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Wang Y, Xu X, Lv Q, Zhao Y, Zhang X, Zang X. Network Analysis of Dyadic Burdens, Psychological Disorders, Psychological Resilience, and Illness- or Caregiving-Related Beliefs in Patients With Chronic Heart Failure and Their Caregivers. J Cardiovasc Nurs 2024:00005082-990000000-00184. [PMID: 38622773 DOI: 10.1097/jcn.0000000000001098] [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: 04/17/2024]
Abstract
BACKGROUND Previous research has examined the dyadic health components consisting of dyadic burdens, psychological disorders, psychological resilience, and illness- or caregiving-related beliefs independently from each other in patients with chronic heart failure (CHF) and their caregivers, but there is a need for further insights into their interconnections. OBJECTIVE We aimed to explore the interconnections among dyadic health components in patients with CHF and their caregivers. METHODS We conducted a cross-sectional study, recruiting in a total of 355 patients with CHF and their 355 respective caregivers, totaling 710 individuals across the dyads. Assessments were conducted on symptom burden, caregiver burden, anxiety, depression, psychological resilience, perceived control, and caregiver self-efficacy. Network analysis was used regarding these constructs as nodes and their associations as edges. RESULTS The strongest edge weight was observed between patients' anxiety and depression, followed by caregivers' anxiety and depression. Patients' depression exhibited the strongest edge weight with dyadic burdens. Caregiver burden was independently correlated with all nodes. Patients' symptom burden had fewer associations with the nodes within the caregiver community. Patients' anxiety, depression, and psychological resilience demonstrated the strongest and most influential correlations with other nodes. CONCLUSIONS The findings illustrated extensive interconnections among dyadic health components in CHF dyads. These findings underscored the significance of managing and intervening with patients and caregivers as a dyadic whole. Given the strong and frequent associations of patients' anxiety, depression, and psychological resilience with other nodes in the network, interventions targeting these nodes may enhance the overall network health of CHF dyads.
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Marques-Sule E, Muñoz-Gómez E, Almenar-Bonet L, Moreno-Segura N, Sánchez-Gómez MC, Deka P, López-Vilella R, Klompstra L, Cabanillas-García JL. Well-Being, Physical Activity, and Social Support in Octogenarians with Heart Failure during COVID-19 Confinement: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15316. [PMID: 36430033 PMCID: PMC9690854 DOI: 10.3390/ijerph192215316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to compare well-being and physical activity (PA) before and during COVID-19 confinement in older adults with heart failure (HF), to compare well-being and PA during COVID-19 confinement in octogenarians and non-octogenarians, and to explore well-being, social support, attention to symptoms, and assistance needs during confinement in this population. METHODS A mixed-methods design was performed. Well-being (Cantril Ladder of Life) and PA (International Physical Activity Questionnaire) were assessed. Semi-structured interviews were performed to assess the rest of the variables. RESULTS 120 participants were evaluated (74.16 ± 12.90 years; octogenarians = 44.16%, non-octogenarians = 55.83%). Both groups showed lower well-being and performed less PA during confinement than before (p < 0.001). Octogenarians reported lower well-being (p = 0.02), higher sedentary time (p = 0.03), and lower levels of moderate PA (p = 0.04) during confinement. Most individuals in the sample considered their well-being to have decreased during confinement, 30% reported decreased social support, 50% increased their attention to symptoms, and 60% were not satisfied with the assistance received. Octogenarians were more severely impacted during confinement than non-octogenarians in terms of well-being, attention to symptoms, and assistance needs. CONCLUSIONS Well-being and PA decreased during confinement, although octogenarians were more affected than non-octogenarians. Remote monitoring strategies are needed in elders with HF to control health outcomes in critical periods, especially in octogenarians.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), 46010 Valencia, Spain
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Elena Muñoz-Gómez
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Luis Almenar-Bonet
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | | | - María-Cruz Sánchez-Gómez
- Department of Didactics, Organization and Research Methods, University of Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI 3078, USA
| | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, 4566 Linkoping, Sweden
| | - Juan Luis Cabanillas-García
- Department of Didactics, Organization and Research Methods, University of Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain
