Health behaviors contribute to quality of life in patients with advanced heart failure independent of psychological and medical patient characteristics

A Web-Based Mind-Body Intervention (Mindful Steps) for Promoting Walking in Chronic Cardiopulmonary Disease: Insights From a Qualitative Study

Background

Given the deleterious effects of physical inactivity in persons with chronic obstructive pulmonary disease (COPD) and/or heart failure (HF), interventions that promote long-term daily physical activity are needed. Mindful Steps, designed to promote walking behaviors in COPD and HF, is a multicomponent intervention that integrates mind-body content with other self-regulatory components. The aim of the current qualitative study was to characterize participants' experiences with Mindful Steps and understand the perceived influence of the intervention on walking and health.

Method

In the context of a pilot randomized controlled feasibility trial comparing the year-long Mindful Steps program to usual care among individuals with COPD and HF, semi-structured qualitative interviews were administered at 6- and 12-months. Interviews were audio recorded and transcribed. The constant comparative method was used to code transcripts, identify categories, and develop interrelated themes.

Results

Nineteen participants (63% female; Mage = 70.2 years, SD = 6.95) who were randomized to the intervention group completed the 6-month interview and 17 completed the 12-month interview. The pedometer with feedback, live group classes, and mind-body videos were described as the most helpful intervention components. Participants learned several strategies that helped their walking (e.g., breathing regulation and awareness, body awareness, mind-body techniques, pacing), described walking as enjoyable, and identified internal reasons for walking (e.g., to feel good). They also reported several physical and mental health benefits of the intervention. Some participants reported limited influence of the intervention on walking or health. Many participants continued to use the strategies they learned in the first half of the intervention at 12-months.

Conclusions

The mind-body content of Mindful Steps appeared to positively influence walking behaviors. Participants' experiences with the intervention helped to identify areas for future intervention refinement. Future quantitative work is needed to corroborate these qualitative findings and assess the efficacy of the intervention on long-term physical activity engagement.

Trial Registration

This trial is registered in Clinical Trials.gov, ID number NCT01551953.

Health Behaviors and Health-Related Quality of Life in Female Medical Staff

The aim of this study was to evaluate the relationship between the intensity of health behaviors and health-related quality of life in female mid-level medical staff. The study group consisted of 153 female mid-level medical staff members. The intensity of health behaviors was examined with the Polish version of Health Behavior Inventory. Health-related quality of life was verified with the Short Form Health Survey questionnaire (SF 36v2). Among the participants, 33% had low, 39% average, and 28% high intensity of health behaviors. The mental component of health-related quality of life was rated higher (83.3 ± 15.3 points) compared to the physical one. The lowest health-related quality of life was observed in the domain of “bodily pain”, while the highest was found for the domain of “social functioning”. Both the physical and mental components of health-related quality of life were significantly positively correlated with health behavior prevalence in all its categories. The post-hoc tests revealed the variation in physical and mental components of HRQoL according to the level of health behavior intensity.

[Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction]

BACKGROUND

The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL.

METHODS

In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients. Relationships between health-related QoL and the studied variables were examined with bivariate correlations and binary logistic regression analysis.

RESULTS

In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41.5) as well as on its physical (median = 17.5) and emotional (median = 11.25) domains. In univariate analysis, the following variables were related to poor QoL with p < 0.005: not being employed, suffering from hypertension, renal failure, anemia, being under a low-salt diet, having no regular physical activity, having the physical symptoms of HF, higher NYHA class and longer QRS duration. In multiple regression analysis, the main independent predictors of poor QoL on the total scale were higher NYHA functional class and renal dysfunction,. The data provided no evidence of an association between LVEF and QoL.

CONCLUSION

This study has found that higher NHYA functional class and chronic kidney disease are risk factors for impaired QoL, independently of disease severity among patients with heart failure.

Quality of Life and Associated Factors in Older Adults With Heart Failure

BACKGROUND

Although heart failure (HF) is negatively known to affect older adults physically, psychologically, and socially, only a few studies have explored the predictors of quality of life (QoL) in older adults with HF in Taiwan.

