well as the interacting and influencing elements of the patient, provider and system.
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Affiliation(s)
- Gursharan K Singh
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Lucie Ramjan
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Caleb Ferguson
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia.,Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia
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Streur MM, Thompson EA, Dougherty CM. Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator. J Pain Symptom Manage 2020; 59:658-667. [PMID: 31707069 PMCID: PMC7024646 DOI: 10.1016/j.jpainsymman.2019.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
CONTEXT Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management. OBJECTIVES The objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation. METHODS This was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression. RESULTS The study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N = 119, 40%), Tired-Rundown (N = 130, 43%), and Mostly Asymptomatic (N = 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years, P < 0.001) and reported more anxiety (P < 0.001) and depression (P < 0.01) than the other classes. Membership in the Multi-Symptom class predicted lower quality of life and resulted in nearly double the rate of hospitalizations after 12 months (P = 0.02, IRR 1.9). CONCLUSION Evaluation of symptom profiles after ICD implantation offers a promising strategy for identifying patients at risk for poor health outcomes.
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Affiliation(s)
- Megan M Streur
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Elaine A Thompson
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Cynthia M Dougherty
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA.
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Liu AY, O’Riordan DL, Marks AK, Bischoff KE, Pantilat SZ. A Comparison of Hospitalized Patients With Heart Failure and Cancer Referred to Palliative Care. JAMA Netw Open 2020; 3:e200020. [PMID: 32101304 PMCID: PMC7137679 DOI: 10.1001/jamanetworkopen.2020.0020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Growing evidence shows that palliative care (PC) improves treatment outcomes in patients with heart failure (HF), but few large-scale studies have prospectively evaluated the processes and outcomes associated with PC consultation for such patients in the real world. OBJECTIVE To characterize processes and outcomes of PC consultations for hospitalized patients with HF compared with patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study of inpatient encounters at community and academic hospitals in the Palliative Care Quality Network enrolled participants between 2013 and 2017. Of a total of 135 197 patients, 57 272 adults with a primary diagnosis of HF or cancer receiving PC consultation were enrolled. Data analysis was performed from April 2018 to December 2019. EXPOSURES Primary diagnosis of HF or cancer. MAIN OUTCOMES AND MEASURES Symptom improvement and changes in care planning documentation after PC consultation. RESULTS At the time of consultation, patients with HF were older (mean age, 75.3 years [95% CI, 75.0-75.5 years] vs 65.2 years [95% CI, 65.0-65.3 years]; P < .001), had lower Palliative Performance Scale scores (mean, 35.6% [95% CI, 35.3%-35.9%] vs 42.4% [95% CI, 42.2%-42.6%]; P < .001), and were more likely to be in a critical care unit (5808 of 16 741 patients [35.3%] vs 4985 of 40 531 patients [12.5%]; P < .001) or a telemetry or step-down unit (5802 of 16 741 patients [35.2%] vs 7651 of 40 531 patients [19.2%]; P < .001) compared with patients with cancer. Patients with HF were less likely than patients with cancer to be referred to PC within 24 hours of admission (6773 of 16 741 patients [41.2%] vs 19 348 of 40 531 patients [49.0%]; P < .001) and had longer hospitalizations before receiving PC consultation requests (mean, 4.6 days [95% CI, 4.4-4.8 days] vs 3.9 days [95% CI, 3.8-4.0 days]; P < .001). Patients with HF were referred less frequently for symptoms other than pain (1686 of 16 488 patients [10.2%] vs 8587 of 39 609 patients [21.7%]; P < .001), but were equally likely to report improvements in anxiety (odds ratio, 0.85; 95% CI, 0.71-1.02; P = .08) and more likely to report improvements in dyspnea (odds ratio, 2.17; 95% CI, 1.83-2.57; P < .001) compared with patients with cancer. Patients with HF were less likely than those with cancer to be discharged alive (odds ratio, 0.78; 95% CI, 0.64-0.96; P = .02) or to be referred to hospice (odds ratio, 0.50; 95% CI, 0.47-0.53; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that PC referral comes late for patients with HF and is used primarily to discuss care planning. Practitioners caring for patients with HF should consider involving PC experts earlier for symptom management.
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Affiliation(s)
- Albert Y Liu
- Department of Medicine, University of California, San Francisco
| | - David L. O’Riordan
- Division of Palliative Medicine, University of California, San Francisco
| | - Angela K. Marks
- Division of Palliative Medicine, University of California, San Francisco
| | - Kara E. Bischoff
- Division of Palliative Medicine, University of California, San Francisco
| | - Steven Z. Pantilat
- Division of Palliative Medicine, University of California, San Francisco
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Abstract
The occurrence of depression, anxiety, and insomnia is strikingly high in patients with heart failure and is linked to increased morbidity and mortality. However, symptoms are frequently unrecognized and the integration of mental health into cardiology care plans is not routine. This article describes the prevalence, identification, and treatment of common comorbid psychological disorders.
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Affiliation(s)
- Katherine E Di Palo
- Office of the Medical Director, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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Raffaa HM, Alasmari B, Abadi S, Al Metrek M, Raffaa H, Al Qarni HM, Alhumayed R, Al Hamad F, Almakhluti F, Al Mani H, Al Halafi F, Assiri M, Al Qahtani S. Adherence of heart failure patients to heart failure medications and its determinants in the Aseer region, Southern Saudi Arabia. J Family Med Prim Care 2020; 9:5041-5045. [PMID: 33209841 PMCID: PMC7652160 DOI: 10.4103/jfmpc.jfmpc_904_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background: Heart failure is a complex clinical syndrome of cardiovascular disease. Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body's needs for blood and oxygen. It is characterised by several attacks of dyspnoea, chest pain, orthopnea and pulmonary or systemic congestion. The heart inability to fulfill the demands of the body further failure of heart to pump the blood with normal efficiency. Lack of patients’ adherence to their treatment may affect their clinical compensation. Aim: To assess the extent of assessing the level and predictors of medication adherence among patients with heart failure in the Aseer region. Methodology: A descriptive cross-sectional approach was used for targeting all registered heart failure patients attending the cardio clinic and chronic diseases clinic in Aseer region hospitals. Data were collected using a direct interview questionnaire that was developed by the researchers with the help of experts. Questionnaire included the patients’ sociodemographic data, co-morbidities, disease-related data and drugs. Results: The study included 151 patients diagnosed with heart failure. About 66% of the patients were above the age of 60 years and 62.3% were males. Exact of 47% of the cases had the disease for less than 3 years and 43.7% of the patients had the treatment for more than 3 years. About 49% of the patients forget to have their medication at least once while 34.4% had problems remembering to take your medication. Totally, more than half of the patients had poor medication adherence and only 7.3% had a high adherence rate. Conclusions and Recommendations: In conclusion, the adherence rate for the patients’ medication was poor due to forgetting to have the medications. Poor adherence was related more with single patients who are not working with poor income.
