Measurement of Health-Related Quality of Life in Chronic Heart Failure, from a Nursing Perspective—a Review of the Literature

Prevalence of chronic pain and chronic widespread pain among subjects with heart failure in the general population: The HUNT study

BACKGROUND

Pain in chronic heart failure (HF) is a significant but often unrecognized symptom. Characteristics of pain in subjects with HF are largely undescribed. The study aimed to address a knowledge gap in the relationship between HF and pain by investigating the prevalence of chronic pain and chronic widespread pain (CWP) among subjects with HF.

METHODS

Population data from the HUNT3 study in Norway (2006-2008, n = 50,802) was used. HF was measured by self-report. CWP was defined as having pain in both sides of the body, pain in the upper and lower limbs, and axial pain for at least 3 months in the last year. Associations between HF and CWP and HF and moderate to high pain intensity were analysed with logistic regression.

RESULTS

Among subjects with HF in the general population, the prevalence of chronic pain was 67.8%, 20.7% had CWP, and 58.8% had moderate to high intensity pain. Compared to participants with cardiovascular disease but not HF, the odds of both CWP (OR = 1.6; 95% CI: 1.3-2.0) and moderate to high intensity pain (OR = 1.3; 95% CI: 1.3-1.8) were higher among participants with HF-controlled for age, sex, body mass index, and comorbidity.

CONCLUSIONS

Our study confirmed the high prevalence of pain among HF subjects. This pain could not be explained by comorbidity or sociodemographic factors, which are relevant for clinical and research purposes. Pain management should not be restricted to cardiac-related pain but to chronic pain in general.

SIGNIFICANCE

This epidemiological study corroborates previous studies reporting a high prevalence of pain in the HF-population. We found that the relationship between HF, CWP, and pain intensity could not be explained by comorbidity or sociodemographic factors, illustrating the burden of chronic pain related to HF. Our results expand the understanding of pain in HF and highlight the need to identify and manage chronic pain among individuals with HF, as widespread pain adds to the symptom burden in individuals with HF.

Internal structure validity and internal consistency reliability of the Minnesota Living with Heart Failure Questionnaire: a systematic review protocol

INTRODUCTION

The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most used tools to measure health-related quality of life in heart failure. Despite extensive use in research, evidence on the MLHFQ's internal structure validity remains heterogeneous and inconclusive. There are no known reviews that systematically summarise the evidence related to the MLHFQ's factor structure (internal structure validity). This gap highlights a need to critically appraise, summarise and compare the available evidence on the internal structure and internal consistency reliability (ICR) of the MLHFQ.

METHODS AND ANALYSIS

The review will adhere to the reporting guidelines of the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We will systematically search eleven electronic databases/search engines (Medline, EMBASE, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, Global Health, Health and Psychosocial Instruments, Scopus, Journals, Web of Science, Google Scholar, and Dissertation and Theses Global) for quantitative studies assessing the MLHFQ's factor structure and ICR. Two reviewers will then independently screen studies for eligibility and assess the quality of included studies using the COnsensus-based Standards for the selection of health status Measurement Instruments checklist. Throughout the review, discrepancies will be resolved through consensus or by the involvement of the third reviewer. We will analyse and present results using descriptive statistics (frequencies, proportions and ranges) and narrative synthesis. We will include all the relevant studies published within the timeframe covered by the database. We carried out the preliminary search in November 2022 except for Dissertation and Theses Global which was searched in September 2023; however, we will update the entire search right before the review completion in January 2024.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data is being collected from individuals. We intend to share the findings of the review at international conferences and publish manuscripts in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42023346919.

Understanding health-related quality of life trajectories among older adults with diabetes mellitus: Mixed methods research

AIM

To examine health-related quality of life trajectories among older adults with diabetes mellitus (DM).

DESIGN

A sequential explanatory mixed method study protocol.

METHODS

In the quantitative phase, health-related quality of life trajectory over 5 years, from 2009 to 2013, of a national representative sample (N = 440) of older adults with DM was analysed using group-based modelling. Next, a qualitative multiple case study (N = 10) was conducted between November 2017 and April 2018. In the mixed phase, by linking the quantitative and qualitative data, similarities and differences among the four trajectories were identified.