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Steinberg RS, Nayak A, Burke MA, Aldridge M, Laskar SR, Bhatt K, Sridharan L, Abdou M, Attia T, Smith A, Daneshmand M, Vega JD, Gupta D, Morris AA. Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies. Clin Transplant 2022; 36:e14502. [PMID: 34634150 PMCID: PMC8752502 DOI: 10.1111/ctr.14502] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Caregiver support is considered necessary after heart transplant (HT) and left ventricular assist device (LVAD) for patients with end-stage heart failure (HF). Few studies have demonstrated how caregivers differ by gender and race, and whether that impacts therapy eligibility. METHODS We examined caregiver relationships among 674 patients (32% women, 55% Black) evaluated at Emory University from 2011 to 2017. Therapy readiness was assessed using the Stanford Integrated Assessment for Transplant (SIPAT). Evaluation outcome according to caregiver relationship was compared using χ2 analysis. Multivariable logistic regression determined the association between caregiver and eligibility according to gender and race. RESULTS Women and Black patients were less likely to have spouses as their support person (P < .001). Women were less likely to be considered eligible for advanced therapies (adjusted odds ratio [aOR] .64, 95% confidence interval [CI] .46-.89; P = .008), with Black women having lower eligibility than White women (aOR .28, 95% CI .11-.72; P = .008). Social support and SIPAT scores did not significantly influence eligibility by gender or race. CONCLUSION Lack of caregiver support is considered a relative contraindication to advanced therapies. Type of caregiver in our cohort varied according to race and gender but did not explain differences in eligibility for advanced therapies.
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Affiliation(s)
| | - Aditi Nayak
- Emory University, Division of Cardiology, Atlanta GA
| | - Michael A. Burke
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Morgan Aldridge
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - S. Raja Laskar
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Kunal Bhatt
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Lakshmi Sridharan
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Mahmoud Abdou
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Tamer Attia
- Emory Transplant Center, Emory Healthcare, Atlanta GA,Emory University, Division of Surgery, Atlanta GA
| | - Andrew Smith
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Mani Daneshmand
- Emory Transplant Center, Emory Healthcare, Atlanta GA,Emory University, Division of Surgery, Atlanta GA
| | - J. David Vega
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Divya Gupta
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Alanna A. Morris
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
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Mahrer-Imhof R, Østergaard B, Brødsgaard A, Konradsen H, Svavarsdóttir EK, Dieperink KB, Imhof L, García-Vivar C, Luttik ML. Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review. Scand J Caring Sci 2021; 36:320-345. [PMID: 34786754 DOI: 10.1111/scs.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. AIMS This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. MATERIALS & METHODS A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. RESULTS A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. DISCUSSION This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.
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Affiliation(s)
- Romy Mahrer-Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark.,Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Erla Kolbrun Svavarsdóttir
- School of Health Sciences, Faculty of Nursing, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Karin B Dieperink
- Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lorenz Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | | | - Marie-Louise Luttik
- Family Care, Hanze University of Applied Sciences, Groningen, The Netherlands
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Hailu Gebru T, Kidanu Berhe K, Tilahun Tsehaye W, Hagos Mekonen H, Gemechu Kiros K, Gebreslassie Gebrehiwot T, Teklebrhan Gebrehiwot G, Hailesilassie Teka Y, Maeruf Mohammed H. Self-Care Behavior and Associated Factors among Heart Failure Patients in Tigray, Ethiopia: A Cross-Sectional Study. Clin Nurs Res 2020; 30:636-643. [PMID: 33016105 DOI: 10.1177/1054773820961243] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to assess the prevalence of self-care behavior and associated factors among heart failure patients. This institutional-based cross-sectional study design was done in Tigray region, Ethiopia. The data collection process was made between February and April 2018. An interviewer assisted structured questionnaire and medical chart review was used to collect the data. Data was entered and analyzed using Statistical Package for the Social Science (SPSS) version 22. Bivariate and multivariable logistic regression were conducted to identify the predictors (p < .05). In this study, a total of 408 study subjects was included. The mean age of the participants was 45.4 (±19). The overall prevalence of good self-care behavior was 45.8% (95% CI: 40.9-50.5). Regression analysis revealed that age, educational level, co-morbidity, knowledge about heart failure, and social support were significantly associated with self-care behavior. Healthcare providers should strengthen patient education to improve self-care behavior.
