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Abou Kamar S, Oostdijk B, Andrzejczyk K, Constantinescu A, Caliskan K, Akkerhuis KM, Umans V, Brugts JJ, Boersma E, van Dalen B, Kardys I. Temporal evolution of anxiety and depression in chronic heart failure and its association with clinical outcome. Int J Cardiol 2024; 411:132274. [PMID: 38880425 DOI: 10.1016/j.ijcard.2024.132274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Although anxiety and depression have been associated with adverse outcomes in chronic heart failure (HF), data on temporal evolution of these symptoms are scarce. We aimed to investigate the association between repeatedly measured depression and anxiety symptoms and clinical outcome in chronic HF patients. METHODS In this prospective observational study, outpatients with chronic HF were included and followed-up for a maximum of 2.5 years. The hospital anxiety and depression scale (HADS) questionnaire was conducted every six months. The primary endpoint was a composite of HF hospitalization, cardiovascular death, heart transplantation and left ventricular assist device (LVAD) implantation. Cox and joint models were used to investigate the association between the HADS score and the endpoint. RESULTS A total of 362 patients filled out a median (25th-75th percentile) of 3 [2-4] questionnaires each. Mean ± SD age was 63 ± 13 years, 72% were men. Anxiety scores remained relatively stable leading up to the endpoint, while depression scores increased. Higher baseline depression scores were significantly associated with the endpoint (hazard ratio [HR] 1.68 and 95% confidence interval [CI] 1.19-2.36 per log(score+1), p = 0.003), while higher baseline anxiety scores did not reach statistical significance (HR [95% CI] 1.34 [0.99-1.83], p = 0.061). When repeatedly measured, both higher anxiety (HR [95% CI] 1.57[1.07-2.30], p = 0.022) and depression (HR [95% CI] 2.04 [1.39-3.06], p < 0.001) scores were significantly associated with the endpoint. CONCLUSION Serial measurements of depression and anxiety symptoms identify chronic HF patients with increased risk of adverse clinical outcomes. Screening for both disorders should be considered in clinical practice.
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Affiliation(s)
- S Abou Kamar
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - B Oostdijk
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - K Andrzejczyk
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A Constantinescu
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - K Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - K M Akkerhuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - V Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B van Dalen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - I Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Priorello LJ, Arbona C. Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure. Health Psychol Open 2024; 11:20551029241250311. [PMID: 38726462 PMCID: PMC11080764 DOI: 10.1177/20551029241250311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.
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Storer B, Kershaw KA, Braund TA, Chakouch C, Coleshill MJ, Haffar S, Harvey S, Newby JM, Sicouri G, Murphy M. Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101877. [PMID: 37336306 DOI: 10.1016/j.cpcardiol.2023.101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.
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Affiliation(s)
- Ben Storer
- The Black Dog Institute, Sydney, Australia
| | | | - Taylor A Braund
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | | | | | - Sam Haffar
- The Black Dog Institute, Sydney, Australia
| | - Samuel Harvey
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Jill M Newby
- The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Gemma Sicouri
- The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Michael Murphy
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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O'Riordan A, Howard S, Keogh TM, Gallagher S. Type D personality is associated with lower cardiovascular reactivity to stress in women. Psychol Health 2023; 38:1515-1535. [PMID: 35007443 DOI: 10.1080/08870446.2021.2025239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examines if Type D personality is (1) associated with cardiovascular reactivity to acute stress in a healthy sample, and (2) has predictive utility for cardiovascular reactivity above its individual subcomponents (negative affect; NA, social inhibition; SI), as well as anxiety and depression. DESIGN Undergraduate students (n = 173) competed a standardised cardiovascular reactivity experimental protocol consisting of resting baseline and stressor phase (mental arithmetic), with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) monitored throughout. MAIN OUTCOME MEASURES The main outcome measures were cardiovascular reactivity to the stressor, which was operationalised as the difference between resting baseline and the stressor phase for SBP, DBP and HR. RESULTS The continuous Type D interaction term (NA × SI) significantly predicted lower SBP reactivity to the mental arithmetic stressor amongst women, independent of NA, SI and confounding variables. Moreover, this remained significant after adjustment for anxiety and depressive symptoms. Depression, NA and SI were also significant independent predictors of SBP reactivity amongst women. CONCLUSION Type D personality is associated with lower SBP reactivity to acute stress in women, which may be indicative of blunted cardiovascular reactivity. This association was independent of NA, SI, Anxiety and Depression.
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Affiliation(s)
- Adam O'Riordan
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Howard
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Tracey M Keogh
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Kasireddy TR, Yukselen Z, Muthyala A, Bansal K, Dasari M, Arun Kumar P, Anugu VR, Majmundar V, Nakhla M, Sharma G, Nasir K, Warraich HJ, Ganatra S, Dani SS. Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes? Curr Probl Cardiol 2023; 48:101795. [PMID: 37207818 PMCID: PMC10191728 DOI: 10.1016/j.cpcardiol.2023.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023]
Abstract
Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.
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Affiliation(s)
| | - Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | | | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Michael Nakhla
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Heart And Vascular Institute, Falls Church, VA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist, Houston, TX
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA and Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
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Thavamani A, Velayuthan S, Patel D, Al-Hammadi N, Sferra TJ, Sankararaman S. Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome. Am J Gastroenterol 2023; 118:1439-1445. [PMID: 37052354 DOI: 10.14309/ajg.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sujithra Velayuthan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis. Psychosom Med 2023; 85:188-202. [PMID: 36640440 DOI: 10.1097/psy.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease. METHOD For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type. RESULTS In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients. CONCLUSION Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.
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Botros D, Khalafallah AM, Huq S, Dux H, Oliveira LAP, Pellegrino R, Jackson C, Gallia GL, Bettegowda C, Lim M, Weingart J, Brem H, Mukherjee D. Predictors and Impact of Postoperative 30-Day Readmission in Glioblastoma. Neurosurgery 2022; 91:477-484. [PMID: 35876679 PMCID: PMC10553112 DOI: 10.1227/neu.0000000000002063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/26/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Postoperative 30-day readmissions have been shown to negatively affect survival and other important outcomes in patients with glioblastoma (GBM). OBJECTIVE To further investigate patient readmission risk factors of primary and recurrent patients with GBM. METHODS The authors retrospectively reviewed records of 418 adult patients undergoing 575 craniotomies for histologically confirmed GBM at an academic medical center. Patient demographics, comorbidities, and clinical characteristics were collected and compared by patient readmission status using chi-square and Mann-Whitney U testing. Multivariable logistic regression was performed to identify risk factors that predicted 30-day readmissions. RESULTS The cohort included 69 (12%) 30-day readmissions after 575 operations. Readmitted patients experienced significantly lower median overall survival (11.3 vs 16.4 months, P = .014), had a lower mean Karnofsky Performance Scale score (66.9 vs 74.2, P = .005), and had a longer initial length of stay (6.1 vs 5.3 days, P = .007) relative to their nonreadmitted counterparts. Readmitted patients experienced more postoperative deep vein thromboses or pulmonary embolisms (12% vs 4%, P = .006), new motor deficits (29% vs 14%, P = .002), and nonhome discharges (39% vs 22%, P = .005) relative to their nonreadmitted counterparts. Multivariable analysis demonstrated increased odds of 30-day readmission with each 10-point decrease in Karnofsky Performance Scale score (odds ratio [OR] 1.32, P = .002), each single-point increase in 5-factor modified frailty index (OR 1.51, P = .016), and initial presentation with cognitive deficits (OR 2.11, P = .013). CONCLUSION Preoperatively available clinical characteristics strongly predicted 30-day readmissions in patients undergoing surgery for GBM. Opportunities may exist to optimize preoperative and postoperative management of at-risk patients with GBM, with downstream improvements in clinical outcomes.
