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Walters GWM, Yeo JL, Bilak JM, Pepper C, Gulsin GS, Freeman SC, Gray LJ, McCANN GP, Brady EM. The Effectiveness of Lifestyle Interventions in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis. J Card Fail 2024:S1071-9164(24)00046-0. [PMID: 38428727 DOI: 10.1016/j.cardfail.2024.01.015] [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: 09/19/2023] [Revised: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To perform a network meta-analysis to determine the effectiveness of lifestyle interventions in exercise tolerance and quality of life (QoL) in people with HFpEF. METHODS Ten databases were searched for randomized controlled trials that evaluated a diet and/or exercise intervention in people with heart failure with preserved ejection fraction until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O2peak) and Quality of Life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesized data using network meta-analysis. RESULTS We identified 13 trials, including a total of 869 participants, and we incorporated 6 different interventions. Improvements in V̇O2peak compared to controls were seen for all exercise interventions (2.88 [95% CI: 1.36; 4.39] mL/kg/min) for high-intensity interval training (HIIT); 2.37 [95% CI: 1.02; 3.71] mL/kg/min for low-intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95% CI: 0.81; 3.29] mL/kg/min for moderate-intensity continuous training (MICT); 1.94 [95% CI: 0.59; 3.29] mL/kg/min for LIT; 1.85 [95% CI: 0.27; 3.44] mL/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61] mL/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95% CI: -11.05 [-20.55; -1.54] mL/kg/min) significantly improved MLHFQ scores. Network meta-analysis indicated that HIIT was the most effective intervention for improving both V̇O2peak (mean improvement 2.88 [95% CI: 1.36; 4.39] mL/kg/min, follow-up range, 4 weeks-3 years) and QoL (-14.45 [95% CI: -24.81; -4.10] points, follow-up range, 12-26 weeks) compared to usual care. CONCLUSIONS This network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL, with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.
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Affiliation(s)
- Grace W M Walters
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK.
| | - Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Joanna M Bilak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Coral Pepper
- University Hospitals Leicester, Headquarters Level 3, Balmoral Building Leicester Royal Infirmary, Infirmary Square Leicester, Leicestershire, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Suzanne C Freeman
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCANN
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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Uszko-Lencer NHMK, Janssen DJA, Gaffron S, Vanfleteren LEGW, Janssen E, Werter C, Franssen FME, Wouters EFM, Rechberger S, Brunner La Rocca HP, Spruit MA. Clustering based on comorbidities in patients with chronic heart failure: an illustration of clinical diversity. ESC Heart Fail 2021; 9:614-626. [PMID: 34796690 PMCID: PMC8787997 DOI: 10.1002/ehf2.13704] [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: 06/11/2021] [Revised: 10/01/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Aims It is increasingly recognized that the presence of comorbidities substantially contributes to the disease burden in patients with heart failure (HF). Several reports have suggested that clustering of comorbidities can lead to improved characterization of the disease phenotypes, which may influence management of the individual patient. Therefore, we aimed to cluster patients with HF based on medical comorbidities and their treatment and, subsequently, compare the clinical characteristics between these clusters. Methods and results A total of 603 patients with HF entering an outpatient HF rehabilitation programme were included [median age 65 years (interquartile range 56–71), 57% ischaemic origin of cardiomyopathy, and left ventricular ejection fraction 35% (26–45)]. Exercise performance, daily life activities, disease‐specific health status, coping styles, and personality traits were assessed. In addition, the presence of 12 clinically relevant comorbidities was recorded, based on targeted diagnostics combined with applicable pharmacotherapies. Self‐organizing maps (SOMs; www.viscovery.net) were used to visualize clusters, generated by using a hybrid algorithm that applies the classical hierarchical cluster method of Ward on top of the SOM topology. Five clusters were identified: (1) a least comorbidities cluster; (2) a cachectic/implosive cluster; (3) a metabolic diabetes cluster; (4) a metabolic renal cluster; and (5) a psychologic cluster. Exercise performance, daily life activities, disease‐specific health status, coping styles, personality traits, and number of comorbidities were significantly different between these clusters. Conclusions Distinct combinations of comorbidities could be identified in patients with HF. Therapy may be tailored based on these clusters as next step towards precision medicine. The effect of such an approach needs to be prospectively tested.