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Affiliation(s)
- Tsegu Hailu Gebru
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
| | - Kalayou Kidanu Berhe
- School of Nursing, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Haftea Hagos Mekonen
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
| | - Kbrom Gemechu Kiros
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
| | | | | | - Yared Hailesilassie Teka
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
| | - Hayat Maeruf Mohammed
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
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The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure. Heart Lung 2020; 49:737-744. [PMID: 32977035 DOI: 10.1016/j.hrtlng.2020.08.011] [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: 03/16/2020] [Revised: 07/10/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health. OBJECTIVES The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver. METHODS A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2). RESULTS Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life. CONCLUSIONS The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.
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7
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Suicide risk in chronic heart failure patients and its association with depression, hopelessness and self esteem. J Clin Neurosci 2019; 68:51-54. [DOI: 10.1016/j.jocn.2019.07.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/26/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
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8
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Lacerda MS, Prado PRD, Barros ALBLD, Lopes JDL. Depressive symptoms in the family caregivers of patients with heart failure: an integrative review. ACTA ACUST UNITED AC 2019; 40:e20180057. [PMID: 31188982 DOI: 10.1590/1983-1447.2019.20180057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022]
Abstract
AIMS Identify the occurrence of depressive symptoms in family caregivers of patients with heart failure and the correlation of other variables with depressive symptoms. DESIGN/METHOD The literature review was conducted in the Web of Science, Medline, LILACS and PubMed databases in March 2017. Papers published between 2004 and 2016, written in English, Spanish or Portuguese were included. The descriptors used were health, heart failure, depression, caregivers, and family. RESULTS 26 papers were selected. 6% to 64% reported depressive symptoms. Depressive symptoms were associated with patients' and caregivers' characteristics. In most cases, depressive symptoms were greater among family caregivers than in the general population and were mainly associated with care burden and quality of life. CONCLUSIONS The studies report depressive symptoms in caregivers of patients with heart failure.
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Affiliation(s)
- Marianna Sobral Lacerda
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Patrícia Rezende do Prado
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Alba Lúcia Bottura Leite de Barros
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Juliana de Lima Lopes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
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10
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Jackson JDS, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Calado FJ. Burden of heart failure on caregivers in China: results from a cross-sectional survey. Drug Des Devel Ther 2018; 12:1669-1678. [PMID: 29922041 PMCID: PMC5996855 DOI: 10.2147/dddt.s148970] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Family and friends play a pivotal role in caring for patients with heart failure (HF); however, evidence of the impact of caregiving is limited. The objectives of this study were to describe the burden of caregiving on informal caregivers of patients with chronic HF in China. MATERIALS AND METHODS A cross-sectional survey of cardiologists, their patients with HF, and those patients' caregivers was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Caregivers of these patients were invited to complete a questionnaire. RESULTS Overall, 458 caregivers completed a questionnaire (mean ± standard deviation age 60.1±10.6 years; 60% female; 77% spouses; 74% retired). Caregivers spent a mean of 24.5 (16.9) hours caregiving per week, and a third reported a reduction in their social activity, time for themselves, or time for family. Caregivers in employment took several days off work in the past 3 months owing to caregiving, sometimes resulting in reduced income. Up to 79% of caregivers reported an impact on their physical or emotional well-being, and 57% reported deterioration in their objective health status. Inconsistencies stemming from differences in the three-level five-dimension EuroQol questionnaire and HF Caregiver Questionnaire were observed for the impact of caregiving on caregivers' health-related quality of life. CONCLUSION Assisting patients with HF is associated with caregiver burden. Addressing the needs of caregivers may help to promote their continued support and improve patient outcomes.
