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Zhang X, Fang W, Zhang Y, Yang M, Wang M, Fan X. The relationship between fatigue, exercise self-efficacy, fear of movement, and quality of life in patients with heart failure: A moderated mediation model. J Health Psychol 2024:13591053241273655. [PMID: 39175156 DOI: 10.1177/13591053241273655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
This study was aimed to examine the moderated mediating effects of exercise self-efficacy and fear of movement on the relationship between fatigue and quality of life in patients with heart failure. A total of 305 patients with heart failure were enrolled in this cross-sectional study. The results showed that fear of movement significantly mediated the relationship between fatigue and quality of life, indicating that relieving fear of movement may be beneficial to improve quality of life. Furthermore, exercise self-efficacy negatively moderated the mediating effect of fear of movement on the relationship between fatigue and physical health-related quality of life. It is suggesting that improving exercise self-efficacy may provide opportunities to buffer the negative effect of fear of movement on physical health-related quality of life in patients with heart failure, especially for those with fatigue. The findings provide additional strategies to optimize quality of life management in patients with heart failure.
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Affiliation(s)
- Xiuting Zhang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Wenjie Fang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Mei Yang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Mei Wang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Shandong University, P.R. China
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2
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Stutsman N, Habecker B, Pavlovic N, Jurgens CY, Woodward WR, Lee CS, Denfeld QE. Sympathetic dysfunction is associated with worse fatigue and early and subtle symptoms in heart failure: an exploratory sex-stratified analysis. Eur J Cardiovasc Nurs 2024; 23:532-539. [PMID: 38196102 PMCID: PMC11257751 DOI: 10.1093/eurjcn/zvad121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
AIMS Physical symptoms impact patients with heart failure (HF) despite treatment advancements; however, our understanding of the pathogenic mechanisms underlying HF symptoms remains limited, including sex differences therein. The objective of this study was to quantify associations between sympathetic markers [norepinephrine (NE) and 3,4-dihydroxyphenylglycol (DHPG)] and physical symptoms in patients with HF and to explore sex differences in these associations. METHODS AND RESULTS We performed a secondary analysis of combined data from two studies: outpatients with HF (n = 111), and patients prior to left ventricular assist device implantation (n = 38). Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) dyspnoea and early/subtle symptom subscales and the Functional Assessment in Chronic Illness Therapy Fatigue Scale (FACIT-F) to capture dyspnoea, early symptoms of decompensation, and fatigue. Norepinephrine and DHPG were measured with high-performance liquid chromatography with electrochemical detection. Multivariate linear regression was used to quantify associations between symptoms and sympathetic markers. The sample (n = 149) was 60.8 ± 15.7 years, 41% women, and 71% non-ischaemic aetiology. Increased plasma NE and NE:DHPG ratio were associated with worse FACIT-F scores (P = 0.043 and P = 0.013, respectively). Increased plasma NE:DHPG ratio was associated with worse HFSPS early/subtle symptoms (P = 0.025). In sex-stratified analyses, increased NE:DHPG ratio was associated with worse FACIT-F scores (P = 0.011) and HFSPS early/subtle scores (P = 0.022) among women but not men. CONCLUSION In patients with HF, sympathetic dysfunction is associated with worse fatigue and early/subtle physical symptoms with associations stronger in women than men.
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Affiliation(s)
- Nina Stutsman
- Oregon Health & Science University, School of Nursing, 3455 SW U.S. Veteran’s Hospital Road, Portland, OR 97239, USA
| | - Beth Habecker
- Oregon Health & Science University, Knight Cardiovascular Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Noelle Pavlovic
- Johns Hopkins School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Corrine Y Jurgens
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - William R Woodward
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
- Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Quin E Denfeld
- Oregon Health & Science University, School of Nursing, 3455 SW U.S. Veteran’s Hospital Road, Portland, OR 97239, USA
- Oregon Health & Science University, Knight Cardiovascular Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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3
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Durante A. Marathon not sprint: fatigue and early symptoms detected with sympathetic dysfunction in patients with heart failure. Eur J Cardiovasc Nurs 2024; 23:e75-e76. [PMID: 38227551 DOI: 10.1093/eurjcn/zvae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Angela Durante
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Via Solaroli 17, Palazzo Bellini, Room P89b, 28100 Novara, Italy
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Roberts Davis MC, Dieckmann NF, Hansen L, Gupta N, Hiatt S, Lee C, Denfeld QE. Are Physical and Depressive Symptoms Different Between Women and Men With Heart Failure?: An Exploration Using Two Analytic Techniques. J Cardiovasc Nurs 2024; 39:401-411. [PMID: 37639560 PMCID: PMC10899528 DOI: 10.1097/jcn.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques. METHODS We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression. RESULTS The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern. CONCLUSIONS There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique.