RESULTS

Four distinctive health-related quality of life trajectories could be distinguished: high then decrease, high stable, medium stable and low then increase. These differed in attitude towards DM, self-management of DM-related tasks, comorbidity-related health-related quality of life, coping with DM and financial concerns about medical needs.

RELEVANCE TO CLINICAL PRACTICE

Our results help illuminate the heterogeneity of health-related quality of life trajectories in older adults with DM. This research may help healthcare providers understand the need to assess the HR-QoL comprehensively and promote HR-QoL for older adults with DM.

Effectiveness of high intensity interval training supplemented with peripheral and inspiratory resistance training in chronic heart failure: a pilot study

Background: Cardiac rehabilitation (CR) is an evidence-based therapy in chronic heart failure (CHF). There is still debate about the optimal training protocol in CHF. The use of high intensity interval training (HIIT) supplemented with peripheral (PRT) and inspiratory resistance training (IRT) might be more beneficial because of the higher impact on the peripheral and inspiratory muscles, with less symptoms of dyspnoea and lower amount of dropouts as a result. We compared our standard exercise-based CR programme, mainly consisting of moderate intensity interval training to a programme combining HIIT, PRT and IRT (resistance training supplemented HIIT (RHIIT) programme).Design: Randomised controlled pilot study.Methods: Twenty patients with CHF were randomised on a 1:1 basis to the standard or RHIIT programme. At baseline and after 3 months, peak exercise capacity (VO₂peak), peripheral (QF) and inspiratory respiratory muscle strength (MIP), quality of life (QOL) and physical activity were measured.Results: The RHIIT programme resulted in a significantly larger improvement in QF (ΔQF RHIIT programme: 19.3 ± 11.8 vs standard programme: -6.89 ± 19.0 Nm (p < .01)) and MIP (ΔMIP RHIIT programme: -44.9 ± 29.9 vs standard programme: 0.56 ± 19.4 cmH₂O (p < .01)). Both programmes equally improved in VO₂peak (p = .91), whereas ventilatory efficiency and physical activity remained stable.Conclusion: HIIT supplemented with PRT and IRT might be applicable as standard protocol in CHF. Larger studies are warranted to confirm our findings. The RHIIT programme resulted in similar training effects in VO₂peak in a shorter training period. This might be beneficial in a chronic patient population such as CHF, where adherence is difficult.

Interplay of Self-efficacy and Social Support in Predicting Quality of Life in Cardiovascular Patients in Pakistan

The primary objective of the present study was to assess independent and interactive relations of perceived social support and self-efficacy with four quality of life (QOL) domains namely physical, psychological, social, and environmental in cardiovascular disease (CVD) patients from a South Asian region. Participants were 172 (age 22-60 years) patients recruited from three major government sector hospitals from the fifth biggest city of South Asia. It was found that overall CVD patients had a better QOL in psychological and environmental domains compared to social and psychological. Furthermore, findings from hierarchical regression analyses indicated that perceived social support and self-efficacy were positively associated with the four QOL domains. Besides main effects, a synergistic interaction between social support and self-efficacy emerged indicating that perceived social support was strongly associated with physical and social QOL in CVD patients who had higher self-efficacy levels, while, perceived social support was weakly associated with the physical and social QOL in CVD patients who had lower self-efficacy levels.