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Alghalayini KW. Using Atlanta Heart Failure Questionnaire in ambulatory heart failure patients with preserved ejection fraction HFPEF. JRSM Cardiovasc Dis 2020; 9:2048004020927642. [PMID: 32528670 PMCID: PMC7265075 DOI: 10.1177/2048004020927642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/15/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The present study uses the Atlanta Heart Failure Questionnaire as a tool to evaluate and design a tailored education material for ambulatory heart failure patients with preserved ejection fraction, highlighting the strengths and weakness toward the planning of education programs. METHODS A total of 450 patients were screened; 112 patients were recruited, and 27-item was used to evaluate the usefulness of this questionnaire. All patients received education by a dedicated medical education about the nature of the disease, risk factors and management including prevention of complications. Descriptive statistics were used for assessing the sample characteristics. RESULTS In the assessment of patient disease knowledge, in a 7-item questionnaire, the most well-understood item was correctly identified in 95% patients, whereas the least-understood item was identified in 1.8% of patients. In the assessment of patient management knowledge, in a 6-item questionnaire, the most well-understood item was correctly identified in 50% of patients and the least-understood item was identified in 10% of patients. In the assessment of patient medication intake knowledge, in a 3-item questionnaire, the most well-understood item was correctly identified in 97.3% of patients and the least-understood item was identified in 26.6% of patients. CONCLUSION For a disease not fully understood, the study has concluded the usefulness of Atlanta Heart Failure Questionnaire for filling the gaps, setting a base line and follow-up in the process of educating ambulatory heart failure patients with preserved ejection fraction HFPF.
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Burrai F, Sanna GD, Moccia E, Morlando F, Cosentino ER, Bui V, Micheluzzi V, Borghi C, Parodi G. Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial. J Card Fail 2019; 26:541-549. [PMID: 31877362 DOI: 10.1016/j.cardfail.2019.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting. METHODS AND RESULTS Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P < .001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P < .001 for both), and cognitive performances (P = .003). CONCLUSIONS Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.
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Affiliation(s)
- Francesco Burrai
- Educational and Research, ATS Sardegna-ASSL Sassari, 07100 Sassari, Italy
| | - Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy.
| | - Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | | | - Eugenio R Cosentino
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Virna Bui
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Valentina Micheluzzi
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | - Claudio Borghi
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
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Chuzi S, Pak ES, Desai AS, Schaefer KG, Warraich HJ. Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient. Curr Heart Fail Rep 2019; 16:220-228. [DOI: 10.1007/s11897-019-00440-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Denfeld QE, Bidwell JT, Gelow JM, Mudd JO, Chien CV, Hiatt SO, Lee CS. Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure. Heart Lung 2019; 49:151-157. [PMID: 31753526 DOI: 10.1016/j.hrtlng.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship between physical and affective symptom clusters in heart failure (HF) is unclear. OBJECTIVES To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups. METHODS This was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively. RESULTS In this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival. CONCLUSION Congruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes.
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Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA.
| | - Julie T Bidwell
- University of California Davis Betty Irene Moore School of Nursing, Sacramento, CA, USA
| | - Jill M Gelow
- Providence Heart & Vascular Institute, Portland, OR, USA
| | - James O Mudd
- Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
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Mizukawa M, Moriyama M, Yamamoto H, Rahman MM, Naka M, Kitagawa T, Kobayashi S, Oda N, Yasunobu Y, Tomiyama M, Morishima N, Matsuda K, Kihara Y. Nurse-Led Collaborative Management Using Telemonitoring Improves Quality of Life and Prevention of Rehospitalization in Patients with Heart Failure. Int Heart J 2019; 60:1293-1302. [PMID: 31735786 DOI: 10.1536/ihj.19-313] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effects of disease management using telemonitoring for patients with heart failure (HF) remain controversial. Hence, we embedded care coordination and enhanced collaborative self-management through interactive communication via a telemonitoring system (collaborative management; CM). This study evaluated whether CM improved psychosocial status and prevented rehospitalization in patients with HF in comparison with self-management education (SM), and usual care (UC).We randomly allocated 59 patients into 3 groups; UC (n = 19), SM (n = 20), and CM (n = 20). The UC group received one patient education session, and the SM and CM groups participated in disease management programs for 12 months. The CM group received telemonitoring concurrently. All groups were followed up for another 12 months. Data were collected at baseline and at 6, 12, 18, and 24 months.The primary endpoint was quality of life (QOL). Secondary endpoints included self-efficacy, self-care, and incidence of rehospitalization. The QOL score improved in CM compared to UC at 18 and 24 months (P < 0.05). There were no significant differences among the 3 groups in self-efficacy and self-care. However, compared within each group, only the CM had significant changes in self-efficacy and in self-care (P < 0.01). Rehospitalization rates were high in the UC (11/19; 57.9%) compared with the SM (5/20; 27.8%) and CM groups (4/20; 20.0%). The readmission-free survival rate differed significantly between the CM and UC groups (P = 0.020).We conclude that CM has the potential to improve psychosocial status in patients with HF and prevent rehospitalization due to HF.
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Affiliation(s)
- Mariko Mizukawa
- Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Hideya Yamamoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Md M Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Makiko Naka
- Heart Failure Center, Hiroshima University Hospital
| | | | | | | | | | | | | | | | - Yasuki Kihara
- Graduate School of Biomedical and Health Sciences, Hiroshima University
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71
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Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure. J Cardiovasc Nurs 2019; 33:217-224. [PMID: 28930784 DOI: 10.1097/jcn.0000000000000447] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL. OBJECTIVE The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL. METHODS In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire). RESULTS The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL. CONCLUSION In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.