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Affiliation(s)
- David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M. Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sakibul Huq
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hayden Dux
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leonardo A. P. Oliveira
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Pellegrino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary L. Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Fitz J, Edelmann F, Hasenfuß G, Sandek A, Nolte K, Hashemi D, Trippel TD, Wachter R, Herrmann-Lingen C. Influence of baseline parameters on one-year physical, mental, and health-related quality of life in patients with heart failure and preserved ejection fraction. ESC Heart Fail 2021; 8:4635-4643. [PMID: 34480783 PMCID: PMC8712837 DOI: 10.1002/ehf2.13593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
Aims To identify baseline parameters longitudinally influencing overall health‐related quality of life (HRQoL), physical function and mental health 1 year later in patients with chronic heart failure and preserved ejection fraction (HFpEF). Methods and results We performed post hoc analyses of the randomized aldosterone in diastolic heart failure (Aldo‐DHF) trial, including 422 patients with HFpEF and NYHA class II or III. Overall HRQoL, measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), physical functioning and mental health, both measured by the Short Form 36 Health Survey (SF‐36), after 12 months were predicted in correlation analyses and multivariate regression analyses with continuous values and worst versus three better HRQoL quartiles as dependent variables. The mean age of the study population was 66.8 ± 7.6 years, 52.4% were female, and 86.0% had NYHA class II. All HRQoL variables at 1 year were predicted by their respective baseline values (all P < 0.001), which were also the best variables to predict lowest versus higher HRQoL quartiles (all P < 0.001). For overall HRQoL, six‐minute‐walking‐distance (P = 0.009), Borg‐score (P = 0.001), coronary heart disease (P = 0.036) and SF‐36 role‐emotional (P = 0.005) independently predicted one‐year‐outcome, while depression diagnosis (P = 0.044), self‐reported health status (P = 0.023) and PHQ depression (P = 0.001) were only significant predictors when excluding MLHFQ total score at baseline. In logistic regression analyses, only SF‐36 role‐emotional (P = 0.016) independently predicted overall HRQoL group status at follow up. For physical functioning, Borg‐score (P ≤ 0.001), 6 min walking distance (P = 0.005), coronary heart disease (P = 0.009), and SF‐36 vitality (P = 0.001) were significant independent predictors, also when excluding baseline physical functioning. Low SF‐36 vitality (P = 0.021) and presence of coronary heart disease (P = 0.027) independently predicted a patient's membership in the lowest quartile 1 year later. For mental health, SF‐36 physical functioning (P = 0.025) and HADS anxiety (P = 0.046) were independent predictors, while self‐rated fatigue and poor performance (P = 0.033) and SF‐36 vitality (P = 0.008) only served as significant predictors when excluding mental health at baseline. HADS anxiety (P = 0.009) also served as independent predictor of a patient's group status after 1 year. Conclusion Overall HRQoL, physical functioning, and mental health of HFpEF patients 1 year later are mainly influenced by their respective baseline values. Other self‐rated baseline parameters also showed independent effects while objective severity measures had limited predictive value.
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Affiliation(s)
- Judith Fitz
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Kathleen Nolte
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Tobias D Trippel
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital, Leipzig, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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12
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Abstract
BACKGROUND An estimated 6.5 million American adults live with heart failure (HF). Elevated anxiety symptoms may worsen HF symptoms and contribute to decreases in overall quality of life (QOL). Mindfulness has been associated with better psychological health with lower levels of anxiety symptoms. Mindfulness may be a modifiable target for reducing anxiety symptoms and increasing QOL in patients with HF. OBJECTIVE The objective of this study is to examine the relationships among anxiety symptoms, dispositional mindfulness, and QOL in patients with symptomatic HF. METHODS In this cross-sectional study, we conducted a secondary analysis of baseline data from 70 participants. We performed descriptive statistics, bivariate Pearson correlations, and multiple linear regression. RESULTS The sample included 70 individuals with a mean age of 65 ± 10.5 years, 89% male, mean left ejection fraction of 45.7 ± 13.6, mean total QOL of 36.9 ± 21.7, mean total mindfulness of 82.2 ± 12.8, and mean anxiety of 4.8 ± 2.9. In multiple regression analyses, total mindfulness was significantly associated with lower anxiety (β = -0.491, P < .01), greater observational mindfulness was significantly associated with lower anxiety (β = -0.377, P < .01), and greater nonreactivity to inner experience was significantly associated with lower anxiety (β = -0.320, P < .05). Lower anxiety was associated with greater total QOL (β = 0.488, P < .01), greater physical QOL (β = 0.381, P < .01), and greater emotional QOL (β = 0.639, P < .01). CONCLUSIONS Mindfulness may be a way of improving both anxiety symptoms and QOL in this population.
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13
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Madrid-García A, Montuenga-Fernández I, Font-Urgelles J, León-Mateos L, Pato E, Jover JA, Fernández-Gutiérrez B, Abasolo L, Rodríguez-Rodríguez L. There and back again: analyzing the effect of outpatient readmission on the quality of life of patients attending a rheumatology clinic. Ther Adv Musculoskelet Dis 2021; 13:1759720X211034867. [PMID: 34377162 PMCID: PMC8326638 DOI: 10.1177/1759720x211034867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022] Open
Abstract
Aims: The aim of this study was to assess the effect of “outpatient readmissions” on the health-related quality of life (HR-QoL) of outpatients from a rheumatology clinic, meaning the effect of the patient’s return to the outpatient clinic after having received care and been discharged. Methods: We conducted an observational longitudinal retrospective study, with patients selected from the Hospital Clínico San Carlos Musculoskeletal cohort, based on having received at least one discharge from the outpatient clinic and having returned (readmission) at least once after the discharge. The main outcomes were the patients’ baseline HR-QoL (measured on the first visit of each episode) and the ΔHR-QoL (difference between the HR-QoL in the last and the first visit of each episode). Successive episodes of admission and readmission were chronologically ordered, paired and analyzed using nested linear mixed models, nested by patients and by admission–readmission tandem. We carried out bivariable and multivariable analyses to assess the effect of demographic, clinical, treatment and comorbidity-related variables in both main outcomes. Results: For the first main outcome, 5887 patients (13,772 episodes) were analyzed. Based on the multivariable level, readmission showed no significant marginal effect on the baseline HR-QoL (p-value = 0.17). Conversely, when analyzing the ΔHR-QoL, we did observe a negative and significant marginal effect (p-value = 0.028), meaning that readmission was associated with a lower gain in the HR-QoL during the follow-up, compared with the previous episode. Conclusion: In the outpatient setting, readmission exerts a deleterious effect in patients undergoing this process. Identification of outpatients more likely to be readmitted could increase the value of the care provided.
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Affiliation(s)
- Alfredo Madrid-García
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Judit Font-Urgelles
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Leticia León-Mateos
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Esperanza Pato
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Juan A Jover
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Lydia Abasolo
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Rodríguez-Rodríguez
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, c\ Prof. Martin Lagos s/n, Madrid 28040, Spain
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14
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Polsook R, Aungsuroch Y. A cross-sectional study of factors predicting readmission in Thais with coronary artery disease. J Res Nurs 2021; 26:293-304. [PMID: 35251254 PMCID: PMC8894994 DOI: 10.1177/1744987120946792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Coronary artery disease is a major cause of morbidity and mortality with high readmission rates. Hospital readmissions for coronary artery disease contribute to rising healthcare costs and are a marker of quality of care. Despite this, prior studies have found that readmission rates vary widely. AIMS This study aims to determine the impact of social support, depression, comorbidities, symptom severity, quality of life and readmission among coronary artery disease patients in Thailand. METHODS A total of 321 coronary artery disease patients from tertiary care hospitals across all regions of Thailand were recruited for this study. Data were analysed using multiple regression analysis. RESULTS The coefficient for social support (beta = -0.22) was found to be significant (p < 0.05), whereas comorbidity, symptom severity, depression and quality of life were not significant. Thus, social support was found to be the most significant predictive factor for readmission. CONCLUSIONS Accordingly, when designing effective nursing interventions, nurses should promote social support interventions for coronary artery disease patients to improve the quality of care, decrease readmission rates and improve patients' quality of life.
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Affiliation(s)
- Rapin Polsook
- Rapin Polsook, Faculty of Nursing, Chulalongkorn University, Floor 11, Boromarajonani Srisatapat Building, Rama 1 Road, Patumwan, Bangkok 10330, Thailand.
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15
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Polsook R, Aungsuroch Y. Factors influencing readmission among Thais with myocardial infarction. BELITUNG NURSING JOURNAL 2021; 7:15-23. [PMID: 37469799 PMCID: PMC10353658 DOI: 10.33546/bnj.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 07/21/2023] Open
Abstract
Background Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (χ2 = 1.39, df = 2, p < 0.50, χ2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusion These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.
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Affiliation(s)
- Rapin Polsook
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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16
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Zwas DR, Keren A, Amir O, Gotsman I. Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression. J Clin Med 2020; 9:jcm9123967. [PMID: 33297471 PMCID: PMC7762354 DOI: 10.3390/jcm9123967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. METHODS Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. RESULTS The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. CONCLUSIONS In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events.