The Effect of Family-Centered Empowerment Model on the Illness Perception in Heart Failure Patients: a Randomized Controlled Clinical Trial

Introduction: Heart failure is a chronic medical condition that, despite the existing therapies, involves different aspects of an individual's life (such as self-care capability). Illness perception is one of the most important variables which seem to improve the self-efficacy skills in chronic diseases such as heart failure. Therefore, this study aimed to investigate the effect of family-centered empowerment model on the perception of the illness in heart failure patients. Methods: This interventional study was performed on 70 heart failure patients, assigned into control and experimental groups, admitted to the heart clinic of Hazrate Fatemeh hospital in Shiraz. After the convenience sampling, the patients were divided into two control and intervention groups by block randomization method. For experimental group, the family-centered empowerment modeling was done in 5 sessions. The research materials included demographic information and Brief illness perception questionnaires (B-IPQ). Data were analyzed using SPSS v.13 software. The statistical tests included Wilcoxon, Man-Whitney, and Independent t-test. P value less than 0.05 was considered as significant. Results: In this study, both control and experimental groups were homogeneous with demographic information. Before the intervention in different dimensions of illness perception, all of the values in both groups were the same; However, after the intervention, a significant difference was observed in all of the dimensions of illness perception, except for Time line; so that the most and the least changes were related to the concern (1.09 (0.61) vs 3 (0.93)), and identity dimensions (0.97 (0.61) vs 2.11 (0.67)), respectively. Conclusion: On the basis of the above, it can be concluded that this model modifies the illness perceptions in heart failure patients. Cardiac nurses should consider family- based empowerment model as a treatment for heart failure patients.

Optimism and quality of life in patients with heart failure

OBJECTIVES

Health-related quality of life (HR-QoL) of patients with heart failure (HF) is low despite the aim of HF treatment to improve HR-QoL. To date, most studies have focused on medical and physical factors in relation to HR-QoL, few data are available on the role of emotional factors such as dispositional optimism. This study examines the prevalence of optimism and pessimism in HF patients and investigates how optimism and pessimism are associated with different patient characteristics and HR-QoL.

METHODS

Dispositional optimism was assessed in 86 HF patients (mean age 70 ± 9 years, 28% female, mean left ventricular ejection fraction 33%) with the Revised Life Orientation Test (LOT-R). HR-QoL was assessed with the Minnesota Living with Heart Failure Questionnaire and the EuroQol.

RESULTS

The (mean ± SD) total score on the LOT-R was 14.6 ± 2.9 (theoretical range 0-24) and the scores on the subscales optimism and pessimism were 8.1 ± 1.9 and 5.5 ± 2.5, respectively. Higher age was related to more optimism (r = 0.22, p &lt; 0.05), and optimism was associated with higher generic HR-QoL (B = 0.04, p &lt; 0.05).Significance of resultsThe association found between optimism and generic HR-QoL of HF patients can lead to promising strategies to improve HF patients' HR-QoL, particularly because the literature has indicated that optimism is a modifiable condition.

Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare

Background

Patients with heart failure (HF) in primary healthcare are in many respects not comparable to those in specialized care and the knowledge about different patient groups with and without HF is limited.

Aims

To compare fatigue and health-related quality of life (Hr-QoL) when adjusting for age, gender and social provision in patients with confirmed HF ( n=49) to a group of patients with symptoms indicating HF but without HF (NHF, n=59) and to an age-and sex-matched control-group ( n=40).

Method

A questionnaire including the Multidimensional Fatigue Inventory, the SF-36, and the Social Provisions Scale was used.

Results

The average age in all groups was 78 years. Patients in the HF and NHF groups reported worse physical QoL and more general and physical fatigue than the control group. HF patients had worse general health than the NHF group.

Conclusion

Elderly patients in primary healthcare with confirmed heart failure and patients with symptoms similar to heart failure perceived they had a significantly worse physical QoL and more general and physical fatigue than an age- and sex-matched control group. The similarities between the patient groups indicate the importance of the symptom experience for Hr-QoL.

Keeping the maintenance of daily life in spite of Chronic Heart Failure. A qualitative study

Background

Patients with CHF (Chronic Heart Failure) is an increasing group in the society. They often experience increasing powerlessness and depression in daily life as well as difficulties adhering to other physical symptoms. Many patients have difficulties to deal with daily demands.

Aims

To describe how persons, living with CHF, perceived the maintenance of their daily life.

Methods

This study was following a phenomenographic method in order to describe variations of perceptions. Data was collected through taped interviews, taken from 17 patients. The sample was selected from patients attending a specialist Chronic Heart Failure day care unit.