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Nguyen Q, Wang K, Nikhanj A, Chen-Song D, DeKock I, Ezekowitz J, Mirhosseini M, Cujec B, Oudit GY. Screening and Initiating Supportive Care in Patients With Heart Failure. Front Cardiovasc Med 2019; 6:151. [PMID: 31696120 PMCID: PMC6817607 DOI: 10.3389/fcvm.2019.00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF. Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population. Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.
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Affiliation(s)
- Quynh Nguyen
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Kaiming Wang
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Anish Nikhanj
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Dale Chen-Song
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Ingrid DeKock
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Bibiana Cujec
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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Abdelbasset WK, Alqahtani BA, Alrawaili SM, Ahmed AS, Elnegamy TE, Ibrahim AA, Soliman GS. Similar effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on depressive disorder in heart failure patients: A 12-week randomized controlled trial. Medicine (Baltimore) 2019; 98:e16820. [PMID: 31393414 PMCID: PMC6709255 DOI: 10.1097/md.0000000000016820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Heart failure related depression is recently increased worldwide. Heart failure (HF) disease is identified as a critical cause of increasing morbidity, hospital readmission, and mortality. The most important purpose of treatment of HF disease is to relief disease problems, improve functional performance, and achieve better quality of life. OBJECTIVES This study was proposed to evaluate the effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on the level of depressive disorder in heart failure patients. STUDY DESIGN 12-week randomized controlled trial. METHODS Sixty nine HF patients with mild to moderate level of depression and ejection fraction <40% were examined before and after 12-week intervention. Their age was ranged from 40 to 60 years. Patients were randomly classified into 3 groups. Group I (n = 23) received low to moderate intensity exercise program (LMIEP), group II (n = 23) received moderate-intensity exercise program (MICEP), and group III (n = 23) did not receive any exercise program (Non-exercised group). All patients were instructed to conduct home-based exercise with their pharmacological therapy. The level of depression was evaluated before and after 12 weeks of the intervention program. RESULTS The 3 study groups were associated with significant decrease of depression level (P < .05). Significant differences were exhibited between the 3 groups in favor to both exercise programs (P < .05) with non-significant differences between the 2 exercise programs (P > .05). CONCLUSIONS Both exercise programs had positive effects in reducing the severity of depression in HF patients. Low to moderate and moderate-intensity exercise programs should be proposed for depression illness specially patients with heart failure.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital
| | - Bader A. Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Saud M. Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmed S. Ahmed
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Tamer E. Elnegamy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmed A. Ibrahim
- Department of Physical Therapy, Kasr Al-Aini Hospital
- Department of Physical Therapy, College of Applied Medical Sciences, Hail University, Hail
| | - Gaber S. Soliman
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Jouf University, Saudi Arabia
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Comparing the Barriers and Facilitators of Heart Failure Management as Perceived by Patients, Caregivers, and Clinical Providers. J Cardiovasc Nurs 2019; 34:399-409. [DOI: 10.1097/jcn.0000000000000591] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Su A, Al'Aref SJ, Beecy AN, Min JK, Karas MG. Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature. Mayo Clin Proc 2019; 94:1304-1320. [PMID: 31272573 DOI: 10.1016/j.mayocp.2019.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
Heart failure represents a clinical syndrome that results from a constellation of disease processes affecting myocardial function. Although recent studies have suggested a declining or stable incidence of heart failure, patients with heart failure continue to have high hospitalization and readmission rates, resulting in a substantial economic and public health burden. We searched PubMed and Google Scholar to identify published literature from 1998 through 2018 using the following keywords: heart failure, readmissions, predictors, prediction models, and interventions. Cited references were also used to identify relevant literature. Developments in the diagnosis and management of patients with heart failure have improved hospitalization and readmission rates in the past few decades. However, heart failure remains the most common cause of hospitalization in persons older than 65 years. As a result, given the enormous clinical and financial burden associated with heart failure readmissions on health care, there has been growing interest in the investigation of mechanisms aimed at improving outcomes and curtailing associated costs of care. Herein, we review the current literature on clinical and socioeconomic predictors of heart failure readmissions, briefly discussing limitations of existing strategies and providing an overview of current technology aimed at reducing hospitalizations.
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Affiliation(s)
- Amanda Su
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Ashley N Beecy
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Cardiology, Weill Cornell Medicine, New York, NY
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Maria G Karas
- Department of Cardiology, Weill Cornell Medicine, New York, NY.
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Flint KM, Fairclough DL, Spertus JA, Bekelman DB. Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:233-241. [PMID: 30649237 PMCID: PMC6613596 DOI: 10.1093/ehjqcco/qcy061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/03/2018] [Accepted: 12/29/2018] [Indexed: 01/06/2023]
Abstract
AIMS Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being ('QoL domains'). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits. METHODS AND RESULTS Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0-100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean ± standard deviation (SD) KCCQ score was 46.9 ± 19.3, mean age was 65.5 ± 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ ≤ 25, 61-84%/48-62% for KCCQ ≤ 50, 84-97%/26-40% for KCCQ ≤ 60, and 96-100%/8-13% for KCCQ ≤ 75. Patients with KCCQ ≤ 60 had mean ± SD 4.5 ± 2.5 QoL domain deficits (maximum 12), vs. 1.6 ± 1.6 for KCCQ > 60 (P < 0.001). Similar results were seen for KCCQ ≤25 (6.6 ± 2.4 vs. 3.3 ± 2.4), KCCQ ≤ 50 (4.8 ± 2.6 vs. 2.5 ± 2) and KCCQ ≤ 75 (4.0 ± 2.6 vs. 1.0 ± 1.2) (all P < 00001). CONCLUSION KCCQ ≤ 60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits.
