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Riegel B, De Maria M, Barbaranelli C, Matarese M, Ausili D, Stromberg A, Vellone E, Jaarsma T. Symptom Recognition as a Mediator in the Self-Care of Chronic Illness. Front Public Health 2022; 10:883299. [PMID: 35655456 PMCID: PMC9152258 DOI: 10.3389/fpubh.2022.883299] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem. Purpose The aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness. Methods A secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance). Results Symptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors. Conclusion Our findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
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Abstract
The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.
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Luo H, Lindell DF, Jurgens CY, Fan Y, Yu L. Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082692. [PMID: 32295183 PMCID: PMC7215728 DOI: 10.3390/ijerph17082692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
A growing body of evidence supports the fact that optimal health-related quality of life is largely dependent on patient competence in symptom perception. However, many studies have reported poor symptom perception in patients with heart failure. In China, there has been no previous research on assessing the symptom perception ability of patients with heart failure. This study aimed to describe how Chinese patients with heart failure perceive their symptoms, as well as to explore their influencing factors. A theory-based, descriptive, correlational cross-sectional design was used in this study. Data on symptom perception and factors related to symptom perception were collected via structured interviews and medical records. A convenience sample of 208 hospitalized patients was enrolled. The degree of symptom perception in this study was at a high level. The results showed that the level of depression, the New York Heart Association functional class, the left ventricular ejection fraction, and educational background were identified as independent factors of symptom perception in Chinese patients with heart failure. The degree of symptom perception of patients with heart failure was affected by personal, psychological, and physiological factors. Health policy and healthcare providers should pay more attention and deepen the understanding to Chinese patients with heart failure to provide better healthcare.
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Affiliation(s)
- Hong Luo
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan 430071, China; (H.L.)
| | - Deborah F. Lindell
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
| | - Corrine Y. Jurgens
- William F. Connell School of Nursing, Boston College, Boston, MA 02647, USA
| | - Yongsheng Fan
- Department of Public Health and Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Liping Yu
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan 430071, China; (H.L.)
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Santos GC, Liljeroos M, Dwyer AA, Jaques C, Girard J, Strömberg A, Hullin R, Schäfer-Keller P. Symptom perception in heart failure: a scoping review on definition, factors and instruments. Eur J Cardiovasc Nurs 2019; 19:100-117. [DOI: 10.1177/1474515119892797] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:Symptom perception in heart failure has been identified as crucial for effective self-care that is a modifiable factor related to decreased hospital readmission and improved survival.Aims:To review systematically the heart failure symptom perception literature and synthesise knowledge on definition, description, factors and instruments.Methods:We conducted a scoping review including studies reporting patient-reported symptom perception in adults with heart failure. Structured searches were conducted in Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, JBI and grey literature. Two authors independently reviewed references for eligibility. Data were charted in tables and results narratively summarised.Results:The search yielded 3057 references, of which 106 were included. The definition of heart failure symptom perception comprised body listening, monitoring signs, recognising, interpreting and labelling symptoms, and furthermore awareness of and assigning meaning to the change. Symptom monitoring, recognition and interpretation were identified as challenging. Symptom perception facilitators include prior heart failure hospitalisation, heart failure self-care maintenance, symptom perception confidence, illness uncertainty and social support. Barriers include knowledge deficits, symptom clusters and lack of tools/materials. Factors with inconsistent impact on symptom perception include age, sex, education, experiences of living with heart failure, comorbidities, cognitive impairment, depression and symptom progression. One instrument measuring all dimensions of heart failure symptom perception was identified.Conclusion:Heart failure symptom perception definition and description have been elucidated. Several factors facilitating or hampering symptom perception are known. Further research is needed to determine a risk profile for poor symptom perception – which can then be taken into consideration when supporting heart failure self-care.
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Affiliation(s)
- Gabrielle Cécile Santos
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Maria Liljeroos
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, USA
| | - Cécile Jaques
- Medical Library, Research and Education Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Josepha Girard
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Roger Hullin
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Petra Schäfer-Keller
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
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5
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Pak VM, Strouss L, Yaggi HK, Redeker NS, Mohsenin V, Riegel B. Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea. J Sleep Res 2018; 28:e12778. [PMID: 30421541 DOI: 10.1111/jsr.12778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
Patients with both heart failure and obstructive sleep apnea often have poor, repeatedly disrupted sleep, and yet they frequently do not complain of excessive daytime sleepiness. Understanding this lack of perceived sleepiness is crucial for the case identification and treatment of obstructive sleep apnea in the heart failure population at high risk of this disease, especially given the association between untreated obstructive sleep apnea and mortality among patients with heart failure. In this review, we present epidemiologic evidence concerning the lack of sleepiness symptoms in heart failure and obstructive sleep apnea, explore possible mechanistic explanations for this relationship, assess the benefits of treatment in this population, discuss implications for clinical practice and explore directions for future research.