Results

Five main categories were identified from 345 statements describing variations in how patients with CHF kept maintenance in their daily life. The categories include: dealing with the realities of life, dealing with thoughts about life's infinity, taking responsibility, dealing with the surrounding world and keeping up with values of life.

Conclusion

The illness symptoms clearly affected daily routines but participants showed remarkable resolve and showed that values in life could be maintained albeit with a few adjustments. No patient expressed a desire to give up. Understanding patients’ perceptions the specialist nurse can transfer these knowledge to other patients in similar situations.

Effect of Support Group Intervention Applied to the Caregivers of Individuals With Heart Failure on Caregiver Outcomes

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.

Factors and Interventions Influencing Health-Related Quality of Life in Patients with Heart Failure: A Review of the Literature

INTRODUCTION

Because of the lack of a cure for patients with chronic heart failure (HF), there has been a progressive interest in the use of health-related quality of life (Hr-QoL) as complementary end-point to mortality and morbidity.

AIM

The aim of this review was from a nursing perspective to describe Hr-QoL and the influencing factors of Hr-QoL, as well as to identify interventions aimed at influencing Hr-QoL in HF patients.

METHOD

Medline, Cinahl and PsycInfo databases were searched from 1995 to 2004. A total of 58 papers were included.

RESULTS

HF symptoms and activity status influence Hr-QoL negatively. However, several individual characteristics such as personality, gender and age must also be taken into consideration because different values might exist regarding what constitutes a good Hr-QoL. Nurse led interventions based on education, support and exercise can influence Hr-QoL positively. There is also a need of more studies about the effects of depression, sleep disturbances, support as well as education on Hr-QoL. There is also a need of exercise studies with larger sample sizes and older patients in higher NYHA classes.

CONCLUSION

Several individual factors impact Hr-QoL, therefore, must nursing interventions are individually adapted to the patient's resources.

Sleep Disturbances in Patients with Chronic Heart Failure and Their Holistic Consequences—What Different Care Actions can be Implemented?

Background: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively.

Aim: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented.

Methods: MEDLINE and CINAHL databases were searched from 1989 to July 2004.

Findings: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45–82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness.

Conclusion: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

Can BNP-guided therapy improve health-related quality of life, and do responders to BNP-guided heart failure treatment have improved health-related quality of life? Results from the UPSTEP study

BACKGROUND

To investigate whether B-type natriuretic peptide (NP)-guided treatment of heart failure (HF) patients improved their health related quality of life (Hr-QoL) compared to routine HF treatment, and whether changes in Hr-QoL differed depending on whether the patient was a responder to NP-guided therapy or not.

METHODS

A secondary analysis of the UPSTEP-study, a Scandinavian multicentre study using a prospective, randomized, open, blinded evaluation design on patients with HF with New York Heart Association (NYHA) class II-IV. NP-guiding was aimed to reduce BNP <150 ng/L if < 75 years or BNP < 300 ng/L if > 75 years. A responder was defined as a patient with a BNP < 300 ng/L and/or a decrease in BNP of at least 40% in week 16 compared to study start. Short form-36 (SF-36) was used to measure Hr-QoL. At the study start, 258 patients presented evaluable SF-36 questionnaires, 131 in the BNP group and 127 in the control group. At the study end 100 patients in the NP-guided group and 98 in the control group, presenting data from both the study start and the study end.

RESULTS

There were no significant differences in Hr-QoL between NP-guided HF treatment and control group; however significant improvements could be seen in four of the eight domains in the NP-guided group, whereas in the control group improvements could be seen in six of the domains. Among the responders improvements could be noted in four domains whereas in the non-responders improvements could be seen in only one domain evaluating within group changes.

CONCLUSIONS

Improved Hr-QoL could be demonstrated in several of the domains in both the NP-guided and the control group. In the responder group within group analyses showed more increased Hr-QoL compared to the non-responder group. However, all groups demonstrated increase in Hr-QoL.