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Affiliation(s)
- Kelsey M Flint
- Rocky Mountain Regional VA Medical Center, Cardiology, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA
- Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA
| | - Diane L Fairclough
- Department of Biostatics and Informatics, Colorado School of Public Health, 13199 E Montview Blvd, Suite 339, Aurora, CO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, USA
| | - David B Bekelman
- Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA
- Rocky Mountain Regional VA Medical Center, Palliative Care, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, 12631 E 17th Ave, Anschutz Medical Campus, Aurora, CO, USA
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Erceg P, Despotovic N, Milosevic DP, Soldatovic I, Mihajlovic G, Vukcevic V, Mitrovic P, Markovic-Nikolic N, Micovic M, Mitrovic D, Davidovic M. Prognostic value of health-related quality of life in elderly patients hospitalized with heart failure. Clin Interv Aging 2019; 14:935-945. [PMID: 31190779 PMCID: PMC6535443 DOI: 10.2147/cia.s201403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose: Previous research has shown that poor health-related quality of life (HRQOL) is associated with adverse long-term prognosis in patients with heart failure (HF); however, there have been inconsistencies among studies and not all of them confirmed the prognostic value of HRQOL. In addition, few studies involved elderly patients and most focused on all-cause mortality and HF-related hospitalization as outcomes. The aim of our study was to determine whether HRQOL is a predictor and an independent predictor of long-term cardiac mortality, all-cause mortality, and HF-related rehospitalization in elderly patients hospitalized with HF. Patients and methods: This prospective observational study included 200 elderly patients hospitalized with HF in Serbia. HRQOL was measured using the Minnesota Living with Heart Failure questionnaire (MLHFQ). The median follow-up period was 28 months. The primary outcome was cardiac mortality, and all-cause mortality and HF-related rehospitalization were secondary outcomes. Survival analysis was conducted using the Kaplan–Meier method and Cox-proportional hazards regression. Results: Subjects with poor HRQOL (higher than the median MLHFQ score) had a higher probability of cardiac mortality (P=0.029) and HF-related rehospitalization (P=0.001) during long-term follow-up. Poor HRQOL was an independent predictor of cardiac mortality (HR: 2.051, 95% CI: 1.260–3.339, P=0.004), all-cause mortality (HR: 1.620, 95% CI: 1.076–2.438, P=0.021), and HF-related rehospitalization (HR: 2.040, 95% CI: 1.290–3.227, P=0.002). Conclusion: HRQOL is an independent predictor of long-term cardiac mortality in elderly patients hospitalized with HF. It also independently predicts all-cause mortality and HF-related rehospitalization. HRQOL could be used as a complementary clinical predictive tool in this patient population.
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Affiliation(s)
- Predrag Erceg
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Department of Geriatrics, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Nebojsa Despotovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Department of Geriatrics, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Dragoslav P Milosevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Department of Geriatrics, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Mihajlovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Department of Geriatrics, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Vladan Vukcevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Predrag Mitrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Markovic-Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Department of Cardiology, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Milica Micovic
- Clinical Department of Geriatrics, "Zvezdara" University Hospital, Belgrade, Serbia
| | - Dragica Mitrovic
- Department of Physical Medicine and Rehabilitation, "Zvezdara" University Hospital, Belgrade, Serbia
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Graney BA, Au DH, Barón AE, Cheng A, Combs SA, Glorioso TJ, Paden G, Parsons EC, Rabin BA, Ritzwoller DP, Stonecipher JJ, Turvey C, Welsh CH, Bekelman DB. Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial to improve quality of life: a study protocol for a randomized clinical trial. Trials 2019; 20:355. [PMID: 31196156 PMCID: PMC6567600 DOI: 10.1186/s13063-019-3417-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/08/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND People living with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) suffer impaired quality of life due to burdensome symptoms and depression. The Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial aims to determine the effect of a multidisciplinary, team-based intervention on quality of life in people with these common diseases. METHODS/DESIGN The ADAPT trial is a two-site, patient-level randomized clinical trial that examines the effectiveness of the ADAPT intervention compared to usual care on patient-reported quality of life at 6 months in veterans with CHF, COPD or ILD with poor quality of life and increased risk for hospitalization or death. The ADAPT intervention involves a multidisciplinary team-a registered nurse, social worker, palliative care specialist, and primary care provider (with access to a pulmonologist and cardiologist)-who meet weekly to make recommendations and write orders for consideration by participants' individual primary care providers. The nurse and social worker interact with participants over six visits to identify and manage a primary bothersome symptom and complete a structured psychosocial intervention and advance care planning. The primary outcome is change in patient-reported quality of life at 6 months as measured by the Functional Assessment of Chronic Illness Therapy-General questionnaire. Secondary outcomes at 6 months include change in symptom distress, depression, anxiety, disease-specific quality of life hospitalizations, and advance care planning communication and documentation. Intervention implementation will be assessed using a mixed-methods approach including a qualitative assessment of participants' and intervention personnel experiences and a quantitative assessment of care delivery, resources, and cost. DISCUSSION The ADAPT trial studies an innovative intervention designed to improve quality of life for veterans with common, burdensome illnesses by targeting key underlying factors-symptoms and depression-that impair quality of life but persist despite disease-specific therapies. Leveraging the skills of affiliate health providers with physician supervision will extend the reach of palliative care and improve quality of life for those with advanced disease within routine outpatient care. The hybrid effectiveness/implementation design of the ADAPT trial will shorten the time to broader dissemination if effective and create avenues for future research. TRIAL REGISTRATION ClinicalTrials.gov, NCT02713347 . Registered March 19, 2016.
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Affiliation(s)
- Bridget A Graney
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA. .,University of Colorado Anschutz Medical Campus, Aurora, USA. .,National Jewish Health, Anschutz Medical Campus, 12700 East 19th Avenue, Research 2, 9th Floor, Box C272, Aurora, CO, 80045, USA.