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Affiliation(s)
- Donna R. Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
- Correspondence: ; Tel.: +972-2-6776564; Fax: +972-2- 6411028
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
| | - Offer Amir
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
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17
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Wedegärtner SM, Schwantke I, Kindermann I, Karbach J. Predictors of heart-focused anxiety in patients with stable heart failure. J Affect Disord 2020; 276:380-387. [PMID: 32871668 DOI: 10.1016/j.jad.2020.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND It has been shown that heart-focused anxiety raises the risk of adverse outcomes in patients with heart disease. Yet, there is a lack of studies investigating this association. We aim at identifying predictors of heart-focused anxiety in patients with stable heart failure to facilitate the identification of individuals with increased risk for adverse outcomes. METHODS We assessed heart-focused anxiety and a set of psychological, demographic/lifestyle, and medical/laboratory variables in a sample of 107 patients with stable chronic heart failure to identify predictors of heart-focused anxiety. RESULTS Heart-focused anxiety was best predicted by self-reported anxiety and quality of life. Moreover, the personality dimension conscientiousness as well as physical activity, and the laboratory value of renal function, the estimated glomerular filtration rate (eGFR), had predictive validity for heart-focused anxiety. LIMITATIONS The present findings should be replicated in a longitudinal design with a less selective sample including more women and participants with more divers ethnical backgrounds. CONCLUSION Heart-focused anxiety is predictable by psychological and lifestyle variables. eGFR, as a laboratory marker for renal function, showed also predictive validity. The awareness of such predictors may help detecting comorbid underlying heart-focused anxiety and thus identify patients with an increased need for psychological care.
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Affiliation(s)
- Sonja Maria Wedegärtner
- Department of Internal Medicine III (Cardiology, Angiology, and Intensive Care) of the Saarland University Medical Center, Saarland University; Kirrberger Str. 100, Building 24; 66421 Homburg/Saar, Germany.
| | - Igor Schwantke
- Department of Internal Medicine III (Cardiology, Angiology, and Intensive Care) of the Saarland University Medical Center, Saarland University; Kirrberger Str. 100, Building 24; 66421 Homburg/Saar, Germany
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology, and Intensive Care) of the Saarland University Medical Center, Saarland University; Kirrberger Str. 100, Building 24; 66421 Homburg/Saar, Germany
| | - Julia Karbach
- Department of Psychology, University of Koblenz-Landau, Fortstraße 7; 76829 Landau/Pfalz
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18
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Garay A, Tapia J, Anguita M, Formiga F, Almenar L, Crespo-Leiro MG, Manzano L, Muñiz J, Chaves J, De Frutos T, Moliner P, Corbella X, Enjuanes-Grau C, Comín-Colet J. Gender Differences in Health-Related Quality of Life in Patients with Systolic Heart Failure: Results of the VIDA Multicenter Study. J Clin Med 2020; 9:jcm9092825. [PMID: 32878281 PMCID: PMC7563299 DOI: 10.3390/jcm9092825] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Previous studies have shown that heart failure is associated with worse health-related quality of life (HRQoL). The existence of differences according to gender remains controversial. We studied 1028 consecutive outpatients with heart failure and reduced ejection fraction (HFrEF) from a multicentre cross-sectional descriptive study across Spain that assessed HRQoL using two questionnaires (KCCQ, Kansas City Cardiomyopathy Questionnaire; and EQ-5D, EuroQoL 5 dimensions). The primary objective of the study was to describe differences in HRQoL between men and women in global scores and domains of health status of patients and explore gender differences and its interactions with heart failure related factors. In adjusted analysis women had lower scores in KCCQ overall summary scores when compared to men denoting worse HRQoL (54.7 ± 1.3 vs. 62.7 ± 0.8, p < 0.0001), and specifically got lower score in domains of symptom frequency, symptoms burden, physical limitation, quality of life and social limitation. No differences were found in domains of symptom stability and self-efficacy. Women also had lower scores on all items of EQ-5D (EQ-5D index 0.58 ± 0.01 vs. 0.67 ± 0.01, p < 0.0001). Finally, we analyzed interaction between gender and different clinical determinants regarding the presence of limitations in the 5Q-5D and overall summary score of KCCQ. Interestingly, there was no statistical significance for interaction for any variable. In conclusion, women with HFrEF have worse HRQoL compared to men. These differences do not appear to be mediated by clinical or biological factors classically associated with HRQoL nor with heart failure severity.
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Affiliation(s)
- Alberto Garay
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Javier Tapia
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Departamento de Ciencias Clínicas, Universidad de Barcelona, 08907 Barcelona, Spain
| | - Manuel Anguita
- Unidad de Insuficiencia Cardíaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba 14004, Argentina;
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, 46009 Valencia, Spain;
| | - María G. Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), 15006 A Coruña, Spain;
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, 28034 Madrid, Spain;
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 La Coruña, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 15705 Santiago de Compostela, Spain
| | - José Chaves
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Trinidad De Frutos
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Pedro Moliner
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
- Cátedra HESTIA en Atención Integrada Social y Sanitaria, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08017 Barcelona, Spain
| | - Cristina Enjuanes-Grau
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Servicio de Cardiologia, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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19
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Rasmussen AA, Larsen SH, Jensen M, Berg SK, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Wiggers H, Johnsen SP. Prognostic impact of self-reported health on clinical outcomes in patients with heart failure. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:397-406. [PMID: 32232437 DOI: 10.1093/ehjqcco/qcaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
AIMS An in-depth understanding of the prognostic value of patient-reported outcomes (PRO) is essential to facilitate person-centred care in heart failure (HF). This study aimed to clarify the prognostic role of subjective mental and physical health status in patients with HF. METHODS AND RESULTS Patients with HF were identified from the DenHeart Survey (n = 1499) and PRO data were obtained at hospital discharge, including the EuroQol five-dimensional questionnaire (EQ-5D), the HeartQoL, and the Hospital Anxiety and Depression Scale (HADS). Clinical baseline data were obtained from medical records and linked to nationwide registries with patient-level data on sociodemographics and healthcare contacts. Outcomes were all-cause and cardiovascular (CV) mortality, CV events, and HF hospitalization with 1- and 3-year follow-up. Analysing the PRO data on a continuous scale, a worse score in the following were associated with risk of all-cause and CV mortality after 1 year: the HeartQoL (adjusted hazard ratios (HRs) 1.91, 95% confidence interval (CI) 1.42-2.57 and 2.17, 95% CI 1.50-3.15, respectively), the EQ-5D (adjusted HRs 1.26, 95% CI 1.15-1.38 and 1.27, 95% CI 1.13-1.42, respectively), the HADS depression subscale (adjusted HRs 1.12, 95% CI 1.07-1.17 and 1.11, 95% CI 1.05-1.17, respectively), and the HADS anxiety subscale (adjusted HRs 1.08, 95% CI 1.03-1.13 and 1.09, 95% CI 1.04-1.15, respectively). Three-year results were overall in concordance with the 1-year results. A similar pattern was also observed for non-fatal outcomes. CONCLUSION Health-related quality of life and symptoms of anxiety and depression at discharge were associated with all-cause and CV mortality at 1- and 3-year follow-up.
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Affiliation(s)
- Anne Ankerstjerne Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Signe Holm Larsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Martin Jensen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
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20
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Sager DM, Burch AE, Alhosaini H, Vaughan T, Sears SF. Changes in cardiac anxiety and self-care practices in heart failure patients following implantation of wireless hemodynamic monitoring sensors. Eur J Cardiovasc Nurs 2020; 19:440-443. [DOI: 10.1177/1474515120905405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Wireless implantable hemodynamic monitors assist cardiac care providers in tailoring medication regimens to reduce chronic heart failure hospital admissions and to improve patient quality of life. Previous research exists to support wireless implantable hemodynamic monitors favorable impact on medical endpoints but, however, their psychological and behavioral effects have not yet been established. The purpose of this pilot study was to investigate patient psychological and behavioral changes after receiving the wireless implantable hemodynamic monitor. Methods: Patients with heart failure ( n=26) who were implanted with wireless implantable hemodynamic monitor sensors completed the Cardiac Anxiety Questionnaire and Self-Care of Heart Failure Index version 6.2 at pre-implant and at one-month post-implant, as well as an initial demographic questionnaire. Results: Heart failure patients who received a wireless implantable hemodynamic monitor experienced a significant reduction in cardiac anxiety, t(25)=2.93, p=0.007, z=−0.46, d=0.58, driven by a reduction in fear of their condition, t(25)=2.26, p=0.03, z=−0.42, d=0.44. Increases in self-care behaviors fell short of significance t(25)=1.67, p=0.11, but showed a medium effect size, d=0.33. Conclusion: Heart failure patients who received a wireless implantable hemodynamic monitor reported significantly reduced cardiac fear, indicating that wireless implantable hemodynamic monitor technology may produce a collateral benefit in psychological effects. Patient self-care may also benefit but the current study was under-powered to reach statistical significance. Patient education about psychological and behavioral aspects of the wireless implantable hemodynamic monitor implant may yield increased patient engagement and broader health benefits if these results are confirmed in a larger study.