PURPOSE

This study was designed to determine the relationships among depression, demographic characteristics, clinical characteristics, and QoL in older patients with HF.

METHODS

This was a cross-sectional study. From January 2013 to June 2014, convenience sampling was used to collect data from 175 older adults with HF at two hospitals in Northern Taiwan. Participant data were collected from medical records and researcher-administered structured questionnaires in face-to-face interviews.

RESULTS

The QoL of the participants was found to be associated with clinical characteristics, including hospital readmission for > 10 days with an increased level of HF-related symptom distress (HFSD) and more-severe depression. Depression was found to have a mediating effect, with the New York Heart Association (NYHA) functional class and HFSD both affecting the QoL of the participants through this intermediary.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

HF is a chronic and debilitating disease that often reduces QoL in older adults significantly. Interventions designed to increase QoL by improving the NYHA functional class and alleviating HFSD are valid treatment options only in cases with depressive symptoms. Nurses treating older adults with HF should consider factors such as NYHA functional class and HFSD to reduce HFSD and readmission rates and to enhance the QoL of these patients. In addition, after both hospital admission and discharge, older adult patients should be assessed regularly to monitor for and quickly address the development of comorbid depression.

The Relationship Between Spiritual Health and Quality of Life of Heart Transplant Candidates

The heart transplantation is a stressful event, and its waiting time is often associated with worsening of clinical conditions and deterioration of the patient's quality of life. Spirituality plays an important role in mental health, so the present study was conducted to investigate the relationship between spiritual health and quality of life of patients undergoing cardiac transplantation. The present descriptive study was performed on 48 patients undergoing cardiac transplantation at the Shahid Rajaee Cardiovascular Center in Tehran during the first half of 2016. The data were collected by Ellisan-Palutzian Spiritual Well-Being Scale, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Iranian Heart Failure Quality of Life Questionnaire (IHF-QOL). We used the SPSS v.20 software to analyze the data via descriptive statistics, parametric and non-parametric correlation and regression tests. The majority of patients (60.4%) had high spiritual health with a median score of 105, and its religious dimension was reported better (P < 0.001 and r = 0.591). With a mean of 63.23 ± 23.25, the quality of life of the majority of patients (75%) was at a poor level based on the Minnesota questionnaire. According to the IHF-QOL, the median total score was 39.50. There was a significant relationship between spiritual health score and quality of life in both questionnaires (MLHFQ: P = 0.006 and r = - 394; IHF-QOL: P = 0.022 and r = 0.329). Considering the positive relationship between spiritual health and quality of life of patients in this study, it is recommended to implement spiritual care and provide fulfillment for various needs of patients along with other medical care services.

Analysis of Health Behaviors in Patients After Liver Transplant

Currently, transplantation is one of the most effective treatments for the failure of organs such as liver, kidneys, or heart. Keeping to specific recommendations by organ recipients is extremely important, as they are vital to the effectiveness of the transplant. Positive health behaviors (HBs) have significant impact on strengthening the recipient's health.

AIM

The aim of this work is to indicate which HBs are exhibited by patients after liver transplants.

MATERIALS AND METHODS

The study group consisted of 115 adult liver recipients, in various times after their transplants. The average age in the group was 53.83 years old. The major reason for transplant was post-inflammatory cirrhosis of liver originating from hepatitis B or C viral infection. A diagnostic survey was used in the study, as well as a tool in the form of an original questionnaire and Juczyński's standard Health Behavior Inventory (HBI) questionnaire.

RESULTS

On the scale of general HBI index, patients achieved high results (M = 101), which shows that most recipients were disciplined in adhering to HBs. The worst results were achieved in the category of good eating habits, which proves that some respondents do not keep to the principles of healthy eating. The longer the time after the transplant, the lesser the extent in complying with HBs by recipients, in the first place in the scope of maintaining positive mental attitude. Specific behaviors were slightly worse, especially in residents of the countryside.

CONCLUSIONS

Adherence to particular categories of health strengthening behaviors is conditioned by specified sociodemographic variables. Sex, level of education, and professional status significantly affect the implementation of pro-health activities. These are best implemented by women who had completed university and high school education who are on a pension or retired.