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA
| | - Anna E Barón
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Cheng
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara A Combs
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas J Glorioso
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
| | - Grady Paden
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Elizabeth C Parsons
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Borsika A Rabin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | | | - Carolyn Turvey
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Center for Access and Delivery Research and Evaluation, Department of Veterans Affairs, Iowa City Health Care System, Iowa City, IA, USA
| | - Carolyn H Welsh
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
| | - David B Bekelman
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
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Endrighi R, Dimond AJ, Waters AJ, Dimond CC, Harris KM, Gottlieb SS, Krantz DS. Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure. Psychol Health 2019; 34:1250-1266. [PMID: 31111738 DOI: 10.1080/08870446.2019.1609676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA
| | - Andrew J Dimond
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | | | - Kristie M Harris
- Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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80
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Aaronson EL, George N, Ouchi K, Zheng H, Bowman J, Monette D, Jacobsen J, Jackson V. The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care. J Pain Symptom Manage 2019; 57:944-951. [PMID: 30776539 PMCID: PMC6713219 DOI: 10.1016/j.jpainsymman.2019.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Heart failure (HF) is associated with symptom exacerbations and risk of mortality after an emergency department (ED) visit. Although emergency physicians (EPs) treat symptoms of HF, often the opportunity to connect with palliative care is missed. The "surprise question" (SQ) "Would you be surprised if this patient died in the next 12 months?" is a simple tool to identify patients at risk for 12-month mortality. OBJECTIVES The objective of this study was to assess the accuracy of the SQ when used by EPs to assess patients with HF. METHODS We conducted a prospective cohort study in which clinicians applied the SQ to patients presenting to the ED with symptoms of HF. Chart review and review of death records were completed. The primary outcome was accuracy of the surprise question to predict 12-month mortality. A univariate analysis for potential predictors of 12-month mortality was performed. RESULTS During the study period, 199 patients were identified, and complete data were available for 97% of observations (n = 193). The one-year mortality was 29%. EPs reported that "they would not be surprised" if the patient died within the next 12 months in 53% of cases. 42.7% of these patients died within 12 months compared to 13.3% in the "would be surprised" group. There was a strong association with death in the "not surprised" group (odds ratio 4.85, 95% CI 2.34-9.98, P < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of the SQ were 78.6%, 56.9%, 42.7%, and 86.7%, respectively, with c-statistic = 0.68. CONCLUSION The SQ screening tool can assist ED providers in identifying HF patients that would benefit from early palliative care involvement.
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Affiliation(s)
- Emily L Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts, USA.
| | - Naomi George
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Zheng
- Biostatistic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Bowman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Factors Affecting Self-care Maintenance and Management in Patients With Heart Failure: Testing a Path Model. J Cardiovasc Nurs 2019; 34:297-305. [PMID: 31033857 DOI: 10.1097/jcn.0000000000000575] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Self-care is indispensable for health maintenance and well-being. This naturalistic decision-making process involves behavioral choices to maintain physiological stability (self-care maintenance) and response to occurring symptoms (self-care management). However, several factors affect self-care, but some have contradictory results. OBJECTIVE We aimed to examine how depressive symptoms, social support, eHealth literacy, and heart failure (HF) knowledge directly and indirectly affect self-care maintenance and management and to identify the mediating role of self-care confidence in self-care maintenance and management. METHODS The study included a total of 141 patients with HF (average age, 65.2 years; male, 55.3%). We analyzed their data, including demographic and clinical characteristics, obtained from the Patient Health Questionnaire-9, Multidimensional Scale of Perceived Social Support, eHealth Literacy Scale, Dutch Heart Failure Knowledge Scale, and Self-Care of Heart Failure Index. Furthermore, path analysis was conducted to examine the effects of the study variables on self-care maintenance and management. RESULTS Self-care confidence significantly and directly affected self-care maintenance and management and mediated the relationships between factor variables (depressive symptoms, social support, and HF knowledge) and outcome variables (self-care maintenance and management). Specifically, depressive symptoms had a negative and direct effect on self-care maintenance, whereas eHealth literacy had significant and direct effects on self-care management and HF knowledge. CONCLUSION Self-care confidence decreases the negative effects of depressive symptoms on self-care. This study underscores the need for interventions targeting patients' self-care confidence to maximize self-care among patients with HF.
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82
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Stockdill ML, Patrician PA, Bakitas M. Understanding and Measuring Symptom Burden in Heart Failure: A Concept Analysis. West J Nurs Res 2019; 41:1423-1447. [PMID: 30895895 DOI: 10.1177/0193945919833710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heart failure is a common, complex, and costly condition accompanied by a high degree of symptom burden. The concept of heart failure symptom burden has been used and measured inconsistently in research. To develop effective symptom management and palliation strategies, a clear conceptual understanding is needed. Rodgers' evolutionary method of concept analysis was used to identify articles in CINAHL, Embase, Scopus, and PubMed focused on chronic heart failure. Analysis of 20 articles revealed key attributes (subjectivity, negative impact on daily life and/or overall functioning, synergistic symptom associations, and symptom exacerbation), related terms (symptom distress and symptom experience), a surrogate term (heart failure burden), antecedents (heart failure classification or stage), and consequences (increased morbidity/mortality, decreased functioning, increased symptom prevalence/severity, decreased quality of life, and recurrent hospital admissions). No gold standard for measurement was identified. Research is needed to validate heart failure symptom burden measurement strategies across populations.
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83
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Moshki M, Khajavi A, Hashemizadeh H, Vakilian F, Minaee S, Martin SS. Dark or Bright Half of the Moon: A Qualitative Study Exploring the Experience of Iranian Heart Failure Patients Regarding their Quality of Life. Open Access Maced J Med Sci 2019; 7:824-830. [PMID: 30962847 PMCID: PMC6447335 DOI: 10.3889/oamjms.2019.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health problem in different societies and has numerous impacts on quality of life (QOL). AIM The present study was carried out with the aim to explore the experience of HF patients regarding the negative effects of the disease on their QOL. METHODS In this qualitative exploratory study data collection was performed through face-to-face, semi-structured, in-depth interviews with 19 patients with HF, who were selected through purposive sampling method from April to September 2017. Data analysis was carried out based on the framework analysis method. RESULTS The negative consequences of HF on QOL emerged in the form of 6 main themes including symptoms, disease complications, cognitive impairment, psychological distress, functional limitations and economic problems. Most of the participants (14 out of 19) assessed their QOL as well or very well. CONCLUSION The majority of the patients in this study, despite the many negative impacts of HF, had a high QOL that could indicate their satisfaction and effective coping with HF by creating a positive outlook and the perceived positive effects of the disease.