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Affiliation(s)
- David M Sager
- Department of Psychology, East Carolina University, USA
| | - Ashley E Burch
- Department of Cardiovascular Sciences, East Carolina University, USA
| | - Hassan Alhosaini
- Department of Cardiovascular Sciences, East Carolina University, USA
- Heart Failure and Pulmonary Hypertension Program, Vidant Health, USA
| | - Tracy Vaughan
- Heart Failure and Pulmonary Hypertension Program, Vidant Health, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, USA
- Department of Cardiovascular Sciences, East Carolina University, USA
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21
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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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22
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Heidari Gorji MA, Fatahian A, Farsavian A. The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: A systematic review and meta-analysis of observational studies. Gen Hosp Psychiatry 2019; 60:27-36. [PMID: 31310898 DOI: 10.1016/j.genhosppsych.2019.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Several psychosocial risk factors have been identified that increase the rate of readmission in heart failure (HF) patients. However, the impact of social isolation (SI) on the rate of readmission is unclear. Therefore, the current review focused on the impact of SI on readmission rates of patients with HF. METHODS A Medline-based strategy was applied to search PubMed, SCOPUS, Cochrane library, ProQuest, and Embase from inception until November 15, 2018. We performed a meta-analysis and pooled results using random effects model. The primary outcome was the odds ratio of readmission in HF patients suffering from SI. We examined the impact of both perceived and objective SI on readmission rates. We also examined the differences in readmission rates between these concepts. The secondary outcomes were the incidence of readmission and the prevalence of SI. RESULTS From 3326 titles, 13 studies (n = 6468 participants) were eligible. The mean follow-up period was 13 months. The cumulative incidence for HF-related hospital readmission was 35.47% (95% CI: 34.29-36.67). The pooled prevalence ratio (PR, (95% CI)) was 37.31% (36.14-38.49), 31.51% (30.36-32.68), 32.82% (29.90-35.88), and 39.57% (37.73-41.45) for SI, living alone, lack of social support, and poor social network, respectively. SI was associated with a 55% greater risk of hospital readmission in patients with HF (OR = 1.55; 95% CI = 1.39-1.73; p < .001). Our analysis did not show a significant difference in the rate of hospital readmission between perceived and objective SI. CONCLUSION SI is prevalent in patients with HF and seems to be consistently linked to hospital readmission in HF patients, regardless of how it is measured. Therefore, it is necessary to develop interventions to reduce the burden of SI in patients with HF.
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Affiliation(s)
- M A Heidari Gorji
- Diabetes Research Center, Department of Medical-Surgical Nursing, Nasibeh Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Fatahian
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Farsavian
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Association between Type D personality and outcomes in patients with non-ischemic heart failure. Qual Life Res 2019; 28:2901-2908. [DOI: 10.1007/s11136-019-02241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
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24
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Lin TK, Hsu BC, Li YD, Chen CH, Lin JW, Chien CY, Weng CY. Prognostic Value of Anxiety Between Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2019; 8:e010739. [PMID: 31181979 PMCID: PMC6645644 DOI: 10.1161/jaha.118.010739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Evidence suggests differences in clinical characteristics, causes, and prognoses between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Most studies have failed to support the prognostic relevance of anxiety in HFrEF or unclassified HF with mean left ventricular ejection fraction <40%. Meanwhile, the association between anxiety and prognoses in HFpEF remains unexamined. This study compared the prognostic value of anxiety between HFrEF and HFpEF. Methods and Results A total of 158 patients with HFrEF (left ventricular ejection fraction=28.51±7.53%) and 108 patients with HFpEF (left ventricular ejection fraction=64.53±9.67%) were recruited between May 2012 and December 2014. Demographic and clinical characteristics, Spielberger State‐Trait Anxiety Inventory, Beck Depression Inventory‐II scale, and 18‐month follow‐up outcomes were recorded during the hospital stay. There were significant differences in age, sex, comorbidities, laboratory biomarkers, discharge medications, and unhealthy behaviors, which supported the contention that HFrEF and HFpEF represent 2 distinct phenotypes, although there were no significant differences in anxiety and 18‐month outcomes. Multiple logistic regression yielded no significant associations between anxiety and 18‐month outcomes in HFrEF. By contrast, trait anxiety could predict 18‐month all‐cause mortality (odds ratio, 1.429; 95% CI, 1.020–2.000; P=0.038), all‐cause readmission or death (odds ratio, 1.147; 95% CI, 1.036–1.271; P=0.008), and cardiac readmission or death (odds ratio, 1.133; 95% CI, 1.031–1.245; P=0.010) in HFpEF after adjusting for possible confounders. Conclusions Trait anxiety was independently associated with 18‐month all‐cause mortality, all‐cause readmission or death, and cardiac readmission or death in HFpEF, but not in HFrEF.
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Affiliation(s)
- Tin-Kwang Lin
- 1 School of Medicine Tzu Chi University Hualien Taiwan.,2 Department of Internal Medicine Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
| | - Bo-Cheng Hsu
- 3 Department of Psychology National Chung Cheng University Chiayi Taiwan
| | - Yi-Da Li
- 1 School of Medicine Tzu Chi University Hualien Taiwan.,2 Department of Internal Medicine Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
| | - Chi-Hsien Chen
- 2 Department of Internal Medicine Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
| | - Jiunn-Wen Lin
- 2 Department of Internal Medicine Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
| | - Chen-Yu Chien
- 2 Department of Internal Medicine Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
| | - Chia-Ying Weng
- 3 Department of Psychology National Chung Cheng University Chiayi Taiwan
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25
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Can We Do More With Less While Building Predictive Models? A Study in Parsimony of Risk Models for Predicting Heart Failure Readmissions. Comput Inform Nurs 2019; 37:306-314. [PMID: 33055494 DOI: 10.1097/cin.0000000000000499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hospital readmission due to heart failure is a topic of concern for patients and hospitals alike: it is both the most frequent and expensive diagnosis for hospitalization. Therefore, accurate prediction of readmission risk while patients are still in the hospital helps to guide appropriate postdischarge interventions. As our understanding of the disease and the volume of electronic health record data both increase, the number of predictors and model-building time for predicting risk grow rapidly. This suggests a need to use methods for reducing the number of predictors without losing predictive performance. We explored and described three such methods and demonstrated their use by applying them to a real-world dataset consisting of 57 variables from health data of 1210 patients from one hospital system. We compared all models generated from predictor reduction methods against the full, 57-predictor model for predicting risk of 30-day readmissions for patients with heart failure. Our predictive performance, measured by the C-statistic, ranged from 0.630 to 0.840, while model-building time ranged from 10 minutes to 10 hours. Our final model achieved a C-statistic (0.832) comparable to the full model (0.840) in the validation cohort while using only 16 predictors and providing a 66-fold improvement in model-building time.
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Causes, Preventability, and Cost of Unplanned Rehospitalizations Within 30 Days of Discharge After Lung Transplantation. Transplantation 2019; 102:838-844. [PMID: 29346256 DOI: 10.1097/tp.0000000000002101] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Unplanned rehospitalizations (UR) within 30 days of discharge are common after lung transplantation. It is unknown whether UR represents preventable gaps in care or necessary interventions for complex patients. The objective of this study was to assess the incidence, causes, risk factors, and preventability of UR after initial discharge after lung transplantation. METHODS This was a single-center prospective cohort study. Subjects completed a modified short physical performance battery to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory at discharge. For each UR, a study staff member and the patient's admitting or attending clinician used an ordinal scale (0, not; 1, possibly; 2, definitely preventable) to rate readmission preventability. A total sum score of 2 or higher defined a preventable UR. RESULTS Of the 90 enrolled patients, 30 (33.3%) had an UR. The single most common reasons were infection (7 [23.3%]) and atrial tachyarrhythmia (5 [16.7%]). Among the 30 URs, 9 (30.0%) were deemed preventable. Unplanned rehospitalization that happened before day 30 were more likely to be considered preventable than those between days 30 and 90 (30.0% versus 6.2%, P = 0.04). Discharge frailty, defined as short physical performance battery less than 6, was the only variable associated with UR on multivariable analysis (odds ratio, 3.4; 95% confidence interval, 1.1-11.8; P = 0.04). CONCLUSIONS Although clinicians do not rate the majority of UR after lung transplant as preventable, discharge frailty is associated with UR. Further research should identify whether modification of discharge frailty can reduce UR.