Functional and psychosocial effects of either a traditional dancing or a formal exercising training program in patients with chronic heart failure: a comparative randomized controlled study

OBJECTIVE

To compare the effects of traditional dancing with formal exercise training in terms of functional and cardiovascular benefits and motivation in patients with chronic heart failure.

DESIGN

Randomized controlled trial.

SETTING

Sports Medicine Laboratory.

SUBJECTS

Fifty-one Greek male patients aged 67.1±5.5 years with chronic heart failure of New York Heart Association (NYHA) class II-III, participated in an eight-month study.

INTERVENTIONS

They were randomly assigned to either training with Greek traditional dances (group A, n=18), formal exercise training (group B, n=16) or a sedentary control group (group C, n=17).

MAIN MEASURES

At entry and the end of the study all patients underwent cardiopulmonary exercise testing, functional ability assessment and quality of life evaluations. The Intrinsic Motivation Inventory was also used to assess participants' subjective experience.

RESULTS

After training group A showed increased peak oxygen consumption by 33.8% (19.5 vs. 26.1 ml/kg/min, p<0.05) and B by 32.3% (19.5 vs. 25.8 ml/kg/min, p<0.05), maximal treadmill tolerance by 48.5% (p<0.05) and by 46.4% (p<0.05), and a decreased Slope of expired minute ventilation for carbon dioxide output (VE/VCO2) slope by 18% (p<0.05) and 19.5% (p<0.05), respectively. Trained patients revealed significant improvement in the quality of life indices. Intrinsic Motivation Inventory was increased only in group A by 26.2% (3.08 vs. 3.87, p<0.05).

CONCLUSIONS

Exercise training in chronic heart failure patients with Greek traditional dances led to functional and cardiovascular benefits similar to formal exercise training and to a higher level of motivation.

Correlating perceived arrhythmia symptoms and quality of life in an older population with heart failure: a prospective, single centre, urban clinic study

AIMS AND OBJECTIVES

To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure.

BACKGROUND

While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined.

DESIGN

Prospective, cross-sectional single-centre study.

METHODS

A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2(™) and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express(®) ) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression.

RESULTS

Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life.

CONCLUSION

Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life.

Reliability and validity of the Korean version of the Minnesota Living with Heart Failure Questionnaire

OBJECTIVE

The aim of this study was to verify the reliability and validity of the Korean language version of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before using this version in clinical practice to assess the quality of care in patients with heart failure in a cardiology clinic.

METHODS

The Korean versions of the MLHFQ, 36-Item Short Form Health Survey, and Center for Epidemiologic Studies Depression Scale were administered to evaluate the psychometric properties among 154 patients with heart failure in a major cardiac center in Korea. Cardiac function was assessed by evaluating left ventricular ejection fraction values, N-terminal pro-brain natriuretic peptide levels, and New York Heart Association classifications.

RESULTS

The questionnaire content and construct validity were supported by factor analysis. Three factors explained 70.7% of the variance. Total and subtotal scales had correlations with the mental and physical component scores of the 36-Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale, supporting the convergent validity of the Korean version of the MLHFQ. We also found that the New York Heart Association classification was associated with the MLHFQ score. The internal consistency of both total and subtotal scales was greater than .80.

CONCLUSION

The Korean version of the MLHFQ demonstrated excellent psychometric properties. These results support the use of the MLHFQ in Korean patients with heart failure. Further studies are recommended to assess the responsiveness to change of the Korean version of the MLHFQ.

Cardiac rehabilitation programs and health-related quality of life. State of the art

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.

Validation of the Minnesota living with heart failure questionnaire in primary care

INTRODUCTION AND OBJECTIVES

To evaluate the applicability, internal consistency and validity of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) when used in primary care, compared with the Short Form-36 (SF-36) health survey.

METHODS

The two questionnaires were administered to 589 patients with chronic heart failure who were registered with 97 primary care physicians. The applicability, internal consistency and validity of the MLHFQ were evaluated and comparisons were made with the SF-36.