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Affiliation(s)
- Mahdi Moshki
- Department of Health Education and Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Abdoljavad Khajavi
- Department of Community Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Haydeh Hashemizadeh
- PhD Candidate of Health Promotion, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Farveh Vakilian
- Department of Cardiology, Fellowship in Heart Failure and Transplantation, Preventive Atherosclerotic Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Minaee
- Fellowship in Heart Failure and Transplantation, Department of Cardiovascular Diseases, Razavi Hospital, Mashhad, Iran
| | - Shadi S Martin
- Hartford Foundation Scholar, University of Nevada, School of Social Work
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84
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Cui X, Dong W, Zheng H, Li H. Collaborative care intervention for patients with chronic heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14867. [PMID: 30921185 PMCID: PMC6456130 DOI: 10.1097/md.0000000000014867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Patients with chronic heart failure (HF) show many symptoms that worsen the quality of life (QoL). Collaborative care intervention (CCI) aims to improve the QoL and symptoms by integrating psychosocial and palliative strategies in chronic care. METHODS The PubMed, EMBASE, and Cochrane library databases were searched from inception to September 2018. The included studies were used to determine pooled standard mean differences (SMDs) and associated 95% confidence intervals (CIs). The data were assessed by fixed- and random effects models, respectively. RESULTS Twenty-one studies including 2999 patients with chronic heart failure were included. The results showed significantly improved QoL in the CCI group compared with the routine care group (SMD = 0.60, 95%CI 0.27-0.94, Pheterogeneity < .001, I = 94.1%). The patients who received face-to-face interventions experienced a significant improvement (SMD = 0.54, 95%CI 0.24-0.85, Pheterogeneity < .001, I = 88.7%) in terms of QoL compared with those administered only telephone interventions. Furthermore, significantly improved anxiety level (SMD = 0.33, 95%CI 0.12-0.55, Pheterogeneity = .612, I = 0%) and 6-min walk test (SMD = 0.46, 95%CI 0.29-0.64, Pheterogeneity = .458, I = 0%) were found in the CCI group compared with the routine care group. CONCLUSION These findings confirmed that collaborative care intervention effectively improves the quality of life as well as psychological (anxiety) and physical (6-min walk test) functions in patients with chronic heart failure compared with routine care. Furthermore, face-to-face interventions show a greater improvement of QoL compared with telephone-only interventions.
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Affiliation(s)
- Xiaoting Cui
- Department of Cardiology, Beijing He Ping Li Hospital
| | - Wenyi Dong
- Department of Neurology, Beijing Huaxin Hospital, Beijing, China
| | | | - Haiyan Li
- Department of Cardiology, Beijing He Ping Li Hospital
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85
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Spindler H, Leerskov K, Joensson K, Nielsen G, Andreasen JJ, Dinesen B. Conventional Rehabilitation Therapy Versus Telerehabilitation in Cardiac Patients: A Comparison of Motivation, Psychological Distress, and Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030512. [PMID: 30759761 PMCID: PMC6388222 DOI: 10.3390/ijerph16030512] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/16/2022]
Abstract
Telerehabilitation (TR) has gained attention as a promising rehabilitation format. Our study examined how patients responded to TR and whether it provided adequate support for their lifestyle changes and self-care efforts when compared to conventional rehabilitation (CR). Cardiac patients (n = 136) were randomly assigned to a TR or CR group. The TR group was provided with relevant health care technology for a period of three months, and both groups filled in questionnaires on their motivation for lifestyle changes and self-care psychological distress, and quality of life at 0, 3, 6, and 12 months. Patients in both groups were found to be equally motivated for lifestyle changes and self-care (p < 0.05) and they experienced similar levels of psychological distress and quality of life. TR is comparable to conventional rehabilitation in motivating patients, preventing psychological distress and improving quality of life. Although we observed an initial increase in autonomous motivation in the telerehabilitation group, this positive difference in motivation does not last over time. As such, neither rehabilitation format seems able to ensure long-term motivation. Therefore, TR may serve as a viable replacement for conventional rehabilitation when considered relevant. Further research is needed to enhance long-term motivation, and maybe telerehabilitation can help to achieve this.
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Affiliation(s)
- Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.
| | - Kasper Leerskov
- SMI®, Department of Health Science and Technology, Aalborg University, 9200 Aalborg East, Denmark.
| | - Katrine Joensson
- Department of Micro- and Nanotechnology, The Technical University of Denmark, 2800 Kgs. Lyngby, Denmark.
| | - Gitte Nielsen
- Department of Cardiology, Vendsyssel Hospital, 9800 Hjoerring, Denmark.
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
| | - Birthe Dinesen
- Laboratory of Welfare Technologies - Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, 9200 Aalborg East, Denmark.
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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Abdelbasset WK, Alqahtani BA, Elshehawy AA, Tantawy SA, Elnegamy TE, Kamel DM. Examining the impacts of 12 weeks of low to moderate-intensity aerobic exercise on depression status in patients with systolic congestive heart failure - A randomized controlled study. Clinics (Sao Paulo) 2019; 74:e1017. [PMID: 31576916 PMCID: PMC6751366 DOI: 10.6061/clinics/2019/e1017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/04/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Psychiatric depression disorder is common in patients with systolic congestive heart failure (HF), and both conditions share underlying pathophysiological mechanisms. The incidence rate of depression disorder has clearly increased with the increase in HF manifestations in recent decades. Depression disorder is considered an independent predisposing factor for hospitalization, disturbed functional performance, and high rates of morbidity and mortality in HF patients. This randomized controlled study was designed to examine the impacts of low- to moderate-intensity aerobic exercise training on depression status in patients with systolic congestive HF. METHODS A total of 46 systolic congestive HF patients with depression (40-60 years of age) were randomized to receive twelve weeks of mild- to moderate-intensity aerobic exercise plus standard medical treatment (exercise group) or standard medical treatment without any exercise intervention (control group). Depression status was examined using the validated Patient Health Questionnaire-9 (PHQ9) pre- and post-intervention at the end of the study program. RESULTS No significant differences were observed between the exercise and control groups in demographic data or clinical characteristics (p>0.05). Both study groups showed a significant reduction in depression status at the end of the 12-week intervention (p<0.05). The comparison between the mean values of the depression scores showed significant differences between the two groups after 6 and 12 weeks of the intervention, indicating a greater reduction in depression scores in the exercise group than in the control group (p<0.05). CONCLUSIONS Twelve weeks of a low- to moderate-intensity aerobic exercise program was safe and effective for reducing depression severity in patients with systolic congestive HF. Low- to moderate-intensity aerobic training should be recommended for cardiac patients, particularly those with HF-related depression.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- *Corresponding author. E-mail:
| | - Bader A Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmed A Elshehawy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Tabuk, Saudi Arabia
| | - Sayed A Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine, Cairo University, Giza, Egypt
| | - Tamer E Elnegamy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Dalia M Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy for Women's Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One 2018; 13:e0205953. [PMID: 30427855 PMCID: PMC6235604 DOI: 10.1371/journal.pone.0205953] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/04/2018] [Indexed: 01/26/2023] Open
Abstract
Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel's theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel's theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.