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Abstract
OBJECTIVE Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms. METHODS Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart. RESULTS In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = -.16; p = .03) and EE (β = -.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = -.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2. CONCLUSIONS We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.
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28
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Lemos M, Calderón JPR, Rios PC, Torres S, Agudelo DM. Depression Levels Following Discharge Predict Quality of Life in Heart Disease Patients. PSICOLOGIA: TEORIA E PESQUISA 2019. [DOI: 10.1590/0102.3772e35443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Depression and stress have been related with poor Health Related Quality of Life (HRQoL) prognosis. However, it is not clear when these depressive symptoms should be measured. A sample of 177 Coronary Heart Disease patients were followed for 15 months aimed to compare the effect of depression and stress measure at time of hospitalization and three months later on the physical HRQoL trajectory. Linear growth models’ results showed that depression and stress after discharge are negatively correlated with the physical HRQoL and depressive symptoms negatively affect the prognosis of these patients.
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29
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Vitamin C Deficiency, High-Sensitivity C-Reactive Protein, and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:6-12. [PMID: 27984333 DOI: 10.1097/jcn.0000000000000389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vitamin C is related to lower levels of high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker that predicts cardiovascular disease. Whether vitamin C deficiency is associated with hsCRP and cardiac events in heart failure (HF) patients has not been examined. PURPOSE The aim of this study is to determine the relationships among vitamin C intake, serum levels of hsCRP, and cardiac events. METHODS A total of 200 HF patients completed a 3-day food diary to determine vitamin C deficiency and provided blood to measure serum levels of hsCRP. Patients were followed for 2 years to obtain data on cardiac event-free survival. Moderation analyses with hierarchical logistic and Cox regressions were used for the data analysis. RESULTS Seventy-eight patients (39%) had vitamin C deficiency and 100 (50%) had an hsCRP level higher than 3 mg/L. Vitamin C deficiency was associated with an hsCRP level higher than 3 mg/L in the hierarchical logistic regression (odds ratio, 2.40; 95% confidence interval, [1.13-5.10]; P = .023). Vitamin C deficiency (hazard ratio, 1.68; 95% CI, 1.05-2.69, P = .029) and hsCRP level higher than 3 mg/L (hazard ratio, 1.79; 95% CI, 1.07-3.01; P = .027) predicted shorter cardiac event-free survival in hierarchical Cox regression. The interaction of hsCRP level higher than 3 mg/L and vitamin C deficiency produced a 2.3-fold higher risk for cardiac events (P = .002) in moderation analysis. Higher level of hsCRP predicted shorter cardiac event-free survival only in patients with vitamin C deficiency (P = .027), but not in those with vitamin C adequacy. CONCLUSION Vitamin C deficiency moderated the relationship between inflammation and cardiac events in patients with HF. Future study is required to determine whether adequate intake of vitamin C could play a protective role against the impact of inflammation on cardiac events in HF patients.
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30
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Wong RL, El-Jawahri A, D'Arpino SM, Fuh CX, Johnson PC, Lage DE, Irwin KE, Pirl WF, Traeger L, Cashavelly BJ, Jackson VA, Greer JA, Ryan DP, Hochberg EP, Temel JS, Nipp RD. Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer. Oncologist 2018; 24:117-124. [PMID: 30082486 PMCID: PMC6324633 DOI: 10.1634/theoncologist.2018-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in patients with advanced cancer. MATERIALS AND METHODS From September 2014 to May 2016, we prospectively enrolled patients with advanced cancer who had an unplanned hospitalization. We performed chart review to obtain information regarding documented depressive symptoms in the 3 months prior to admission and use of antidepressant medications at the time of admission. We compared differences in hospital LOS by presence or absence of depressive symptoms and used adjusted linear regression to examine if antidepressant medications moderated these outcomes. RESULTS Of 1,036 patients, 126 (12.2%) had depressive symptoms documented prior to admission, and 288 (27.8%) were taking antidepressant medications at the time of admission. Patients with depressive symptoms experienced longer hospital LOS (7.25 vs. 6.13 days; p = .036). Use of antidepressant medications moderated this relationship; among patients not on antidepressant medications, depressive symptoms were associated with longer hospital LOS (7.88 vs. 6.11 days; p = .025), but among those on antidepressant medications, depressive symptoms were not associated with hospital LOS (6.57 vs. 6.17 days; p = .578). CONCLUSION Documented depressive symptoms prior to hospital admission were associated with longer hospital LOS. This effect was restricted to patients not on antidepressant medications. Future studies are needed to investigate if use of antidepressant medications decreases LOS for patients hospitalized with advanced cancer and the mechanisms by which this may occur. IMPLICATIONS FOR PRACTICE This study investigated the prevalence of documented depressive symptoms in patients with advanced cancer in the 3 months prior to an unplanned hospitalization and the prevalence of use of antidepressant medications at time of hospital admission. The relationship of these variables with hospital length of stay was also examined, and it was found that documented depressive symptoms were associated with prolonged hospital length of stay. Interestingly, antidepressant medications moderated the relationship between depressive symptoms and hospital length of stay. These findings support the need to recognize and address depressive symptoms among patients with advanced cancer, with potential implications for optimizing health care utilization.
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Affiliation(s)
- Risa L Wong
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara M D'Arpino
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charn-Xin Fuh
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - P Connor Johnson
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Lage
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Department of Psychiatry, Sylvester Comprehensive Cancer Center and University of Miami, Miami, Florida, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara J Cashavelly
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David P Ryan
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ephraim P Hochberg
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Zhang M, Liu L, Shi Y, Yang Y, Yu X, Angerer P, Kristensen TS, Li J. Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study. Gen Hosp Psychiatry 2018; 53:59-64. [PMID: 29859340 DOI: 10.1016/j.genhosppsych.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate longitudinal associations of burnout with heart rate variability (HRV) in patients after their first events of acute coronary syndrome (ACS). METHODS In total, two hundred eight patients participated in this one-year follow-up study. On the day before discharge, their personal burnout level was assessed by the Copenhagen Burnout Inventory. HRV signals were collected at four time points: the day before discharge, one month, six month and one year after discharge. HRV was measured by 24-hour ambulatory electrocardiography and analyzed in time and frequency domains. Generalized estimating equations were applied to analyze the associations of burnout at baseline with longitudinal tracking of HRV during follow-up in format of natural logarithmic transformation. RESULTS After adjusting for relevant confounding factors, high burnout at baseline was significantly associated with low standard deviation of NN intervals (SDNN), a time domain measure of HRV (p < 0.05). Also, baseline burnout was inversely associated with five frequency domain measures, i.e., high frequency power (HF), low frequency power (LF), very low frequency power (VLF), and ultra low frequency power (ULF), and total power (TP) (all p < 0.05). CONCLUSION Personal burnout is longitudinally associated with decreased HRV during one-year period among patients after first ACS.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Ling Liu
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yunke Shi
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yanfei Yang
- Cardiology Department, Kunming Children's Hospital, Kunming, Yunnan 650228, China
| | - Xiaoju Yu
- Cardiology Department, 1st hospital of Yibin City, Yibin, Sichuan 644000, China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
| | | | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
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32
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Yeh HF, Shao JH. Depression in Community-Dwelling Elderly Patients With Heart Failure. Arch Psychiatr Nurs 2018; 32:248-255. [PMID: 29579520 DOI: 10.1016/j.apnu.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
The present cross-sectional study discussed the relationship between comorbid depression, demographic characteristics, clinical characteristics, and dietary self-efficacy among Taiwanese community-dwelling elderly patients with heart failure (HF). Specifically, the study examined 175 community-dwelling elderly patients with HF between July 2013 and June 2014. In total, 47.13% of the patients exhibited symptoms of depression. Those without a spouse, who were currently employed, who had an ejection fraction <30%, who had been readmitted to the hospital 2 or more times, and who had a high level of HF symptom distress were significantly more likely to be depressed. Therefore, it is crucial that care programs designed for these patients include the self-management of HF symptoms, psychological consultations, cognitive behavioral therapy, and physical exercise.