RESULTS

More than 90% of patients completed the questionnaires. The percentage of uncompleted items was low. Cronbach's alpha ranged from 0.79 to 0.94 for the various MLHFQ dimensions. Exploratory factorial analysis identified two factors that explained 65.8% of the variance. Moderate to good correlations were observed between similar dimensions of the MLHFQ and SF-36 (correlation coefficient -0.43 to -0.73). There were significant associations between scores on the MLHFQ and clinical measures of disease severity.

CONCLUSIONS

When used in primary care, the MLHFQ had a high level of acceptability and good psychometric properties compared with the SF-36. Consequently, it would be useful for assessing health-related quality of life in patients with chronic heart failure.

Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory

PURPOSE

Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients.

METHODS

We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework.

RESULTS

We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature.

CONCLUSIONS

We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patient-centered care.

Qualidade de vida relacionada à Saúde em Idosos com Insuficiência cardíaca: avaliação com instrumento específico

OBJETIVO: Avaliar a qualidade de vida relacionada à Saúde em idosos com insuficiência cardíaca. MÉTODOS: Estudo transversal realizado em dois hospitais universitários. Foram entrevistados 170 idosos com insuficiência cardíaca em seguimento ambulatorial. Para avaliar a qualidade de vida, foi utilizado o instrumento Minnesota Living With Heart Failure Questionnaire. RESULTADOS: Os resultados do estudo apontaram menor influência da doença sobre a dimensão emocional da qualidade de vida. Entretanto, as questões vinculadas à dimensão física, que avaliam fadiga e dispneia, apresentaram maior impacto na qualidade de vida dos idosos. A consistência interna do instrumento específico de qualidade de vida foi alta, indicando confiabilidade satisfatória (α >0,80). CONCLUSÃO: Este estudo possibilitou a avaliação da qualidade de vida dos idosos com insuficiência cardíaca e mostrou a dimensão física, como o aspecto mais comprometido. É essencial a implementação de estratégias que melhorem a função física desses pacientes.

Health-related quality of life among the elderly with heart failure: a generic measurement

CONTEXT AND OBJECTIVE

Health-related quality-of-life (HRQoL) instruments have been greatly used among patients with heart failure (HF), although few of them are specific for elderly people. Among the generic instruments, the Medical Study 36-item Short-Form Health Survey (SF-36) is widely used. The aim here was to evaluate HRQoL among elderly individuals with HF through this generic instrument.

DESIGN AND SETTING

Cross-sectional study at two university hospitals in São Paulo, Brazil.

METHODS

170 elderly people with HF who were being followed up as outpatients were interviewed. To evaluate HRQoL, SF-36 was used.

RESULTS

The sample was composed of subjects with a mean age of 67.5 (± 6.2) years, with a diagnosis of HF for 65.9 (± 42.4) months, in functional class I (38.8%; 66) or II (42.9%; 73) and with reduced left ventricular ejection fraction (LVEF) (51.2%). The mental and social HRQoL domains did not seem to be compromised, since they presented high scores. Patients with HF typically had impaired physical capacity, which may explain the lower scores in the physical domain. Cronbach's alpha coefficients were greater than 0.77 for all dimensions, except for general health status.

CONCLUSION

The HRQoL measurements using SF-36 presented a high level of reliability when applied to Brazilian elderly individuals with HF. This population presented lower scores for the functional capacity and physical dimensions. This provides support for intervention studies aiming towards optimization of HRQoL in this group.

Sleep disordered breathing, insomnia, and health related quality of life -- a comparison between age and gender matched elderly with heart failure or without cardiovascular disease

AIMS

The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL).

METHODS

Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36).

RESULTS

The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, p<0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS.

CONCLUSIONS

SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.

Health-related quality of life after coronary artery bypass grafting

AIM

The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others.

BACKGROUND

Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both.

METHOD

In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001-2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient-significant other pairs existed (n = 163).

FINDINGS

Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support were associated with change in health-related quality of life.

CONCLUSION

Further research is needed to identify factors explaining the change in health-related quality of life to develop interventions to support patients and significant others.