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Affiliation(s)
- Victoria M Pak
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biobehavioral Research Collaborative, School of Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Yale School of Nursing, West Haven, Connecticut, USA.,Emory Nell Hodgson School of Nursing, Atlanta, Georgia, USA
| | - Lisa Strouss
- Jefferson Medical Center, Philadelphia, Pennsylvania, USA
| | - Henry K Yaggi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Vahid Mohsenin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Barbara Riegel
- Department of Biobehavioral Research Collaborative, School of Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Kvalem IL, Bergh I, Sogg S, Mala T. Psychosocial characteristics associated with symptom perception 1 year after gastric bypass surgery—a prospective study. Surg Obes Relat Dis 2017; 13:1908-1913. [DOI: 10.1016/j.soard.2017.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
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7
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Farmer SA, Magasi S, Block P, Whelen MJ, Hansen LO, Bonow RO, Schmidt P, Shah A, Grady KL. Patient, Caregiver, and Physician Work in Heart Failure Disease Management: A Qualitative Study of Issues That Undermine Wellness. Mayo Clin Proc 2016; 91:1056-65. [PMID: 27492912 DOI: 10.1016/j.mayocp.2016.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors underlying heart failure hospitalization. METHODS Between January 1, 2012, and May 31, 2012, we combined medical record reviews and cross-sectional qualitative interviews of multiple patients with heart failure, their clinicians, and their caregivers from a large academic medical center in the Midwestern United States. The interview data were analyzed using a 3-step grounded theory-informed process and constant comparative methods. Qualitative data were compared and contrasted with results from the medical record review. RESULTS Patient nonadherence to the care plan was the most important contributor to hospital admission; however, reasons for nonadherence were complex and multifactorial. The data highlight the importance of patient education for the purposes of condition management, timeliness of care, and effective communication between providers and patients. CONCLUSION To improve the consistency and quality of care for patients with heart failure, more effective relationships among patients, providers, and caregivers are needed. Providers must be pragmatic when educating patients and their caregivers about heart failure, its treatment, and its prognosis.
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Affiliation(s)
- Steven A Farmer
- Office of Clinical Practice Innovation, George Washington University School of Medicine and Health Sciences, Washington, DC; Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago
| | - Phoebe Block
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Luke O Hansen
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert O Bonow
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ami Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L Grady
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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8
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Hammash MH, Lennie TA, Crawford T, Heo S, Chung ML, Biddle MJ, Dekker R, Wu JR, Rayens MK, Moser DK. Depressive Symptoms: Mediator of Event-Free Survival in Patients With Heart Failure. West J Nurs Res 2016; 39:539-552. [PMID: 27411977 DOI: 10.1177/0193945916658883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depressive symptoms and poor health perceptions are predictors of higher hospitalization and mortality rates (heart failure [HF]). However, the association between depressive symptoms and health perceptions as they affect event-free survival outcomes in patients with HF has not been studied. The purpose of this secondary analysis was to determine whether depressive symptoms mediate the relationship between health perceptions and event-free survival in patients with HF. A total of 458 HF patients (61.6 ± 12 years, 55% New York Heart Association Class III/IV) responded to one-item health perception question and completed the Patient Health Questionnaire-9. Event-free survival data were collected for up to 4 years. Multiple regression and Cox proportional hazards regression analysis showed that depressive symptoms mediated the relationship between health perceptions and event-free survival. Decreasing depressive symptoms is essential to improve event-free survival in patients with HF.