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Affiliation(s)
- Hsiang-Fen Yeh
- Nursing Department, Tzu Chi University of Science and Technology, Taiwan.
| | - Jung-Hua Shao
- School of Nursing, College of Medicine, Chang Gung University; Department of Orthopedics, Chang Gung Memorial Hospital, Linkou, Taiwan.
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33
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Neff C, Totten C, Plymale M, Oyler DR, Davenport D, Roth JS. Associations between anxiolytic medications and ventral hernia repair. Hernia 2018; 22:753-757. [PMID: 29594842 DOI: 10.1007/s10029-018-1766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.
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Affiliation(s)
- C Neff
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - C Totten
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - M Plymale
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA.
| | - D R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536, USA
| | - D Davenport
- Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - J S Roth
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
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Nikiphorou E, Norton S, Young A, Dixey J, Walsh D, Helliwell H, Kiely P. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network UK prospective cohorts. Rheumatology (Oxford) 2018; 57:1194-1202. [PMID: 29590474 DOI: 10.1093/rheumatology/key066] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/14/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine associations between BMI and disease activity, functional ability and quality of life in RA. METHODS Data from two consecutive, similarly designed UK multicentre RA inception cohorts were used: the Early RA Study (ERAS) and the Early RA Network (ERAN). Recruitment figures/median follow-up for the ERAS and ERAN were 1465/10 years (maximum 25 years), and 1236/6 years (maximum 10 years), respectively. Standard demographic and clinical variables were recorded at baseline and annually. Multilevel piecewise longitudinal models with a change point at 2 years were used with the 28-joint DAS (DAS28), ESR, HAQ and 36-item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) components as dependent variables. BMI was examined in separate models as both continuous and categorical variables (based on World Health Organization definitions) and up to 5 years from disease onset. RESULTS BMI data from 2386 newly diagnosed RA patients (11 348 measures) showed an increase in BMI of 0.27 U annually (95% CI 0.21, 0.33). Baseline obesity was associated with a significant reduction in the odds of achieving a low year 2 DAS28 [OR 0.52 (95% CI 0.41, 0.650)]. At year 2, HAQ and SF-36 PCS scores were significantly worse but not at year 5 in patients obese at baseline. Obesity at year 2 was associated with higher DAS28 scores at year 2, but not at year 5, and also associated with significantly higher HAQ and SF-36 PCS scores at years 2 and 5. CONCLUSION Obesity prevalence is rising in early RA and associates with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low DAS28. The data argue strongly for obesity management to become central to treatment strategies in RA.
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Affiliation(s)
- Elena Nikiphorou
- Academic Rheumatology Department, King's College London, UK.,Rheumatology, Whittington Hospital NHS Trust, London, UK
| | - Sam Norton
- Academic Rheumatology Department, King's College London, UK
| | - Adam Young
- Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, Hatfield, UK
| | - Josh Dixey
- Department of Rheumatology, New Cross Hospital, Wolverhampton, UK
| | - David Walsh
- Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK
| | | | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospitals NHS Foundation Trust, London, UK
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Micronutrient Deficiency Independently Predicts Adverse Health Outcomes in Patients With Heart Failure. J Cardiovasc Nurs 2018; 32:47-53. [PMID: 26544174 DOI: 10.1097/jcn.0000000000000304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite growing evidence on the important role of micronutrients in prognosis of heart failure (HF), there has been limited research that micronutrient deficiency predicts health outcomes in patients with HF. PURPOSE The aim of this study was to determine whether micronutrient deficiency independently predicts adverse health outcomes. METHODS A total of 113 consecutive outpatients with HF completed a 3-day food diary to measure intake of 15 micronutrients. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary micronutrient deficiencies. Patients completed the Minnesota Living With HF Questionnaire to assess health-related quality of life (HRQoL) and were followed up for 1 year to determine cardiac-related hospitalization or cardiac death. Hierarchical multiple linear regressions and Cox proportional hazard regressions were used to determine whether micronutrient deficiencies predicted health outcomes. RESULTS Fifty-eight patients (51%) had at least 3 micronutrient deficiencies (range, 0-14). Calcium, magnesium, and vitamin D were the most common micronutrient deficiencies. Micronutrient deficiency was independently associated with worse HRQoL (β = .187, P = .025) in hierarchical multiple linear regression. Thirty-nine patients were hospitalized or died during 1-year follow-up because of cardiac problems. The number of micronutrient deficiencies independently predicted cardiac event-free survival (hazard ratio, 1.14; 95% confidence interval, 1.02-1.28). CONCLUSIONS These findings show that micronutrient deficiency independently predicted poor HRQoL and earlier cardiac event-free survival in patients with HF. Further research is needed to provide for specific dietary guidelines for better health outcomes in HF patients.
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Rong X, Peng Y, Yu H, Li D. Factors associated with adoption of coping strategies among Chinese patients with heart failure in ethnic minority regions. J Clin Nurs 2018; 27:3324-3334. [PMID: 29193457 DOI: 10.1111/jocn.14199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the coping strategies in patients with heart failure (HF) in the ethnic minority regions of China and to explore the factors affecting the adoption of coping strategies. BACKGROUND Effective coping with illness is an important element that influences the adaptation and increases the patient quality of life. Although different factors have been proposed to be determinants of coping strategy, findings are inconclusive, especially when it comes to the cultural background. DESIGN A cross-sectional study was performed. METHODS A total of 360 HF patients in four districts of Xinjiang were enrolled. All participants completed the Medical Coping Modes Questionnaire, the Minnesota Living with HF Questionnaire and self-management Questionnaire. RESULTS Heart failure patients had lower scores in confrontation and higher scores in avoidance and acceptance resignation than patients in the Chinese norm. The multiple regression analysis revealed several factors that indicate confrontation coping including symptom management, employment status and psychological and social management, whereas religion (R2), disease duration, employment status and payment system (P2) were identified as indicators of avoidance coping. In addition, ethnicity (E1), disease duration and employment status were indicators of acceptance resignation coping. CONCLUSIONS Our findings from this study suggest that HF patients in the ethnic minority regions may use less confrontation coping and more avoidance and acceptance resignation coping than patients in the Chinese norm. Moreover, the cultural background, duration of disease, quality of life and self-management play important roles in the selection of HF coping strategy. RELEVANCE TO CLINICAL PRACTICE The disparities of racial/ethnic exist in coping strategy. Healthcare providers are required to better understand the role of religion in the coping process and how it contributes to the selection of coping strategies.
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Affiliation(s)
- Xiaoshan Rong
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Youqing Peng
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiping Yu
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan Li
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Zhang M, Loerbroks A, Li J. Job burnout predicts decline of health-related quality of life among employees with cardiovascular disease: A one-year follow-up study in female nurses. Gen Hosp Psychiatry 2018; 50:51-53. [PMID: 29054016 DOI: 10.1016/j.genhosppsych.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether job burnout is associated with health-related quality of life (HRQOL) in employees with cardiovascular disease. METHODS In this longitudinal study, we included 305 female hospital nurses with cardiovascular disease. Job burnout was measured by the 6-item Copenhagen Burnout Inventory at baseline. We categorized study participants into low, intermediate and high levels of job burnout based on tertiles. HRQOL at baseline and at one-year follow-up was operationalized in terms of the physical and mental functioning summary scores of the short form 8-item health survey (SF-8), which is an abbreviated version of the widely used SF-36 with score ranges of 0-100. Linear regression was applied to examine longitudinal associations. RESULTS After taking into account relevant socio-demographic, behavioral, and work-related covariates as well as HRQOL scores at baseline, we found that both physical functioning and mental functioning declined (by 2.53 points and 3.02 points respectively, p<0.05) in the high job burnout group compared with the low job burnout group. Dose-response relationships were also observed (p<0.05). CONCLUSION Job burnout predicts decline of HRQOL one year later among employees with cardiovascular disease.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
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Nipp RD, El-Jawahri A, Moran SM, D'Arpino SM, Johnson PC, Lage DE, Wong RL, Pirl WF, Traeger L, Lennes IT, Cashavelly BJ, Jackson VA, Greer JA, Ryan DP, Hochberg EP, Temel JS. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 2017; 123:4720-4727. [PMID: 29057450 DOI: 10.1002/cncr.30912] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization. METHODS We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. RESULTS We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P < .001), psychological distress (PHQ-4 total: B, 0.11; P = .040), and depression symptoms (PHQ-4 depression: B, 0.22; P = .017) were associated with longer hospital LOS. Physical (ESAS: hazard ratio, 1.01; P < .001), and anxiety symptoms (PHQ-4 anxiety: hazard ratio, 1.06; P = .045) were associated with a higher likelihood for readmission. CONCLUSIONS Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Samantha M Moran
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara M D'Arpino
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Connor Johnson
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel E Lage
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Risa L Wong
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Sylvester Comprehensive Cancer Center and University of Miami, Miami, Florida
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Inga T Lennes
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Barbara J Cashavelly
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Vicki A Jackson
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ephraim P Hochberg
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
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The Relationship of Depressive Symptoms and Vitamin D Intake to Cardiac Event–Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2017; 32:480-487. [DOI: 10.1097/jcn.0000000000000369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeon SW, Lim HE, Yoon S, Na KS, Ko YH, Joe SH, Kim YH. Does Type D Personality Impact on the Prognosis of Patients Who Underwent Catheter Ablation for Atrial Fibrillation? A 1-Year Follow-Up Study. Psychiatry Investig 2017; 14:281-288. [PMID: 28539946 PMCID: PMC5440430 DOI: 10.4306/pi.2017.14.3.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/20/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Although Type D personality has been associated with the prognosis of various cardiac diseases, few studies have investigated the influence of Type D personality on the cardiac and psychiatric prognoses of patients with atrial fibrillation (AF). METHODS Depression, anxiety, and quality of life were measured at baseline and 6 months. The recurrence of AF was measured during 1-year following radiofrequency catheter ablation (RFCA) for AF. The Kaplan-Meier method with log-rank tests were used to compare the cumulative recurrence of AF. ACox proportional hazard model was conducted to identify factors that contribute to the recurrence of AF. RESULTS A total of 236 patients admitted for RFCA were recruited. Patients with a Type D personality had higher levels of depression and anxiety and a poorer quality of life compared to controls. Although depression, anxiety, and quality of life had improved 6 months after RFCA, significant differences in psychiatric symptoms remained between patients with and without Type D personality. In the Cox models, the type of AF was the only factor that influenced the recurrence of AF. CONCLUSION Our results suggest that Type D personality predominately influences psychological distress in patients with AF, but not the recurrence of AF.