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Affiliation(s)
- Nicole H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Department of Research & Development, CIRO, Horn, The Netherlands
| | - Daisy J A Janssen
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Lowie E G W Vanfleteren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eefje Janssen
- Department of Research & Development, CIRO, Horn, The Netherlands
| | - Christ Werter
- Department of Cardiology, Laurentius Hospital, Roermond, The Netherlands
| | - Frits M E Franssen
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | | | | | - Martijn A Spruit
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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Structural relationship model of type D personality and depression with the mediating role of cognitive distortions and family functioning in irritable bowel syndrome patients and healthy people: A multi-group analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Park C, Won MH, Son YJ. Mediating effects of social support between Type D personality and self-care behaviours among heart failure patients. J Adv Nurs 2020; 77:1315-1324. [PMID: 33249650 DOI: 10.1111/jan.14682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
AIMS Patients with heart failure exhibit poor adherence to self-care behaviours. Recent studies have shown a link between Type D personality, social support, and self-care behaviours of patients with chronic diseases. However, the mechanisms underlying this relationship have received little empirical attention in those with heart failure. This study aimed to identify the mediating effects of social support in the relationship between Type D personality and self-care behaviours in patients with heart failure. DESIGN This study employed a descriptive cross-sectional design. METHODS The sample comprised 170 patients aged over 18 years who had been diagnosed with heart failure for over 6 months and visited a tertiary care university hospital in Seoul. From April-July 2019, data were collected through an interview conducted using a structured questionnaire and a review of medical records by two trained research assistants. Multiple regression models were tested using the SPSS PROCESS procedure with bootstrapping to determine the significance of the mediation. RESULTS The prevalence of Type D personality in patients with heart failure was 20.0%. Significant associations were identified among Type D personality, social support, and self-care behaviours. Results revealed an indirect effect, suggesting that the effects of Type D personality on self-care behaviours were mediated by social support. CONCLUSION Heart failure patients with Type D personality were likely to lack social support, which may have influenced their low adherence to self-care behaviours. Thus, to facilitate long-lasting self-care behaviours, it is vital to provide supportive care or educational programs for patients with Type D personality. IMPACT Providing sustainable social support can have a positive impact on the long-term self-care maintenance of patients with heart failure patients who have a Type D personality. Future studies are required to further elucidate the underlying mechanisms of the relationship between Type D personality, social support, and self-care behaviours.
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Affiliation(s)
- Chanhee Park
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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5
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Heo JM, Kim CG. The mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure. Jpn J Nurs Sci 2020; 17:e12359. [PMID: 32812696 DOI: 10.1111/jjns.12359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/05/2020] [Accepted: 06/10/2020] [Indexed: 02/03/2023]
Abstract
AIM There have been few studies done looking at the relationship between resilience, Type D personality, and self-care behavior in patients with heart failure. The purpose of this study was to identify the mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure. METHODS The subjects consisted of a sample of 90 heart failure patients aged ≥20 years who visited the cardiology outpatient clinic in the Chungbuk area of South Korea. RESULTS Among 90 patients, 49 subjects (54.0%) were classified as Type D personality, who exhibited statistically significant differences in resilience and self-care behavior (p < .001). A statistically significant correlation was also observed between self-care behavior score and resilience score (p < .01). The resilience had full mediation effects on the relationship between Type D personality and self-care behavior. In other words, the higher their resilience, the better their self-care behavior. CONCLUSIONS The study showed that resilience and Type D personality have important effects on self-care behavior.
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Affiliation(s)
- Ji Min Heo
- Management & Welfare Division, Settlement Support Center for North Korea Refugees (Hanawon), Anseong-si, Gyeonggi-do, South Korea
| | - Chul-Gyu Kim
- Department of Nursing, Chungbuk National University, Cheongju, Chungbuk, South Korea
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6
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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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7
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Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery. BMC Psychol 2019; 7:27. [PMID: 31046844 PMCID: PMC6498670 DOI: 10.1186/s40359-019-0303-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 04/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery. METHODS We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study. RESULTS A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3-6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2-2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04). CONCLUSIONS Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.