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Affiliation(s)
| | | | | | - Seongkum Heo
- 3 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - Jia-Rong Wu
- 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Kemper KJ, Carmin C, Mehta B, Binkley P. Integrative Medical Care Plus Mindfulness Training for Patients With Congestive Heart Failure. J Evid Based Complementary Altern Med 2016; 21:282-90. [DOI: 10.1177/2156587215599470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022] Open
Abstract
Congestive heart failure (CHF) has a high rate of morbidity and mortality. It is often accompanied by other medical and psychosocial comorbidities that complicate treatment and adherence. We conducted a proof of concept pilot project to determine the feasibility of providing integrative group medical visits plus mindfulness training for patients recently discharged with CHF. Patients were eligible if they had been discharged from an inpatient stay for CHF within the 12 months prior to the new program. The Compassionate Approach to Lifestyle and Mind–Body (CALM) Skills for Patients with CHF consisted of 8 weekly visits focusing on patient education about medications, diet, exercise, sleep, and stress management; group support; and training in mind–body skills such as mindfulness, self-compassion, and loving-kindness. Over two 8-week sessions, 8/11 (73%) patients completed at least 4 visits. The patients had an average age of 57 years. The most common comorbidities were weight gain, sleep problems, and fatigue. After the sessions, 100% of patients planned to make changes to their diet, exercise, and stress management practices. Over half of the patients who met with a pharmacist had a medication-related problem. Improvements were observed in depression, fatigue, and satisfaction with life. Integrative group visits focusing on healthy lifestyle, support, and skill-building are feasible even among CHF patients and should be evaluated in controlled trials as a patient-centered approach to improving outcomes related to improving medication management, depression, fatigue, and quality of life.
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Affiliation(s)
| | | | - Bella Mehta
- The Ohio State University, Columbus, OH, USA
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10
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Hall KT, Tolkin BR, Chinn GM, Kirsch I, Kelley JM, Lembo AJ, Kaptchuk TJ, Kokkotou E, Davis RB, Conboy LA. Conscientiousness is modified by genetic variation in catechol-O-methyltransferase to reduce symptom complaints in IBS patients. Brain Behav 2015; 5:39-44. [PMID: 25722948 PMCID: PMC4321393 DOI: 10.1002/brb3.294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/22/2014] [Accepted: 09/29/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Attention to and perception of physical sensations and somatic states can significantly influence reporting of complaints and symptoms in the context of clinical care and randomized trials. Although anxiety and high neuroticism are known to increase the frequency and severity of complaints, it is not known if other personality dimensions or genes associated with cognitive function or sympathetic tone can influence complaints. Genetic variation in catechol-O-methyltransferase (COMT) is associated with anxiety, personality, pain, and response to placebo treatment. We hypothesized that the association of complaint reporting with personality might be modified by variation in the COMT val158met genotype. METHODS We administered a standard 25-item complaint survey weekly over 3-weeks to a convenience sample of 187 irritable bowel syndrome patients enrolled in a placebo intervention trial and conducted a repeated measures analysis. RESULTS We found that complaint severity rating, our primary outcome, was negatively associated with the personality measures of conscientiousness (β = -0.31 SE 0.11, P = 0.003) and agreeableness (β = -0.38 SE 0.12, P = 0.002) and was positively associated with neuroticism (β = 0.24 SE 0.09, P = 0.005) and anxiety (β = 0.48 SE 0.09, P < 0.0001). We also found a significant interaction effect of COMT met alleles (β = -32.5 SE 14.1, P = 0.021). in patients genotyped for COMT val158met (N = 87) specifically COMT × conscientiousness (β = 0.73 SE 0.26, P = 0.0042) and COMT × anxiety (β = -0.42 SE 0.16, P = 0.0078) interaction effects. CONCLUSION These findings potentially broaden our understanding of the factors underlying clinical complaints to include the personality dimension of conscientiousness and its modification by COMT.
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Affiliation(s)
- Kathryn T Hall
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Benjamin R Tolkin
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Garrett M Chinn
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; School of Psychology, University of Plymouth Devon, UK
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts ; Endicott College Beverly, Massachusetts
| | - Anthony J Lembo
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Department of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Efi Kokkotou
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Department of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Roger B Davis
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
| | - Lisa A Conboy
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts ; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Massachusetts
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Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation. Am J Med 2013; 126:916-24. [PMID: 23932160 DOI: 10.1016/j.amjmed.2013.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. METHODS We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression. RESULTS PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001). CONCLUSIONS PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes.