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Affiliation(s)
- Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Seoyoung Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Kyoung Se Na
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sook-Haeng Joe
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
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Abstract
OBJECTIVE The construct of vital exhaustion has been identified as a potential independent psychological risk factor for incident and recurrent coronary heart disease (CHD). Despite several decades of research, no systematic review or meta-analysis has previously attempted to collate the empirical evidence in this field. The purpose of this study was to review and quantify the impact of vital exhaustion on the development and progression of CHD. METHODS Prospective and case-control studies reporting vital exhaustion at baseline and CHD outcomes at follow-up were derived from PubMed, PsycINFO (1980 to July 2015; articles in English and published articles only), and bibliographies. Information on aim, study design, sample size, inclusion and exclusion criteria, assessment methods of psychological risk factors, and results of crude and adjusted regression analyses were abstracted independently by two authors. RESULTS Thirteen prospective (n = 52,636) and three case-control (cases, n = 244; controls, n = 457) studies assessed vital exhaustion and could be summarized in meta-analyses. The pooled adjusted risk of CHD in healthy populations was 1.50 (95% confidence interval [CI] = 1.22-1.85) for prospective studies, and 2.61 (95% CI = 1.66-4.10) for case-control studies using hospital controls. Risk of recurrent events in patients with CHD was 2.03 (95% CI = 1.54-2.68). The pooled adjusted risk of chronic heart failure in healthy populations was 1.37 (95% CI = 1.21-1.56), but this was based on results from only two studies. CONCLUSIONS Vital exhaustion is associated with increased risk of incident and recurrent CHD.
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Mangolian Shahrbabaki P, Nouhi E, Kazemi M, Ahmadi F. The sliding context of health: the challenges faced by patients with heart failure from the perspective of patients, healthcare providers and family members. J Clin Nurs 2017; 26:3597-3609. [DOI: 10.1111/jocn.13729] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Parvin Mangolian Shahrbabaki
- Department of Medical Surgical; School of Nursing and Midwifery; Nursing Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - Esmat Nouhi
- Department of Medical Surgical; School of Nursing and Midwifery; Nursing Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - Majid Kazemi
- Department of Medical Surgical; School of Nursing and Midwifery; Rafsanjan University of Medical Sciences; Rafsanjan Iran
| | - Fazlollah Ahmadi
- Nursing Department; Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
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Gathright EC, Goldstein CM, Josephson RA, Hughes JW. Depression increases the risk of mortality in patients with heart failure: A meta-analysis. J Psychosom Res 2017; 94:82-89. [PMID: 28183407 PMCID: PMC5370194 DOI: 10.1016/j.jpsychores.2017.01.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is a risk factor for mortality in cardiovascular diseases. Prior studies confirm that depression predicts adverse outcomes in patients with heart failure (HF). However, data were inconclusive regarding the effect of depression on mortality. This meta-analysis examines the relationship between depression and mortality in HF. METHODS Prospective studies of depression and mortality in HF published between 1999 and April 2016 were located using PubMed, PsychINFO, and MEDLINE. Comprehensive Meta-Analysis software was used to compute an aggregated effect size estimates of hazard ratios and to conduct subgroup analyses. RESULTS Eighteen studies met inclusion criteria. For 8 aggregated univariate and 14 multivariate estimates, depressive symptoms were related to all-cause mortality. A pooled HR of 3 multivariate analyses indicated that depressive symptoms were not linked to cardiovascular mortality. In subgroup analyses, depression predicted all-cause mortality in samples with a mean age >65. The impact of depression on all-cause mortality also differed by follow-up duration, with samples with shorter follow-up durations demonstrating a larger effect. CONCLUSIONS In HF, depression is related to increased all-cause mortality risk, with stronger effects in samples with shorter follow-up and in older adults. In older adults, depression may serve as a marker of more severe HF. However, this possibility is difficult to examine given inconsistent adjustment for HF severity. Additional studies may assist in determining the relationship between depression and cardiovascular mortality, as the low number of studies examining cardiovascular mortality may have precluded detection of an effect.
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Affiliation(s)
- Emily C Gathright
- Department of Psychological Sciences, Kent State University, Kent, OH 44240, USA; Alpert Medical School, Brown University, Providence, RI 02903, USA.
| | | | - Richard A Josephson
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH 44106, USA; Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH 44240, USA
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Condén E, Rosenblad A, Wagner P, Leppert J, Ekselius L, Åslund C. Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients? Eur J Prev Cardiol 2017; 24:522-533. [PMID: 28071958 DOI: 10.1177/2047487316687427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.
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Affiliation(s)
- Emelie Condén
- 1 Centre for Clinical Research, Uppsala University, Sweden.,2 School of Health, Care and Social Welfare, Malardalen University, Sweden
| | | | | | - Jerzy Leppert
- 1 Centre for Clinical Research, Uppsala University, Sweden
| | - Lisa Ekselius
- 3 Department of Neuroscience, Uppsala University, Sweden
| | - Cecilia Åslund
- 1 Centre for Clinical Research, Uppsala University, Sweden
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Miloyan B, Bulley A, Bandeen-Roche K, Eaton WW, Gonçalves-Bradley DC. Anxiety disorders and all-cause mortality: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1467-1475. [PMID: 27628244 PMCID: PMC5102798 DOI: 10.1007/s00127-016-1284-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review and meta-analysis of prospective cohort studies that examined the relationship between anxiety disorders, or clinically significant anxiety symptoms, at baseline and all-cause mortality at follow-up relative to control participants without clinically significant anxiety. METHODS PubMed, EMBASE, PsycInfo, and CINAHL were searched through July 2015, along with manual searches of published reviews and forward and backward snowball searches of included studies. Studies were excluded if anxiety was not defined with a standardized instrument, or if participants were followed-up for 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening. RESULTS Forty-two estimates from 36 articles were included in the meta-analysis with a total sample of 127,552 participants and over 11,573 deaths. The overall hazard ratio (HR) estimate of mortality in clinically anxious participants relative to controls was 1.09 (95 % CI 1.01-1.16); however, this was reduced after adjusting for publication bias (1.03; 95 % CI 0.95-1.13). There was no evidence of increased mortality risk among anxious participants derived from community samples (0.99; 95 % CI 0.96-1.02) and in studies that adjusted for a diagnosis of depression (1.01; 95 % CI 0.96-1.06). CONCLUSIONS These findings suggest that positive associations in the literature are attributable to studies in smaller samples, comorbid depression (or other psychiatric conditions) among participants, and possible confounding in medical patient samples followed-up for short durations.