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Affiliation(s)
- James DS Jackson
- Real World Research, Adelphi Real World, Bollington, Cheshire, UK
| | - Sarah E Cotton
- Real World Research, Adelphi Real World, Bollington, Cheshire, UK
| | - Sara Bruce Wirta
- Real World Evidence Center of Excellence, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research & Access Strategy, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Real World Evidence Center of Excellence, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Real World Evidence Center of Excellence, Novartis Pharma AG, Basel, Switzerland
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11
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Bangerter LR, Griffin JM, Dunlay SM. Qualitative study of challenges of caring for a person with heart failure. Geriatr Nurs 2018; 39:443-449. [PMID: 29452768 DOI: 10.1016/j.gerinurse.2017.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) is a chronic health condition that causes significant morbidity among older adults, many of whom receive support and care from an informal caregiver. Caregiving is a difficult role with many responsibilities and challenges. An in-depth understanding of these challenges is necessary to develop services, resources, and interventions for HF caregivers. The goal of this study was to qualitatively ascertain the most significant challenges facing HF caregivers. We conducted semi-structured interviews with 16 caregivers of a person with HF (PHF). Content analysis revealed challenges rooted within the PHF (negative affect, resistant behavior, independence, and illness) Caregiver (balancing employment, lack of support, time, and caregiver health) and Relational level (PHF/caregiver dyadic relationship and other relationships). These findings can be used to inform interventions and support services for HF caregivers.
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Affiliation(s)
- Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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12
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Effect of Support Group Intervention Applied to the Caregivers of Individuals With Heart Failure on Caregiver Outcomes. Holist Nurs Pract 2016; 30:272-82. [PMID: 27501210 DOI: 10.1097/hnp.0000000000000164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to evaluate the effectiveness of support group intervention applied to the caregivers of individuals with heart failure on caregiver outcomes. Quasi-experimental research was conducted with 69 caregivers as control (n = 35) and intervention (n = 34) groups in the cardiology outpatient clinic of a university hospital. The intervention group participated in support group meetings structured according to the Neuman Systems Model, and the data were collected from both the intervention and control groups before the intervention and 3 and 6 months later. Caregivers in the intervention group had significantly lower burden scores compared with the control group in all subdimensions except objective personal care, in terms of the group × time interaction in a statistical way (P < .05). Caregivers in the intervention and control groups had similar scores of depression symptoms (P > .05). The burden of caregivers in the intervention group showed a statistically significant decrease compared with the preintervention in all dimensions at 3 months. Thus, it is suggested to extend the support group interventions for caregivers of patients with heart failure and conduct these interventions in a longer period.
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13
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Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals. BMC Health Serv Res 2016; 16:361. [PMID: 27503510 PMCID: PMC4977661 DOI: 10.1186/s12913-016-1609-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022] Open
Abstract
Background Compared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers’ (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure. Methods We conducted an online-survey with 315 nurses and physicians of different medical disciplines. Results Even though heart failure patients’ need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration. Conclusions In order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers. Trial registration DRKS00007119 Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1609-x) contains supplementary material, which is available to authorized users.
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Abstract
BACKGROUND The majority of heart failure (HF) self-care research remains focused on patients, despite the important involvement of family caregivers. Although self-care confidence has been found to play an important role in the effectiveness of HF self-care management on patient outcomes, no known research has examined self-care confidence within a dyadic context. OBJECTIVE The purpose of this study was to identify individual and dyadic determinants of self-care confidence in HF care dyads. METHODS Multilevel modeling, which controls for the interdependent nature of dyadic data, was used to examine 329 Italian HF dyads (caregivers were either spouses or adult children). RESULTS Both patients and caregivers reported lower-than-adequate levels of confidence, with caregivers reporting slightly higher confidence than patients. Patient and caregiver levels of confidence were significantly associated with greater patient-reported relationship quality and better caregiver mental health. Patient confidence in self-care was significantly associated with patient female gender, nonspousal care dyads, poor caregiver physical health, and low care strain. Caregiver confidence to contribute to self-care was significantly associated with poor emotional quality of life in patients and greater perceived social support by caregivers. CONCLUSIONS Findings are supportive of the need for a dyadic perspective of HF self-care in practice and research as well as the importance of addressing the needs of both members of the dyad to maximize optimal outcomes for both.
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15
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Evangelista LS, Strömberg A, Dionne-Odom JN. An integrated review of interventions to improve psychological outcomes in caregivers of patients with heart failure. Curr Opin Support Palliat Care 2016; 10:24-31. [PMID: 26716392 PMCID: PMC4760617 DOI: 10.1097/spc.0000000000000182] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article examines interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure. RECENT FINDINGS Eight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of four to six sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n = 4), depressive symptoms (n = 1), stress mastery (n = 1), caregiver confidence and preparedness (n = 1), and caregiver mastery (n = 1). SUMMARY Compared with dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with heart failure. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of heart failure caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance heart failure caregiver support and education.