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Negative affectivity and social inhibition are associated with increased cardiac readmission in patients with heart failure: A preliminary observation study. PLoS One 2019; 14:e0215726. [PMID: 31002696 PMCID: PMC6474614 DOI: 10.1371/journal.pone.0215726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background Type D personality was hypothesized to influence clinical and patient-centered outcomes patients with heart failure. The aim of this study was to investigate the association between negative affectivity and social inhibition components of Type D personality and cardiac readmission in patients with heart failure. Methods A prospective observational study design was used. A total of 222 patients with heart failure were recruited from the department of cardiology in two regional hospitals in Taiwan. The 14-item Type D Scale-Taiwanese version was used to assess negative affectivity and social inhibition of the patients. Logistic regression analyses were conducted to determine the association of both Z-score transformed and dichotomized negative affectivity and social inhibition with 6-month and 18-month cardiac readmissions. Results A total of 55 patients (24.8%) and 89 patients (40.1%) had cardiac readmissions within 6 months and 18 months, respectively. Multiple logistic regression analyses of Z-score transformed negative affectivity and social inhibition were significantly associated with (1) 6-month cardiac readmission with odds ratios of 1.62 (P = 0.003) and 1.48 (P = 0.014), respectively and (2) 18-month cardiac readmission with odds ratios of 1.45 (P = 0.013) and 1.38 (P = 0.031), respectively. Similar findings were obtained when negative affectivity and social inhibition were analyzed as dichotomized scores. Conclusions Negative affectivity and social inhibition components of the Type D personality were significantly associated with a higher risk of cardiac readmission in both 6 months and 18 months after the initial hospitalization in patients with heart failure.
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Liu L, Wang X, Cao X, Gu C, Yang C, OuYang Y. Self-care confidence mediates the relationship between type D personality and self-care adherence in chinese heart failure patients. Heart Lung 2018; 47:216-221. [DOI: 10.1016/j.hrtlng.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 03/02/2018] [Indexed: 11/26/2022]
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10
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Mujezinovic A, Kwiet J, Kornhaber R, Holt R, Streimer J, Vandervord J, Rogers V, Shaw J, Law J, Cleary M, McLean L. Type-D Personality and Elevated Psychological Symptoms In Early Adjustment of Severe Burn Injury Patients. Issues Ment Health Nurs 2018; 39:337-343. [PMID: 29436882 DOI: 10.1080/01612840.2017.1416506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.
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Affiliation(s)
- Ajdin Mujezinovic
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Julia Kwiet
- b Severe Burns Injury Unit (SBIU), Royal North Shore Hospital , Sydney , NSW , Australia.,c Social Work, Royal North Shore Hospital , Sydney , NSW , Australia
| | - Rachel Kornhaber
- d University of Tasmania, School of Health Sciences, College of Health and Medicine , Sydney , NSW , Australia
| | - Rachael Holt
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Jeffrey Streimer
- e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,f The University of Sydney , Sydney , NSW , Australia.,g RANZCP , Australia
| | - John Vandervord
- b Severe Burns Injury Unit (SBIU), Royal North Shore Hospital , Sydney , NSW , Australia
| | - Vanessa Rogers
- e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,h The University of Sydney, Northern Clinical School , Sydney , NSW , Australia
| | - Joanne Shaw
- i The University of Sydney, Psycho-Oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science , Sydney , NSW , Australia
| | - Jeremy Law
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Michelle Cleary
- d University of Tasmania, School of Health Sciences, College of Health and Medicine , Sydney , NSW , Australia
| | - Loyola McLean
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia.,e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,j The University of Sydney, Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School , Sydney , New South Wales , Australia.,k Cumberland Hospital, Western Sydney Local Health District, Sydney West and Greater Southern Psychiatry Training Network, Sydney , New South Wales , Australia
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Sokoreli I, Pauws SC, Steyerberg EW, de Vries GJ, Riistama JM, Tesanovic A, Kazmi S, Pellicori P, Cleland JG, Clark AL. Prognostic value of psychosocial factors for first and recurrent hospitalizations and mortality in heart failure patients: insights from the OPERA-HF study. Eur J Heart Fail 2018; 20:689-696. [DOI: 10.1002/ejhf.1112] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/27/2017] [Accepted: 11/19/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ioanna Sokoreli