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Affiliation(s)
- Beyon Miloyan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Adam Bulley
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Karen Bandeen-Roche
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William W Eaton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Ramos S, Prata J, Bettencourt P, Gonçalves FR, Coelho R. Depression predicts mortality and hospitalization in heart failure: A six-years follow-up study. J Affect Disord 2016; 201:162-70. [PMID: 27235819 DOI: 10.1016/j.jad.2016.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF. METHODS A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors. RESULTS During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors. LIMITATIONS Only outpatient sample; measure of DS only at baseline; cause of death was not known. CONCLUSION This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.
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Affiliation(s)
- Sónia Ramos
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal.
| | - Joana Prata
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | | | - Rui Coelho
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal; Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University of Porto, Portugal
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Moncrieft AE, Llabre MM, Gallo LC, Cai J, Gonzalez F, Gonzalez P, Ostrovsky NW, Schneiderman N, Penedo FJ. Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study. Psychol Health 2016; 31:1342-58. [PMID: 27456582 DOI: 10.1080/08870446.2016.1208820] [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: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if hostility is associated with physical and mental health-related quality of life (QoL) in US. Hispanics/Latinos after accounting for depression and anxiety. METHODS Analyses included 5313 adults (62% women, 18-75 years) who completed the ancillary sociocultural assessment of the Hispanic Community Health Study/Study of Latinos. Participants completed the Center for Epidemiological Studies Depression Scale, Spielberger Trait Anxiety Scale, Spielberger Trait Anger Scale, Cook-Medley Hostility cynicism subscale and Short Form Health Survey. In a structural regression model, associations of hostility with mental and physical QoL were examined. RESULTS In a model adjusting for age, sex, disease burden, income, education and years in the US., hostility was related to worse mental QoL, and was marginally associated with worse physical QoL. However, when adjusting for the influence of depression and anxiety, greater hostility was associated with better mental QoL, and was not associated with physical QoL. CONCLUSIONS Results indicate observed associations between hostility and QoL are confounded by symptoms of anxiety and depression, and suggest hostility is independently associated with better mental QoL in this population. Findings also highlight the importance of differentiating shared and unique associations of specific emotions with health outcomes.
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Affiliation(s)
- Ashley E Moncrieft
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Maria M Llabre
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Linda C Gallo
- b Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Jianwen Cai
- c Department of Biostatistics , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Franklyn Gonzalez
- c Department of Biostatistics , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Patricia Gonzalez
- b Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Natania W Ostrovsky
- d Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Neil Schneiderman
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Frank J Penedo
- e Department of Medical Social Sciences , Northwestern University , Chicago , IL , USA
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Vongmany J, Hickman LD, Lewis J, Newton PJ, Phillips JL. Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review. Eur J Cardiovasc Nurs 2016; 15:478-485. [DOI: 10.1177/1474515116635923] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/14/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey Vongmany
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia
| | | | - Joanne Lewis
- Faculty of Health, University of Technology Sydney, Australia
| | - Phillip J Newton
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia
| | - Jane L Phillips
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia
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Lewis EF, Kim HY, Claggett B, Spertus J, Heitner JF, Assmann SF, Kenwood CT, Solomon SD, Desai AS, Fang JC, McKinlay SA, Pitt BA, Pfeffer MA. Impact of Spironolactone on Longitudinal Changes in Health-Related Quality of Life in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial. Circ Heart Fail 2016; 9:e001937. [PMID: 26962133 DOI: 10.1161/circheartfailure.114.001937] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Heart failure (HF) with preserved ejection fraction patients have equally impaired health-related quality of life (HRQL) compared with those with HF with reduced ejection fraction, but limited studies have evaluated the impact of therapies on changes in HRQL. METHODS AND RESULTS Patients ≥50 years of age, with symptomatic HF and left ventricular ejection fraction ≥45%, were enrolled in Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) and randomized to spironolactone or placebo. Patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ), which was the primary HRQL instrument, and EQ5D visual analog scale at baseline, 4 months, 12 months, and annually thereafter. McMaster Overall Treatment Evaluation was assessed at 4 and 12 months to assess global change scores. Change scores (+SD) were calculated to determine between-group differences, and multivariable repeated-measures models were created to identify other factors associated with change scores. Paired KCCQ data were available for 91.7% of 3445 TOPCAT patients. By 4 months, the mean change in KCCQ was 7.7±16 and mean change in EQ5D visual analog scale was 4.7±16. Adjusted mean changes in KCCQ for the spironolactone group were significantly better than those for the placebo group at 4-month (1.54 better; P=0.002), 12-month (1.35 better; P=0.02), and 36-month (1.86 better; P=0.02) visits. No between-group differences in EQ5D visual analog scale change scores or McMaster Overall Treatment Evaluation were noted. Older age, obesity, current smoking, New York Heart Association class III/IV, and comorbid illnesses were associated with declines in KCCQ scores. Use of spironolactone was an independent predictor of improved KCCQ scores. CONCLUSIONS In symptomatic HF with preserved ejection fraction patients, use of spironolactone was associated with an improvement in HF-specific HRQL. Several modifiable risk factors were associated with HRQL deterioration. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Eldrin F Lewis
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.).
| | - Hae-Young Kim
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - John Spertus
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - John F Heitner
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Susan F Assmann
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Christopher T Kenwood
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Akshay S Desai
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - James C Fang
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Sonia A McKinlay
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Bertram A Pitt
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
| | - Marc A Pfeffer
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (E.F.L., B.C., S.D.S., A.S.D., M.A.P.); New England Research Institutes, Watertown, MA (H.-Y.K., S.F.A., C.T.K., S.A.M.); Mid America Heart Institute/UMKC, Kansas City, MO (J.S.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah, Division of Cardiology, Salt Lake City (J.C.F.); and University of Michigan School of Medicine, Ann Arbor (B.A.P.)
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Easton K, Coventry P, Lovell K, Carter LA, Deaton C. Prevalence and Measurement of Anxiety in Samples of Patients With Heart Failure: Meta-analysis. J Cardiovasc Nurs 2016; 31:367-79. [PMID: 25930162 PMCID: PMC4915759 DOI: 10.1097/jcn.0000000000000265] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Rates of anxiety in patients with heart failure (HF) vary widely, and not all assessment instruments used in this patient population are appropriate. It is timely to consolidate the evidence base and establish the prevalence and variance of anxiety in HF samples. METHODS A systematic review, meta-analysis, and meta-regression were conducted to identify the prevalence, variance, and measurement of anxiety in patients with HF. RESULTS A total of 14,367 citations were identified, with 73 studies meeting inclusion criteria. A random effects pooled prevalence of 13.1% (95% confidence interval [CI], 9.25%-16.86%) for anxiety disorders, 28.79% (95% CI, 23.30%-34.29) for probable clinically significant anxiety, and 55.5% (95% CI, 48.08%-62.83%) for elevated symptoms of anxiety was identified. Rates of anxiety were highest when measured using the Brief Symptom Scale-Anxiety scale (72.3%) and lowest when measured using the Generalised Anxiety Disorder-7 (6.3%). CONCLUSION Many patients with HF would benefit if screened for anxiety and treated. The conceptualization and measurement of anxiety accounted for most variance in prevalence rates. The Generalised Anxiety Disorder-7 or the Hospital Anxiety and Depression Scale appear to be the most appropriate instruments for this clinical population, with evidence to suggest they can discriminate between depression and anxiety, omit somatic items that may contaminate identification of anxiety in a population with physical comorbidities, and provide thresholds with which to differentiate patients and target treatments. Although there are limitations with the collation of diverse measurement methods, the current review provides researchers and clinicians with a more granular knowledge of prevalence estimates of anxiety in a population of HF patients.
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Affiliation(s)
- Katherine Easton
- Katherine Easton, PhD, MRes, BSc (Hons) Translational Research Scientist, CATCH (Centre for Assistive Technology and Connected Healthcare), University of Sheffield, United Kingdom. Peter Coventry, PhD, MSc, MA (Econ), BSc Senior Research Fellow, Institute of Population Health, University of Manchester, United Kingdom. Karina Lovell, PhD, MSc, BA (Hons), RN Director of Research and Professor of Mental Health, School of Nursing, Midwifery & Social Work, University of Manchester, United Kingdom. Lesley-Anne Carter, MSc NHR Doctoral Fellow, Institute of Population Health, University of Manchester, United Kingdom. Christi Deaton, PhD, RN, FAHA, FESC Florence Nightingale Foundation Professor of Clinical Nursing Research, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, United Kingdom
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