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Affiliation(s)
- Lorraine S Evangelista
- aUCI Program in Nursing Science, University of California Irvine, Irvine, California bDepartment of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping, Sweden cSchool of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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Timonet Andreu E, Morales Asencio JM, Canca Sanchez JC, Sepulveda Sanchez J, Mesa Rico R, Rivas Ruiz F. Effects and consequences of caring for persons with heart failure: (ECCUPENIC study) a nested case-control study. J Adv Nurs 2015; 71:2987-97. [PMID: 26189814 DOI: 10.1111/jan.12732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
Abstract
AIM Primary: To report a research protocol to analyse the relationship between the degree of heart failure and the health-related quality of life of patients and their family caregivers. Secondary: To identify the characteristics of heart failure patients and their caregivers and the association between these characteristics and hospital admissions. Moreover, to conduct a longitudinal analysis of the relationship between patients' and that of their family caregivers. BACKGROUND As heart failure progresses, it reduces the patient's quality of life and progressive functional deterioration requires hospital admission and the provision of healthcare resources. The availability of a family caregiver is a key element in addressing and managing this healthcare problem and some research results have associated this factor with the prognosis for heart failure. DESIGN Multicentre cohort nested case-control study. METHODS Exploratory analysis: Descriptive statistics, measures of central tendency and dispersion or percentages. Bivariate analysis: Using Student's t-test and chi-square test, anova and non-parametric tests. Survival analysis: Kaplan-Meier curves. Multivariate analysis: Cox's proportional hazards model. All calculations performed with an alpha level of 0·05. DISCUSSION Lack of family support for patients with HF or greater duration of care is associated with more hospitalizations and increased depression among caregivers. Further longitudinal studies with a large population sample are required.
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Affiliation(s)
| | - José Miguel Morales Asencio
- Nursing and Podiatry Department/Research Methods and Evidence, Health Sciences School, University of Malaga, Spain
| | - José Carlos Canca Sanchez
- Costa del Sol Public Healthcare Agency, Marbella, Spain.,Health Sciences School, University of Malaga, Spain
| | | | - Rafael Mesa Rico
- Cardiology Unit, Costa del Sol Public Healthcare Agency, Marbella, Spain
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Narożny W, Gromnicki M, Majkowicz M, Kuczkowski J, Sochaczewska A. Jakość życia chorych z nagłym niedosłuchem czuciowo-nerwowym. Otolaryngol Pol 2014; 68:69-76. [DOI: 10.1016/j.otpol.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/07/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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Macdonald M, Lang A, Storch J, Stevenson L, Donaldson S, Barber T, Iaboni K. Home care safety markers: a scoping review. Home Health Care Serv Q 2014; 32:126-48. [PMID: 23679662 DOI: 10.1080/01621424.2013.783523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health.
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Iqbal J, Francis L, Reid J, Murray S, Denvir M. Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality. Eur J Heart Fail 2014; 12:1002-8. [DOI: 10.1093/eurjhf/hfq114] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Javaid Iqbal
- Centre for Cardiovascular Science, Queens Medical Research Institute; University of Edinburgh; EH16 4TJ Edinburgh UK
| | | | - Janet Reid
- Lothian Heart Failure Network; NHS Lothian; Edinburgh UK
| | - Scott Murray
- Primary Palliative Care Research Group; University of Edinburgh; Edinburgh UK
| | - Martin Denvir
- Centre for Cardiovascular Science, Queens Medical Research Institute; University of Edinburgh; EH16 4TJ Edinburgh UK
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20
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Abstract
Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes.
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Affiliation(s)
- David L Hare
- Department of Medicine, University of Melbourne, Heidelberg Vic 3084, Australia Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Samia R Toukhsati
- Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Peter Johansson
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
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21
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Macdonald MT, Lang A, Storch J, Stevenson L, Barber T, Iaboni K, Donaldson S. Examining markers of safety in homecare using the international classification for patient safety. BMC Health Serv Res 2013; 13:191. [PMID: 23705841 PMCID: PMC3669614 DOI: 10.1186/1472-6963-13-191] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health. METHODS The safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk. RESULTS Safety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes. CONCLUSION The ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.