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Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, Levenson JL, Henningsen P. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403:2649-2662. [PMID: 38879263 DOI: 10.1016/s0140-6736(24)00623-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 08/29/2024]
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Christopher Burton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
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6
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Wilson K, Rich C, Hakimi Z, Horneff R, Fishman J, Mellor J, Earl L, Taylor Y, Simons A, Conyers J, Mulherin B, Majerus E, Röth A. Pegcetacoplan in paroxysmal nocturnal haemoglobinuria: Its use, its clinical effectiveness, and its influence on health-related quality of life and productivity. Eur J Haematol 2024; 112:516-529. [PMID: 37994576 DOI: 10.1111/ejh.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To describe real-world use/effectiveness of pegcetacoplan (PEG) in paroxysmal nocturnal haemoglobinuria (PNH). METHODS Data were drawn from the Adelphi PNH Disease Specific Programme™, a cross-sectional survey conducted in France, Italy, Germany, Spain and the United States from January to November 2022. Patients had a confirmed PNH diagnosis and received PEG for ≥1 month. Physicians reported patient characteristics, treatment use/satisfaction and their perception of patients' fatigue and health-related quality of life (HRQoL). Patients reported treatment satisfaction and completed questionnaires assessing fatigue, HRQoL and productivity. Descriptive statistics were reported. RESULTS Overall, 14 physicians provided data for 61 patients who had received 1080 mg/dose PEG for 1.3-14.8 months. At data collection compared to PEG initiation: haemoglobin was 2.5 g/dL higher on average; proportion of patients with lactate dehydrogenase (LDH) ≥1.5 × upper limit of normal was reduced by 27.4%; physician-perceived fatigue was lower and HRQoL better. Physician- and patient-reported treatment satisfaction was high for >90% of patients. Physicians and patients were more satisfied with PEG than previously prescribed C5 complement inhibitors. Mean work impairment and activity impairment in the 7 days prior to data collection were 32.9% and 22.4%, respectively. CONCLUSIONS These real-world data support the effectiveness of PEG through positive effects on haemoglobin, LDH, fatigue and HRQoL.
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Affiliation(s)
| | | | | | | | - Jesse Fishman
- Apellis Pharmaceuticals, Waltham, Massachusetts, USA
| | | | | | | | | | | | - Brian Mulherin
- Hematology Oncology of Indiana, Indianapolis, Indiana, USA
| | - Elaine Majerus
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Alexander Röth
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
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Heif DM, Masa'Deh R, AbuRuz ME, Hamaideh SH, Rayan A, Al-Yateem N. The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure. Holist Nurs Pract 2024; 38:85-92. [PMID: 38363969 DOI: 10.1097/hnp.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.
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Affiliation(s)
- Dunia M Heif
- Applied Science Private University, Amman, Jordan (Ms Heif); Psychiatric Mental Health, School of Nursing, Applied Science Private University, Amman, Jordan (Dr Masa'Deh); Critical Care Nursing, School of Nursing, Applied Science Private University, Amman, Jordan (Dr AbuRuz); Department of Community & Mental Health Nursing, Faculty of Nursing, Hashemite University, Zarqa, Jordan (Dr Hamaideh); Faculty of Nursing, Zarqa University, Jordan (Dr Rayan); and Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates (Dr Al-Yateem)
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8
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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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9
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Ballesteros O, Mark S, Block A, Mackin L, Paul S, Cooper B, Abbott M, Chang S, Hammer MJ, Levine J, Pozzar R, Snowberg K, Tsai K, Van Blarigan E, Van Loon K, Miaskowski CA. COVID-19 pandemic stress and cancer symptom burden. BMJ Support Palliat Care 2024; 13:e1351-e1362. [PMID: 37541779 DOI: 10.1136/spcare-2023-004319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups. METHODS Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests. RESULTS Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments. CONCLUSION Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important 'benchmark data' to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.
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Affiliation(s)
- Olivia Ballesteros
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Sueann Mark
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Astrid Block
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lynda Mackin
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Steven Paul
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Bruce Cooper
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Maura Abbott
- Department of Nursing, Columbia University Medical Center, New York, New York, USA
| | - Susan Chang
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Marilyn J Hammer
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jon Levine
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Karin Snowberg
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Katy Tsai
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Erin Van Blarigan
- Department of Epidemiology and Biostatistics, School of Medicine, UCSF, San Francisco, California, USA
| | - Katherine Van Loon
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Christine A Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
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Al-Sutari MM, Abdalrahim MS. Symptom Burden and Quality of Life Among Patients With Heart Failure. SAGE Open Nurs 2024; 10:23779608241242023. [PMID: 38559894 PMCID: PMC10981229 DOI: 10.1177/23779608241242023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/16/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Heart failure is a debilitating condition that is associated with several burdensome symptoms that impede patients' quality of life. However, patients' experience of distressing symptoms and their impacts on their quality of life is not studied in Jordan. Objectives To assess the severity of distressing symptoms and to assess the relationships between these symptoms and the quality of life among patients with heart failure in Jordan. Methods A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Heart failure patients (n = 167) who visited the outpatient clinics in three hospitals in Amman between July and November 2021 were included. The Edmonton Symptom Assessment System and Short-Form 36 tool were used. Results Participants were more likely males with a mean age of 55.2 years (SD = 13.7). The most distressing symptoms among patients with heart failure were tiredness (M = 4.56, SD = 3.24), worse well-being (M = 4.34, SD = 2.52), and drowsiness (M = 3.5, SD = 3.06), respectively. Symptoms burden were negatively associated with the physical and the mental components summary of the quality of life. Pain, tiredness, nausea, loss of appetite, anxiety, and poor well-being were significant predictors of the physical components. The predictors of the mental components were tiredness, nausea, loss of appetite, and anxiety. Conclusions This study revealed that patients with heart failure facing significant symptom burden. The patients showed inadequate quality of life in both physical and mental components that were inversely associated with symptom burden. Given the debilitating effects of symptom burden on heart failure patients' quality of life, therefore, symptom assessment and management have to be a priority.