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Affiliation(s)
- Ting-Yu Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- National Defense Medical Center, School of Medicine, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
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89
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Stein LA, Goldmann E, Zamzam A, Luciano JM, Messé SR, Cucchiara BL, Kasner SE, Mullen MT. Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke. Front Neurol 2018; 9:890. [PMID: 30450075 PMCID: PMC6224432 DOI: 10.3389/fneur.2018.00890] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.
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Affiliation(s)
- Laura A. Stein
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, NY, United States
| | - Ahmad Zamzam
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jean M. Luciano
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven R. Messé
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael T. Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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90
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Fischer SM, Min SJ, Atherly A, Kline DM, Gozansky WS, Himberger J, Lopez J, Lester K, Fink RM. Apoyo con Cariño (support with caring): RCT protocol to improve palliative care outcomes for Latinos with advanced medical illness. Res Nurs Health 2018; 41:501-510. [PMID: 30302769 DOI: 10.1002/nur.21915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/09/2018] [Indexed: 11/07/2022]
Abstract
Latinos are more likely to experience uncontrolled pain, and institutional death, and are less likely to engage in advance care planning. Efforts to increase access to palliative care must maximize primary palliative care and community based models to meet the ever-growing need in a culturally sensitive and congruent manner. Patient navigator interventions are community-based, culturally tailored models of care that have been successfully implemented to improve disease prevention, early diagnosis, and treatment. We have developed a patient navigation intervention to improve palliative care outcomes for seriously ill Latinos. We describe the protocol for a National Institute of Nursing Research-funded randomized controlled trial designed to determine the effectiveness of the manualized patient navigator intervention. We aim to enroll 240 Latino adults with non-cancer, advanced medical illness from both urban and rural clinical sites. Participants will be randomized to the intervention group (five palliative care patient navigator visits plus bilingual educational materials) or control group (usual care plus bilingual educational materials). Outcomes include quality of life (Functional Assessment of Chronic Illness Therapy), advance care planning (Advance Care Planning Engagement survey), pain (Brief Pain Inventory), symptom management (Edmonton Symptom Assessment Scale-revised), hospice utilization, and cost and utilization of healthcare resources. This culturally tailored, evidence-based, theory-driven, innovative patient navigation intervention has significant potential to improve palliative care for Latinos, and facilitate health equity in palliative and end-of-life care.
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Affiliation(s)
- Stacy M Fischer
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sung-Joon Min
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam Atherly
- University of Vermont, College of Medicine, Burlington, Vermont
| | - Danielle M Kline
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Wendolyn S Gozansky
- Kaiser Permanente, Institute for Health Research, Colorado Permanente Medical Group, Denver, Colorado
| | - John Himberger
- University of Colorado, South, Colorado Springs, Colorado
| | - Joseph Lopez
- University of Colorado, North, Colorado Springs, Colorado
| | | | - Regina M Fink
- Division of General Internal Medicine, University of Colorado School of Medicine, College of Nursing, Aurora, Colorado
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91
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Comparative symptom biochemistry between moderate and advanced heart failure. Heart Lung 2018; 47:565-575. [PMID: 30314637 DOI: 10.1016/j.hrtlng.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF). OBJECTIVES The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF. METHODS This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage. Linear modeling was used to compare relationships among biomarkers and physical symptoms between cohorts. RESULTS Worse myocardial stress, systemic inflammation and endothelial dysfunction were associated with worse physical symptoms in moderate HF (n=48), but less physical symptom burden in advanced HF (n=48). CONCLUSIONS Where patients are in the HF trajectory needs to be taken into consideration when exploring biological underpinnings of physical HF symptoms.
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92
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Changes in Heart Failure Symptoms are Associated With Changes in Health-related Quality of Life Over 12 Months in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:460-466. [DOI: 10.1097/jcn.0000000000000493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Auld JP, Mudd JO, Gelow JM, Lyons KS, Hiatt SO, Lee CS. Patterns of heart failure symptoms are associated with self-care behaviors over 6 months. Eur J Cardiovasc Nurs 2018; 17:543-551. [PMID: 29442523 PMCID: PMC6067986 DOI: 10.1177/1474515118759074] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time. AIMS To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time. METHOD Latent mixture analysis was used to identify subgroups based on physical symptoms of dyspnea, sleepiness and edema (using the heart failure somatic perception and Epworth sleepiness scales). Growth modeling was used to determine if symptom subgroups were associated with self-care behaviors (using the self-care in heart failure index) over 6 months. Sociodemographic and clinical variables predicting the likelihood of subgroup membership were identified using logistic regression. RESULTS The sample ( n=146) was on average 57 years old, 70% were men and 59% had class III/IV heart failure. Two symptom subgroups were identified (entropy 0.91): a high symptom group ( n=24; 16%) with no significant change in symptoms over time (high sustained), and a low symptom group ( n=122; 84%) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (odds ratio (OR) 3.67, P=0.023) and patients with more depressive symptoms (OR 1.16, P=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin-angiotensin-aldosterone system agent were less likely to be in the high symptom group (OR 0.17, P=0.015). CONCLUSION Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. The results of this study support symptoms as an important driver of self-care behaviors.
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Affiliation(s)
- Jonathan P. Auld
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - James O. Mudd
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Jill M. Gelow
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Karen S. Lyons
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Shirin O. Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Christopher S. Lee
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
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95
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AbuRuz ME. Anxiety and depression predicted quality of life among patients with heart failure. J Multidiscip Healthc 2018; 11:367-373. [PMID: 30104881 PMCID: PMC6071625 DOI: 10.2147/jmdh.s170327] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Anxiety and depression are prevalent among patients with heart failure. However, their effect on the quality of life (QoL) is not well investigated in developing countries. Therefore, the purpose of this study was to test the effect of anxiety and depression on QoL among Jordanian patients with heart failure. Patients and methods Two hundred patients with a confirmed diagnosis of heart failure from 1 governmental and 1 private hospital in Amman, Jordan, were recruited between March and August, 2017. A descriptive, cross-sectional design was used. Anxiety and depression were measured using the Arabic version of the Hospital Anxiety and Depression Scale. QoL was measured using the Arabic version of the Short Form-36. Results Patients reported poor QoL in both physical component summary (M ± SD; 35.8±9.6) and mental component summary (M ± SD; 41.5±11.3). Prevalence rates for anxiety and depression were 62% and 65%, respectively. In stepwise regression analysis, anxiety and depression were independent predictors for poor QoL in both summaries, p<0.001. Conclusion Patients with heart failure have poor QoL and high anxiety and high depression prevalence rates. Inclusion of routine assessment and management of anxiety and depression in heart failure protocols is highly recommended.