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Affiliation(s)
- Marilyn T Macdonald
- School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, PO Box, 15000, Halifax, Nova Scotia B3H 4R2, Canada.
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22
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Schowalter M, Gelbrich G, Störk S, Langguth JP, Morbach C, Ertl G, Faller H, Angermann CE. Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol 2012; 102:269-78. [PMID: 23262494 DOI: 10.1007/s00392-012-0531-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
AIMS Heart failure is known to profoundly affect health-related quality of life (HRQoL). We aimed to describe both generic and disease-specific HRQoL in a large community-based sample of patients with systolic heart failure (SHF) and to identify important somatic and psychosocial correlates. METHODS AND RESULTS Seven hundred and two patients, 67 ± 12 years old, 71 % men, with distributions of New York Heart Association (NYHA) functional classes I/II/III/IV of 2/55/39/4 % were included in this cross-sectional analysis. Generic HRQoL was measured with the SF-36 health survey, disease-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire, and depression with the self-reported Patient Health Questionnaire (PHQ-9). Both generic- and disease-specific HRQoL measurements indicated moderate to poor HRQoL. The KCCQ scores demonstrated higher sensitivity to the varying levels of heart failure severity as compared to the SF-36 scores. Patients with either a minor (15 %) or a major depression (24 %) reported significantly and substantially lower HRQoL (p < .001) than patients without depression did. In multivariable regression analyses, depression accounted for the largest part of the variance of both generic and specific HRQoL (12 and 36 %, respectively), whereas most biomedical variables had no or only a marginal influence. CONCLUSION Patients with SHF suffer from severe limitations of HRQoL. Depression was the most important correlate of both generic and disease-specific HRQoL.
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Affiliation(s)
- Marion Schowalter
- Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D 97070 Würzburg, Germany.
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Changes in Depressive Symptoms in Spouses of Post Myocardial Infarction Patients. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:158-65. [DOI: 10.1016/j.anr.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 11/23/2022] Open
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Borren I, Tambs K, Idstad M, Ask H, Sundet JM. Psychological distress and subjective well-being in partners of somatically ill or physically disabled: the Nord-Trøndelag Health Study. Scand J Psychol 2012; 53:475-82. [PMID: 23170864 DOI: 10.1111/sjop.12009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study investigated the cross-sectional associations between various somatic conditions in one partner and the level of distress and well-being in the spouse. The study is based on survey data from the Norwegian Nord-Trøndelag Health Study, HUNT II (1995-1997). A sample of 9,797 married or cohabiting couples with valid data on subjective well-being (SWB), psychological distress (Hopkins Symptom Check List (SCL)-10) and somatic illness were identified. Regression analyses stratified by sex were conducted with SCL-10 and SWB scores as dependent variables and a joint somatic score as predictor, including; stroke, cancer, angina, myocardial infarction and physical disability (PD). The contribution of each somatic condition was also explored. Spouses of persons previously diagnosed with at least one somatic condition scored significantly lower on SWB and significantly higher on SCL-10 than spouses of healthy persons, though effect sizes were small. The effect seems to be at least partly mediated by the ill partner's psychological distress. Of the specific conditions, PD had the most significant contribution for both genders, though an association between male angina and spousal distress/SWB was also demonstrated.
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Affiliation(s)
- Ingrid Borren
- Norwegian Institute of Public Health, Division of Mental Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway.
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25
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Health-related quality of life and anemia in hospitalized patients with heart failure. Int J Cardiol 2012; 161:151-5. [DOI: 10.1016/j.ijcard.2012.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/16/2012] [Accepted: 05/05/2012] [Indexed: 12/18/2022]
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Löfvenmark C, Saboonchi F, Edner M, Billing E, Mattiasson AC. Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial. J Clin Nurs 2012; 22:115-26. [PMID: 22946864 DOI: 10.1111/j.1365-2702.2012.04201.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. BACKGROUND When a person is diagnosed with heart failure, the daily life of the family members is also affected. DESIGN Randomised controlled trial. METHODS A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. RESULTS There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2) = 0·35) and depression (p = 0·021, R(2) = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). CONCLUSION Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. RELEVANCE TO CLINICAL PRACTICE Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.
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Affiliation(s)
- Caroline Löfvenmark
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine and Sophiahemmet University College, Stockholm, Sweden.