Dietary patterns and components to prevent and treat heart failure: a comprehensive review of human studies

Growing evidence has emerged about the role of dietary patterns and components in heart failure (HF) incidence and severity. The objective here is to provide a comprehensive summary of the current evidence regarding dietary patterns/components and HF. A comprehensive search of online databases was conducted using multiple relevant keywords to identify relevant human studies. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets have consistently been associated with decreased HF incidence and severity. Regarding specific dietary components, fruit, vegetables, legumes and whole grains appear beneficial. Current evidence suggests that red/processed meats, eggs and refined carbohydrates are harmful, while fish, dairy products and poultry remain controversial. However, there is a notable lack of human intervention trials. The existing but limited observational and interventional evidence from human studies suggests that a plant-based dietary pattern high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans-fat and Na may decrease HF incidence/severity. Potential mechanisms include decreased oxidative stress, homocysteine and inflammation but higher antioxidant defence and NO bioavailability and gut microbiome modulation. Randomised, controlled trials are urgently required.

A Review of Plant-based Diets to Prevent and Treat Heart Failure

Evidence supporting the role of nutrition in heart failure (HF) incidence and severity is growing. A comprehensive search of online databases was conducted using relevant keywords to identify human studies including diet and HF. Several plant-based diets have consistently been associated with decreased HF incidence and severity, notably the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets. Several other plant-based dietary patterns, including low-fat diets and the rice diet, also show promise. Higher dietary quality, as assessed using different scores, seems to provide protective qualities. Fruit, vegetables, legumes and wholegrains appear to be beneficial, whereas red/processed meats, eggs and refined carbohydrates appear harmful. Some evidence suggests detrimental effects of dairy products and poultry, but more research is needed. There is observational and interventional evidence that a plant-based diet high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans fats may decrease the incidence and severity of HF. Potential mechanisms for this include decreased oxidative stress, homocysteine and inflammation levels, as well as higher antioxidant defence and nitric oxide bioavailability with gut microbiome modulation. Well-designed randomised, controlled nutrition intervention trials specific to HF are urgently required.

Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: analyses from INTERMACS

BACKGROUND

Destination therapy left ventricular assist devices (DT LVADs) are being implanted in older adults on an increasing basis. Older patients have a higher risk for mortality and morbidity post-LVAD, which may impact their health-related quality of life (HRQOL). We aimed to determine the change in HRQOL by age from before implant to 1 year after DT LVAD implant and identify factors associated with the change.

METHODS

Data were collected from 1,470 continuous-flow DT LVAD patients at 108 institutions participating in INTERMACS from January 21, 2010 to March 31, 2012. Patients were divided into three cohorts: <60 years of age (n = 457); 60 to 69 years of age (n = 520); and ≥70 years of age (n = 493). HRQOL was measured using the generic EuroQol instrument (EQ-5D-3L). Data were collected pre-implant and 3, 6 and 12 months post-implant. Statistical analyses included descriptive statistics, Kaplan-Meier survival analyses and multivariable regression analyses.

RESULTS

HRQOL improved in all patients. Generally, older patients reported better HRQOL than younger patients pre-implant (≥70 years: mean 40; 60 to 69 years: mean 33; and <60 years: mean 31; p < 0.0001) and 1 year post-implant (≥70 years: mean 77; 60 to 69 years: mean 72; <60 years: mean 70; p = 0.01) using the EQ-5D visual analog scale (VAS), with 0 = worst imaginable health state and 100 = best imaginable health state. The magnitude of improvement in EQ-5D scores from pre-implant to 1-year post-LVAD implant was similar in all age groups (≥70 years: mean change 33; 60 to 69 years: mean change 35; <60 years: mean change 35; p = 0.77). Factors associated with improvement in HRQOL from before to 1 year after implant were a lower VAS score pre-implant and fewer rehospitalizations post-implant (R(2) = 61.3%, p < 0.0001).

CONCLUSIONS

Older patients reported better HRQOL than younger patients before and after LVAD implantation. The magnitude of improvement was similar for all age groups, with >70% of all patients showing clinically significant increases (>10 points on the VAS). Rehospitalization appears to reduce the magnitude of improvement.