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Affiliation(s)
- Mohannad Eid AbuRuz
- Clinical Nursing Department, College of Nursing, Applied Science Private University, Amman, Jordan,
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96
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Lewin WH, Schaefer KG. Integrating palliative care into routine care of patients with heart failure: models for clinical collaboration. Heart Fail Rev 2018; 22:517-524. [PMID: 28191605 DOI: 10.1007/s10741-017-9599-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Heart failure (HF) affects nearly 5.7 million Americans and is described as a chronic incurable illness carrying a poor prognosis. Patients living with HF experience significant symptoms including dyspnea, pain, anxiety, fatigue, and depression. As the illness advances into later stages, symptoms become more intense and refractory to standard treatments, leading to recurrent acute-care utilization and contributing to poor quality of life. Advanced HF symptoms have been described to be as burdensome, if not more than, those in cancer populations. Yet access to and provision of palliative care (PC) for this population has been described as suboptimal. The Institute of Medicine recently called for better access to PC for seriously ill patients. Despite guidelines recommending the inclusion of PC into the multidisciplinary HF care team, there is little data offering guidance on how to best operationalize PC skills in caring for this population. This paper describes the emerging literature describing models of PC integration for HF patients and aims to identify key attributes of these care models that may help guide future multi-site clinical trials to define best practices for the successful delivery of PC for patients living with advanced HF.
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Affiliation(s)
- Warren H Lewin
- Brookdale Department of Geriatrics and Palliative Medicine, The Mount Sinai Hospital, New York, NY, 10029, USA.
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA.
| | - Kristen G Schaefer
- Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, 450 Brookline Ave, DA-2007, Boston, MA, 02215, USA
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Gorodeski EZ, Goyal P, Hummel SL, Krishnaswami A, Goodlin SJ, Hart LL, Forman DE, Wenger NK, Kirkpatrick JN, Alexander KP. Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future. J Am Coll Cardiol 2018; 71:1921-1936. [PMID: 29699619 PMCID: PMC7304050 DOI: 10.1016/j.jacc.2018.02.059] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.
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Affiliation(s)
- Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California
| | - Sarah J Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Linda L Hart
- Bon Secours Heart and Vascular Institute, Richmond, Virginia
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center. J Cardiovasc Nurs 2018; 31:313-22. [PMID: 25829136 DOI: 10.1097/jcn.0000000000000256] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. OBJECTIVE The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. METHODS Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. RESULTS A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). CONCLUSIONS Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
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Cognitive Function Does Not Impact Self-reported Health-Related Quality of Life in Heart Failure Patients. J Cardiovasc Nurs 2018; 31:405-11. [PMID: 26132279 DOI: 10.1097/jcn.0000000000000277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with heart failure (HF) often demonstrate impairment across multiple domains of cognitive functioning and report poor health-related quality of life (HRQoL). Previous researchers have found that cognitive deficits were generally not associated with HRQoL in a carefully evaluated sample. The exception was memory, which was only weakly associated with HRQoL. However, cognitive deficits interfere with self-care and disease self-management, which could be expected to affect HRQoL. OBJECTIVE We sought to verify this counterintuitive finding in a large well-characterized sample of HF patients using a well-validated neuropsychological battery. METHODS Participants were 302 adults (63% male) predominately white (72.5%) HF patients (68.7 ± 9.6 years) recruited from 2 medical centers. Self-reported HRQoL was assessed using the Kansas City Cardiomyopathy Questionnaire. Participants completed a neuropsychological battery examining attention, executive function, memory, and visuospatial functioning. Hierarchical multiple linear regression was used for analyses. RESULTS Mild global cognitive impairment was observed in 29.5% of the sample (Modified Mini-Mental State [3MS] Examination score <90). Controlling for gender, depression, HF severity, premorbid IQ, comorbidities, and education, only executive function predicted HRQoL, β = .17, P < .05. However, executive function accounted for only 0.6% of the variance in HRQoL. CONCLUSION Cognitive function generally did not predict HRQoL in HF patients. The correlates of HRQoL in HF do not appear to include mild cognitive impairment. Other factors may play a bigger role such as disease severity, age, and depressive symptoms. Future studies should investigate modifiable determinants of HRQoL in HF patients, toward the goal of finding interventions that preserve HRQoL during this chronic illness.
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Bekelman DB, Allen LA, McBryde CF, Hattler B, Fairclough DL, Havranek EP, Turvey C, Meek PM. Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial. JAMA Intern Med 2018; 178:511-519. [PMID: 29482218 PMCID: PMC5876807 DOI: 10.1001/jamainternmed.2017.8667] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. OBJECTIVE To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. INTERVENTIONS Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. MAIN OUTCOMES AND MEASURES The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. RESULTS Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control arm (difference, 2.6; 95% CI, -1.3 to 6.6; P = .19). Among secondary outcomes, depressive symptoms and fatigue improved at 6 months with CASA (effect size of -0.29 [95% CI, -0.53 to -0.04] for depressive symptoms and -0.30 [95% CI, -0.55 to -0.06] for fatigue; P = .02 for both). There were no significant changes in overall symptom distress, pain, shortness of breath, or number of hospitalizations. Mortality at 12 months was similar in both arms (10 patients died receiving CASA, and 13 patients died receiving usual care; P = .52). CONCLUSIONS AND RELEVANCE This multisite randomized clinical trial of the CASA intervention did not demonstrate improved heart failure-specific health status. Secondary outcomes of depression and fatigue, both difficult symptoms to treat in heart failure, improved. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01739686.
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Affiliation(s)
- David B Bekelman
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Connor F McBryde
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Brack Hattler
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Diane L Fairclough
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - Edward P Havranek
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.,Department of Medicine, Denver Health, Denver, Colorado
| | | | - Paula M Meek
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora
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