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Baldasseroni S, Pratesi A, Orso F, Foschini A, Marella AG, Bartoli N, Mossello E, Bari MD, Marchionni N, Tarantini F. Age-related impact of depressive symptoms on functional capacity measured with 6-minute walking test in coronary artery disease. Eur J Prev Cardiol 2013; 21:647-54. [PMID: 23787796 DOI: 10.1177/2047487313494581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients affected by coronary artery disease (CAD) have a high prevalence of depressive disorders. It has been suggested that depressive symptoms significantly reduce exercise stress test performance in CAD patients, whereas their influence on functional capacity tests, such as the 6-minute walking test (6WT), has been less investigated. The aim of this study was to evaluate the correlation between depressive symptoms and 6WT in patients with CAD and the role of age on this relationship. METHODS We enrolled 148 CAD patients. Global functional capacity was measured with 6WT and the presence of depressive symptoms with the 30-item Geriatric Depression Scale (GDS). GDS score was analysed as a continuous variable or categorized as depression absent (score <10), probable (10-14), or present (≤15). RESULTS A significant inverse correlation was observed between GDS score and distance walked at 6WT. Patients positive for depressive symptoms (probable or present) had a significantly worse performance compared to those with GDS score <10. In multivariable analysis adjusted for indexes of cardiovascular disease severity and comorbidity, the presence of depressive symptoms proved to be an independent predictor of distance walked at 6WT; the predictivity of depressive symptoms on 6WT was age dependent. CONCLUSIONS Depressive symptoms negatively affect 6WT performance among older CAD subjects. Non-cardiovascular parameters, such as psycho-affective disorders, must be taken into account for the interpretation of 6WT performance in old age.
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13
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Abstract
PURPOSE The purpose of this article is to provide an overview of relevant clinical issues including pathophysiology, clinical presentation, assessment/diagnosis, and treatment strategies regarding depression in the heart failure (HF) patient. This information was synthesized to create a clinical protocol to guide the practitioner in identifying, diagnosing, and treating depression in adult HF patients. This protocol was designed for use in the primary care or HF clinic setting. DATA SOURCES PubMed and CINAHL were utilized to search for articles pertaining to HF and depression. CONCLUSIONS The presence of depression in HF is associated with a worsening prognosis, increased risk of death, rehospitalization, and functional decline. The practitioner must identify predisposing factors for depression and evaluate symptoms. Self-rated screening instruments can assist the practitioner in identifying those with depression. Evidence is lacking regarding the treatment of depression in HF but selective serotonin reuptake inhibitors are likely the best option. IMPLICATIONS FOR PRACTICE Understanding depression as it occurs in patients with HF is critical. If depression is identified and properly managed it may lead to better patient outcomes.
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Affiliation(s)
- Louise Smith
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
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14
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Self-reported health-related quality of life and sleep disturbances in Taiwanese people with heart failure. J Cardiovasc Nurs 2011; 25:503-13. [PMID: 20938252 DOI: 10.1097/jcn.0b013e3181e15c37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND RESEARCH OBJECTIVE Health-related quality of life (HRQOL) has been viewed as the most important clinical outcome of heart failure (HF) management. However, information about the predictors of HRQOL in Taiwanese people with HF is limited, especially for the effects of sleep disturbances on HF. PURPOSE The purpose of this study was to identify predictors of HRQOL in Taiwanese people with HF, especially focusing on the extent to which sleep variables are related to HRQOL. METHODS A cross-sectional, descriptive correlational design was used. A nonprobability sample of 125 participants was recruited from the outpatient departments of 2 hospitals located in southern Taiwan. Participants were face-to-face individually interviewed to complete the Kansas City Cardiomyopathy Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Charlson Comorbidity Index. Data for concomitant health problems and HF characteristics were collected from the medical records. RESULTS The mean Kansas City Cardiomyopathy Questionnaire overall summary score for HRQOL in this sample was 70.50 (SD, 19.63). Health-related quality of life physical symptom had the highest score, and the psychological satisfaction domain had the lowest. Six predictors of the HRQOL were identified by using a 3-step hierarchical multiple regression analysis with forward method. The predictors were education (R² = 0.09), New York Heart Association functional class (R² = 0.398), Charlson Comorbidity Index number (R² = 2.6), subjective sleep quality (R² = 0.037), sleep disturbances (R² = 0.015), and sleep latency (R² = 0.018), and together they accounted for a total of 58.5% of the variance in HRQOL. CONCLUSIONS Nurses should use a holistic perspective to help patients understand and manage the impact of HF on their daily lives. Effective interventions for improving HRQOL should be designed based on patients' needs and lifestyles. The study findings could serve as a baseline for further longitudinal studies to explore the long-term effects of correlates and causal relationships among the variables in this Taiwanese population with HF.
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Abstract
BACKGROUND Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom.