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Małgorzewicz S, Rutkowski P, Jankowska M, Dębska- Ślizień A, Rutkowski B, Łysiak-Szydłowska W. Effects of Renal-specific Oral Supplementation in Malnourished Hemodialysis Patients. J Ren Nutr 2011; 21:347-53. [DOI: 10.1053/j.jrn.2010.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/03/2010] [Accepted: 07/06/2010] [Indexed: 11/11/2022] Open
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Pelegrino VM, Dantas RAS, Clark AM. Health-related quality of life determinants in outpatients with heart failure. Rev Lat Am Enfermagem 2011. [DOI: 10.1590/s0104-11692011000300002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This descriptive and exploratory study analyzed variables associated with health-related quality of life among 130 outpatients. Health-related quality of life was measured through the Minnesota Living with Heart Failure Questionnaire. Significant associations were found between patients’ health-related quality of life and their age (r=-0.177; p=0.044), vitality (r=-0.625; p=<0.001) as well as mental health (r=-0.672; p=<0.001), which are both SF-36 domains. The linear regression showed that heart failure symptom severity, vitality and mental health explained 54% of HRQOL measurement variation. To control symptoms and preserve good mental well-being are important to maintain health-related quality of life and to deliver effective heart failure care.
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Abstract
The etiology, predictive value, and biobehavioral aspects of depression in heart failure (HF) are described in this article. Clinically elevated levels of depressive symptoms are present in approximately 1 out of 5 patients with HF. Depression is associated with poor quality of life and a greater than 2-fold risk of clinical HF progression and mortality. The biobehavioral mechanisms accounting for these adverse outcomes include biological processes (elevated neurohormones, autonomic nervous system dysregulation, and inflammation) and adverse health behaviors (physical inactivity, medication nonadherence, poor dietary control, and smoking). Depression often remains undetected because of its partial overlap with HF-related symptoms and lack of systematic screening. Behavioral and pharmacologic antidepressive interventions commonly result in statistically significant but clinically modest improvements in depression and quality of life in HF, but not consistently better clinical HF or cardiovascular disease outcomes. Documentation of the biobehavioral pathways by which depression affects HF progression will be important to identify potential targets for novel integrative behavioral and pharmacologic interventions.
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Affiliation(s)
- Willem J Kop
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Ågren S, Evangelista L, Davidson T, Strömberg A. The influence of chronic heart failure in patient-partner dyads--a comparative study addressing issues of health-related quality of life. J Cardiovasc Nurs 2011; 26:65-73. [PMID: 21127426 PMCID: PMC3246077 DOI: 10.1097/jcn.0b013e3181ec0281] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving patients' HRQOL, but the awareness of partners' and families' role and situation is increasing. Therefore, further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF. OBJECTIVES To describe and compare HRQOL, quality-adjusted life-year (QALY) weights, symptoms of depression, and perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and sex-matched group. METHODS Data were collected from 135 patient-partner dyads at 2 Swedish hospitals. Data on the reference group were collected from the same region. RESULTS Patients had lower HRQOL in all dimensions (P<.001) except in the mental health domain and lower QALY weights compared with their partners (P<.001). Mental health scores were lower in partners compared with the age- and sex-matched references (P<.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than did their partners (P<.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners. CONCLUSIONS Our findings confirm that partners of patients with chronic HF have markedly diminished mental health. Interventions focusing on education and psychosocial support may potentially promote mental health in partners and enhance their ability to support the patient.
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Affiliation(s)
- Susanna Ågren
- Susanna Ågren, PhD, RN Medical Doctor, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University; Department of Cardiothoracic Surgery, Linköping University Hospital; and The Swedish Institute for Health Sciences, Lund, Sweden. Lorraine Evangelista, PhD, RN Senior Lecturer, School of Nursing, University of California, Los Angeles. Thomas Davidson, PhD Health Economist, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Sweden. Anna Strömberg, PhD, RN Professor, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University; and Department of Cardiology Linköping University Hospital, Sweden
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Barbareschi G, Sanderman R, Leegte IL, van Veldhuisen DJ, Jaarsma T. Educational Level and the Quality of Life of Heart Failure Patients: A Longitudinal Study. J Card Fail 2011; 17:47-53. [DOI: 10.1016/j.cardfail.2010.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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