- Philips Research - Healthcare; Eindhoven The Netherlands
- Department of Public Health; Centre for Medical Decision Making, Erasmus MC; Rotterdam The Netherlands
| | - Steffen C. Pauws
- Philips Research - Healthcare; Eindhoven The Netherlands
- TiCC - University of Tilburg; Tilburg The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health; Centre for Medical Decision Making, Erasmus MC; Rotterdam The Netherlands
- Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden The Netherlands
| | | | | | | | | | | | - John G. Cleland
- University of Hull; Hull UK
- National Heart & Lung Institute; Imperial College; London UK
- Robertson Centre for Biostatistics & Clinical Trials; University of Glasgow; Glasgow UK
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12
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Prevalence and risk markers of early psychological distress after ICD implantation in the European REMOTE-CIED study cohort. Int J Cardiol 2017; 240:208-213. [DOI: 10.1016/j.ijcard.2017.03.124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
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Kessing D, Denollet J, Widdershoven J, Kupper N. Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis. Eur J Cardiovasc Nurs 2017; 16:605-613. [PMID: 28895482 PMCID: PMC5624300 DOI: 10.1177/1474515117702021] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Self-care is assumed to benefit health outcomes in patients with chronic heart failure (HF), but the evidence is conflicting for health-related quality of life (HRQOL). The aim of this study was to examine the association of (changes in) self-care with HRQOL while adjusting for psychological distress. METHODS In total, 459 patients (mean age = 66.1 ± 10.5 years, 73% male) with chronic HF completed questionnaires at baseline and at 6, 12 and 18 months of follow-up. Self-care and HF-specific HRQOL were quantified with the European Heart Failure Self-care Behaviour scale and the Minnesota Living with Heart Failure Questionnaire. RESULTS Using general linear models, multivariable between-subject (estimate = -0.14, p = 0.005) and no within-subject effects of self-care were found for better HRQOL over time. Associations between self-care and HRQOL were fully explained by depression (estimate = 1.77, p < 0.001). Anxiety (estimate = 4.49, p < 0.001) and Type D personality (estimate = 13.3, p < 0.001) were associated with poor HRQOL, but only partially accounted for the relationship between self-care and emotional HRQOL. CONCLUSIONS Self-care was prospectively associated with better disease-specific HRQOL in patients with HF, which was fully accounted for by depression, and partially accounted for by anxiety and Type D personality. Changes in self-care within a person did not affect HRQOL. Psychological distress should be considered in future efforts to address self-care and HRQOL.
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Affiliation(s)
- Dionne Kessing
- 1 Center of Research on Psychology in Somatic diseases (C oRPS), Tilburg University, Tilburg, The Netherlands
| | - Johan Denollet
- 1 Center of Research on Psychology in Somatic diseases (C oRPS), Tilburg University, Tilburg, The Netherlands
| | - Jos Widdershoven
- 1 Center of Research on Psychology in Somatic diseases (C oRPS), Tilburg University, Tilburg, The Netherlands.,2 Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Nina Kupper
- 1 Center of Research on Psychology in Somatic diseases (C oRPS), Tilburg University, Tilburg, The Netherlands
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Cao X, Wang XH, Wong EM, Chow CK, Chair SY. Type D personality negatively associated with self-care in Chinese heart failure patients. J Geriatr Cardiol 2016; 13:401-7. [PMID: 27594867 PMCID: PMC4984567 DOI: 10.11909/j.issn.1671-5411.2016.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/28/2016] [Accepted: 05/01/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Little is known about the association between type D personality and self-care behaviors in heart failure (HF) patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients. METHODS A cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index (V6) and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The methods used for data analysis included descriptive analysis, independent-sample t-test, χ (2) test, and multiple linear regression. RESULTS A total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9 ± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV (87%), and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors. CONCLUSIONS Type D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality.