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Smithline HA, Caglar S, Blank FSJ. Physician vs patient assessment of dyspnea during acute decompensated heart failure. ACTA ACUST UNITED AC 2010; 16:60-4. [PMID: 20412470 DOI: 10.1111/j.1751-7133.2009.00127.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study assessed agreement between physician and patient self-reported measures of dyspnea severity during acute decompensated heart failure (ADHF). Both the physician and patient measured the change in dyspnea severity over 1 hour using 2 methods: (1) the difference of two static dyspnea measures (STATIC) and (2) a single transitional measure (TRANS). Likert scales and visual analog scales (VASs) were used. Data on 112 patients were analyzed. The mean difference between physician and patient VAS scores was 1 mm (limits of agreement: -54 to 56 mm) using the STATIC data. For TRANS data, the mean difference was 5 mm (limits of agreement: -75 to 86 mm). For the Likert scales, the weighted kappa was 0.13 and 0.23 for STATIC and TRANS data, respectively. The wide limits of agreement restrict our ability to substitute physician assessment for patient self-assessment of dyspnea in patients with ADHF.
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Affiliation(s)
- Howard A Smithline
- Baystate Medical Center, Emergency Medicine, Springfield, MA 01199, USA.
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17
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Hallas CN, Wray J, Andreou P, Banner NR. Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart Lung 2010; 40:111-21. [PMID: 20561889 DOI: 10.1016/j.hrtlng.2009.12.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 12/13/2009] [Accepted: 12/22/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND Mood is an independent predictor of mortality and quality of life (QoL) for people with heart failure. However, the underlying belief systems involved in mood are unknown. OBJECTIVE We sought to identify psychological and clinical variables predicting mood and QoL for people diagnosed with heart failure (HF). METHODS One hundred and forty-six HF patients were assessed with standardized measures, to determine their beliefs about HF, coping styles, mood, and QoL. RESULTS Patients with more negative beliefs about the consequences of HF and with less perceived control over symptoms showed maladaptive coping styles such as denial and behavioral disengagement, and more severe levels of depression and anxiety. Depression also independently predicted QoL outcomes. CONCLUSIONS Anxious and depressed patients have more negative beliefs about HF, leading to negative coping behaviors and poor QoL. Our evidence suggests that changing negative beliefs may improve the psychological well-being and QoL of patients, irrespective of disease severity.
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Affiliation(s)
- Claire N Hallas
- Royal Brompton & Harefield National Health Service Trust, Harefield, Middlesex, United Kingdom.
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18
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Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease. J Gen Intern Med 2008; 23:1757-62. [PMID: 18690488 PMCID: PMC2585678 DOI: 10.1007/s11606-008-0749-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 06/11/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD). OBJECTIVE To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD. DESIGN AND PATIENTS Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged > or =50 years who participated in the 2004 Health and Retirement Survey. MEASUREMENTS Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score > or =3 on CES-D8 were classified as having clinically significant depressive symptoms. MAIN RESULTS Of 1,736 participants with COPD, 40% had > or =3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for > or =3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02-1.03]), female gender (1.2 [1.1-1.3]), current smoking (1.5 [1.3-1.7]), marital status [divorced/separated (1.8 [1.6-2.1]), widowed (1.8 [1.6-2]), never married (1.4 [1.1-1.8]), < or =high school degree (1.6 [1.5-1.8]), dyspnea (2.3 [2.1-2.6]), difficulty walking (2.8 [2.5-3.2]), and co-morbid diabetes (1.2 [1.1-1.4]), arthritis (1.3 [1.2-1.5]) or cancer (1.2 [1.1-1.4]). CONCLUSIONS Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients.
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Hayes D, Anstead MI, Ho J, Phillips BA. Insomnia and chronic heart failure. Heart Fail Rev 2008; 14:171-82. [PMID: 18758945 DOI: 10.1007/s10741-008-9102-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 07/01/2008] [Indexed: 11/29/2022]
Abstract
Insomnia is highly prevalent in patients with chronic disease including chronic heart failure (CHF) and is a significant contributing factor to fatigue and poor quality of life. The pathophysiology of CHF often leads to fatigue, due to nocturnal symptoms causing sleep disruption, including cough, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. Inadequate cardiac function may lead to hypoxemia or poor perfusion of the cerebrum, skeletal muscle, or visceral body organs, which result in organ dysfunction or failure and may contribute to fatigue. Sleep disturbances negatively affect all dimensions of quality of life and is related to increased risk of comorbidities, including depression. This article reviews insomnia in CHF, cardiac medication side-effects related to sleep disturbances, and treatment options.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, University of Kentucky College of Medicine J410 Kentucky Clinic, 740 South Limestone Street, Lexington, KY 40536, USA.
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