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Affiliation(s)
- Manal Mohammed Al-Sutari
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
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11
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Rivera FB, Choi S, Carado GP, Adizas AV, Bantayan NRB, Loyola GJP, Cha SW, Aparece JP, Rocha AJB, Placino S, Ansay MFM, Mangubat GFE, Mahilum MLP, Al-Abcha A, Suleman N, Shah N, Suboc TMB, Volgman AS. End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines. Am J Hosp Palliat Care 2024; 41:87-98. [PMID: 36705612 DOI: 10.1177/10499091231154575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.
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Affiliation(s)
| | - Sarang Choi
- Ateneo de Manila School of Medicine and Public Health, Pasig City, Philippines
| | - Genquen Philip Carado
- University of the East Ramon Magsaysay Memorial Medical Center, Inc, Quezon City, Philippines
| | - Arcel V Adizas
- University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | | | | | | | | | - Siena Placino
- St Luke's Medical Center College of Medicine, William H. Quasha Memorial, Manila, Philippines
| | | | | | | | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natasha Suleman
- Department of Palliative Care, Lincoln Medical Center, Bronx, NY, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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12
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Cardiac function in relation to functional status and fatigue in patients with post-COVID syndrome. Sci Rep 2022; 12:19575. [PMID: 36380000 PMCID: PMC9664421 DOI: 10.1038/s41598-022-24038-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with Post-COVID syndrome (PCS) are frequently referred for cardiologic evaluation. We assessed cardiac function and biomarkers in relation to functional status and fatigue in patients with PCS. This prospective single-center cohort study included 227 patients with persisting symptoms after COVID-19 infection. Most frequent complaints were fatigue (70%), dyspnea (56%), neurocognitive symptoms (34%) and chest pain (28%). Standardized questionnaires were used to assess Post-COVID-Functional-Scale (PCFS) and fatigue (MFI-20). The fatigue severity was inversely related to age and did not correlate with cardiovascular diseases, echocardiographic findings, or biomarkers. Similarly, mild to moderate functional impairment (PCFS 1-3) did not correlate with cardiovascular alterations. However, the subgroup of patients with significant functional impairment (PCFS = 4) had more frequent cardiovascular comorbidities, biomarkers and impaired global longitudinal strain (GLS). Patients with elevated troponin T showed abnormal GLS, reduced left ventricular ejection fraction and impaired tricuspid annular plane systolic excursion. The majority of patients with PCS shows a normal cardiac function. Only the small subgroup of patients with severe functional impairment and patients with elevated troponin T is at risk for impaired cardiac function and likely to benefit from specialized care by a cardiologist.
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Olano-Lizarraga M, Wallström S, Martín-Martín J, Wolf A. Causes, experiences and consequences of the impact of chronic heart failure on the person´s social dimension: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e842-e858. [PMID: 34918403 DOI: 10.1111/hsc.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Chronic heart failure (CHF) is a progressive and disabling condition that significantly impacts patients' daily lives. One of its effects is decreased opportunities to participate in social life, leading to reduced social interaction, loneliness, social isolation and lack of social support to continue with their daily life activities. This study aimed to explore the causes, experiences, and consequences of the impact of CHF on the social dimension of the person. According to the Arksey & O'Malley method, a scoping review of the literature was conducted to examine existing knowledge in the area, summarise existing evidence and identify gaps in the literature. The search was conducted in the PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. Twenty-six articles were identified. The reasons why CHF influences the social dimension of the person were multifactorial and related to physical aspects, sociodemographics, lifestyle changes and the feelings experienced by these patients. Social relationships play a key role, and the benefits of good social relationships and the impact of poor or inadequate social support were identified. Furthermore, the influence of alterations in the social dimension on the CHF patient's clinical outcomes was described. This approach will help to detect and better understand the bidirectional influence that exists in each person between social isolation, relationships, and support life experiences, self-care activities, and morbi-mortality rates. These findings have shown the importance of detecting higher-risk groups and systematically assessing factors related to the social dimension in all patients with CHF.
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Affiliation(s)
- Maddi Olano-Lizarraga
- School of Nursing, Adult Nursing Care, Universidad de Navarra, Pamplona, Spain
- Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Jesús Martín-Martín
- School of Nursing, Adult Nursing Care, Universidad de Navarra, Pamplona, Spain
- Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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