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Affiliation(s)
- Xi Cao
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiu-Hua Wang
- Nursing School, Central South University, Changsha, China
| | - Eliza Ml Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Choi Kai Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
OBJECTIVE Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. METHODS Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. RESULTS Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44). CONCLUSIONS Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
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Nahlén Bose C, Elfström ML, Björling G, Persson H, Saboonchi F. Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure. Scand J Caring Sci 2016; 30:704-713. [DOI: 10.1111/scs.12297] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/26/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Catarina Nahlén Bose
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Magnus L. Elfström
- Academy of Health; Care and Social Welfare; Mälardalen University; Eskilstuna/Västerås Sweden
| | - Gunilla Björling
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - Hans Persson
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - Fredrik Saboonchi
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Neuroscience; Division of Insurance Medicine; Karolinska Institutet; Stockholm Sweden
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Bunz M, Lenski D, Wedegärtner S, Ukena C, Karbach J, Böhm M, Kindermann I. Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clin Res Cardiol 2015; 105:216-24. [PMID: 26481915 DOI: 10.1007/s00392-015-0909-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/20/2015] [Indexed: 01/14/2023]
Abstract
AIMS We analysed heart-focused anxiety (HFA) and its predictors in patients with heart failure before implantation of an implantable cardioverter defibrillator (ICD). Herein, we report the baseline data of the Anxiety-CHF Study which investigates HFA before and after ICD implantation. METHODS AND RESULTS HFA, general anxiety and depression, perceived quality of life (QoL) and type D personality were measured with validated psychological instruments. Clinical parameters such as severity of heart failure measured by NYHA class and left ventricular ejection fraction (EF) were determined. One hundred and ten patients were interrogated before ICD implantation (70 % male, mean age = 60.5 ± 14.9 years, mean EF = 31 % ± 9 %, 91 % NYHA II-III, 92 % primary prevention). HFA was present in 53 patients (48.6 %); 37 participants (33.9 %) showed increased levels of general anxiety and 33 patients (30.3 %) showed increased levels of depression with clinical significant levels in 16 subjects (14.7 %) for general anxiety and 13 subjects (11.9 %) for depression. Poor QoL was reported in 30 patients (27.5 %). HFA was correlated with QoL, general anxiety, depression, type D personality, myocardial infarction (MI), and systolic blood pressure. QoL, general anxiety and former MI were significant predictors of HFA (R (2) = 0.453). CONCLUSION Heart-focused anxiety is highly prevalent in heart failure patients prior to ICD implantation. Measures of disease severity such as EF or NYHA class do not predict HFA, neither does Type D personality. HFA is predicted by a history of MI and psychological parameters such as general anxiety and impaired QoL. CLINICALTRIALS. GOV IDENTIFIER NCT02226770.
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Affiliation(s)
- Maxie Bunz
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Denise Lenski
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Psychotherapy Practice, Saarbrücken, Germany
| | - Sonja Wedegärtner
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Julia Karbach
- Institut für Psychologie, Goethe-Universität, Frankfurt, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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18
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Kessing D, Denollet J, Widdershoven J, Kupper N. Fatigue and self-care in patients with chronic heart failure. Eur J Cardiovasc Nurs 2015; 15:337-44. [DOI: 10.1177/1474515115575834] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Dionne Kessing
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Johan Denollet
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, the Netherlands
| | - Nina Kupper
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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LENARCZYK RADOSŁAW, JĘDRZEJCZYK-PATEJ EWA, MAZUREK MICHAŁ, SZULIK MARIOLA, KOWALSKI OSKAR, PRUSZKOWSKA PATRYCJA, SOKAL ADAM, ŚREDNIAWA BEATA, BOIDOL JOANNA, KOWALCZYK JACEK, PODOLECKI TOMASZ, MENCEL GRZEGORZ, KALARUS ZBIGNIEW. Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:8-17. [DOI: 10.1111/pace.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- RADOSŁAW LENARCZYK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - EWA JĘDRZEJCZYK-PATEJ
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - MICHAŁ MAZUREK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - MARIOLA SZULIK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - OSKAR KOWALSKI
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - PATRYCJA PRUSZKOWSKA
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - ADAM SOKAL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - BEATA ŚREDNIAWA
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - JOANNA BOIDOL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - JACEK KOWALCZYK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - TOMASZ PODOLECKI
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - GRZEGORZ MENCEL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - ZBIGNIEW KALARUS
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
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20
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Alhurani AS, Dekker R, Tovar E, Bailey A, Lennie TA, Randall DC, Moser DK. Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure. SAGE Open Med 2014; 2. [PMID: 26246898 PMCID: PMC4523379 DOI: 10.1177/2050312114552093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. Method: A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol. Results: Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95–1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99–5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95–1.18; p = 0.32) was not a significant predictor of salivary cortisol level. Conclusion: Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.
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Affiliation(s)
- Abdullah S Alhurani
- College of Nursing, University of Kentucky, Lexington, KY, USA
- The University of Jordan, Amman, Jordan
| | - Rebecca Dekker
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Elizabeth Tovar
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Alison Bailey
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - David C Randall
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Positive affect, anhedonia, and compliance with self-care in patients with chronic heart failure. J Psychosom Res 2014; 77:296-301. [PMID: 25201483 DOI: 10.1016/j.jpsychores.2014.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Optimal self-care is crucial in patients with chronic heart failure (HF). While the focus of research has been on negative mood states, adequate psychological resources may be required to successfully engage in HF self-care. Therefore, the longitudinal associations of multiple positive affect measures in explaining HF self-care including consulting behavior were examined while adjusting for depressive symptoms and potential covariates (e.g., disease severity). METHODS In this prospective cohort study, 238 patients (mean age: 66.9 ± 8.6 years, 78% men), with chronic HF completed questionnaires at baseline and 1-year follow-up. Positive affect was assessed with the Positive and Negative Affect Schedule (PANAS) and the Global Mood Scale (GMS). Anhedonia, i.e. diminished interest or pleasure, was assessed with a subscale of the Hospital Anxiety and Depression Scale (HADS). The 9-item European Heart Failure Self-care Behaviour scale was completed to assess HF self-care including consultation behavior. RESULTS Linear mixed modeling results showed that anhedonia was most strongly associated with both poor self-care (estimate=-.72, P<.001) and consulting behavior (estimate=-.44, P<.001) over time, after adjustment for covariates and depressive symptoms. GMS positive affect was related to better HF self-care adjusting for standard depressive symptoms but not when adjusting for anhedonia. PANAS positive affect was not independently related to self-care. CONCLUSION Anhedonia was associated with worse compliance with self-care among chronic HF patients over time, irrespective of disease severity and depression. Associations between positive affect and self-care were dependent on the measures used in multivariable analyses.
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Abstract
BACKGROUND Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample. PURPOSE The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population. METHODS A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7). RESULTS Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A. CONCLUSION In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.
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23
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de Pedro-Cuesta J, García-Sagredo P, Alcalde-Cabero E, Alberquilla A, Damián J, Bosca G, López-Rodríguez F, Carmona M, de Tena-Dávila MJ, García-Olmos L, Salvador CH. Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain. PLoS One 2013; 8:e77482. [PMID: 24391687 PMCID: PMC3879317 DOI: 10.1371/journal.pone.0077482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/02/2013] [Indexed: 11/19/2022] Open
Abstract
Background Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions. Patients and Methods 300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) DisabilityAssessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients. Results Mean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death. Conclusions A considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.
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Affiliation(s)
- Jesús de Pedro-Cuesta
- Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain
- * E-mail:
| | | | - Enrique Alcalde-Cabero
- Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain
| | - Angel Alberquilla
- Multiprofessional Education Unit for Family and Community Care (Centre), Servicio Madrileño de Salud, Madrid, Spain
| | - Javier Damián
- Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain
| | - Graciela Bosca
- Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain
| | | | - Monserrat Carmona
- Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Madrid, Spain
| | | | - Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Servicio Madrileño de Salud, Madrid, Spain
| | - Carlos H. Salvador
- Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain
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