A causal model of health-related quality of life in Thai patients with heart-failure

BACKGROUND

Heart failure is an increasing global health problem which adversely affects all aspects of a patient's health-related quality of life (HRQOL).

PURPOSE

The hypothesized causal model of HRQOL in Thai heart-failure patients was based on Wilson and Cleary's HRQOL conceptual model. We examined causal relationships among bio-physiological status, symptoms, functional status, general health perception (GHP), and HRQOL shown in the model, and added an additional item-social support.

METHODS

A stratified four-stage random sampling method was used to obtain 422 heart-failure patients 18 years of age and older who visited nine outpatient hospital clinics from five regions of Thailand including metropolitan Bangkok. In addition to the participants' personal medical records, research instruments consisted of a personal information questionnaire, the Enhancing Recovery in Coronary Heart Disease Social Support Instrument, Cardiac Symptom Survey, the New York Heart Association functional classification system, a 100-mm horizontal visual analogue scale of GHP, and the Minnesota Living with Heart Failure Questionnaire. Data were analyzed using SPSS and AMOS computer programs.

RESULTS

The model fit well with the empirical data (chi(2)=19.87, df=13, p=0.10, GFI =0.99, and RMSEA=0.04). Symptom status was the most influential factor affecting HRQOL by both direct and indirect effects through functional status and GHP. Social support was the least influential factor affecting HRQOL. Social support had a negative direct effect on HRQOL, but had a positive indirect effect on HRQOL through symptom status and GHP.

CONCLUSIONS

HRQOL was affected by each variable proposed in our causal model of HRQOL in Thai heart-failure patients. Symptom status had the strongest effect on HRQOL.

CLINICAL RELEVANCE

A comprehensive symptom management and prevention program that includes the described health outcome measures could lead to improved HRQOL for Thai heart-failure patients, and perhaps others.

Global Perceived Health and Health-Related Quality of Life in Elderly Primary Care Patients with Symptoms of Heart Failure

Background: The aim was to examine whether a single question about global perceived health (GPH) is associated with the domains of health-related quality of life (HR-QoL) as assessed by the SF-36, and whether the scores in these domains differ from the different scores of the GPH in relation to left ventricular ejection fraction (LVEF).

Method: The study included 412 elderly outpatients with symptoms of heart failure (HF). Echocardiography was used to determine their LVEF, and GPH was assessed by the first question on the SF-36.

Results: The correlations between GPH and the different domains in SF-36 ranged from 0.33 to 0.64 in patients with LVEF ≥ 50% and was between 0.29 and 0.59 in patients with LVEF < 40%. Regression analyses revealed GPH to be the strongest predictor of HR-QoL. Patients with LVEF < 40% rating poor GPH differed significantly ( p < 0.05) from those with good or moderate GPH in six of the eight HR-QoL domains.

Conclusion: One question about GPH gives a good general description of HR-QoL and may therefore be used as a simple tool to assess HR-QoL in elderly outpatients with clinical symptoms of HF.

Pain and quality of life in hospitalized patients with heart failure

The pain experience of patients with heart failure (HF) and its impact on their quality of life (QOL) has not been described in sufficient detail. This study sampled patients hospitalized with HF to describe the prevalence and severity of bodily pain; evaluate differences in bodily pain related to selected demographic and disease-specific characteristics; and evaluate the effect of selected demographic, disease-specific characteristics, bodily pain, and mental health on QOL. Two items from the Medical Outcomes Study--Short Form (SF-36) were used to measure pain, and one subscale of the SF-36 was used to evaluate mental health. The Minnesota Living With Heart Failure Questionnaire was used to measure QOL. Patients with HF (n=93) had a mean age of 75 years, were predominantly male (65%), and lived alone (47.3%). Lung diseases and diabetes were the most common comorbidities; 58% were categorized as New York Heart Association (NYHA) Class III, whereas 58% of the sample was diagnosed with HF in the past four years. Of note, 85% of the patients reported pain and 42.5% said that it was in the severe or very severe range. No demographic variables were associated with pain, whereas a higher number of chronic conditions were associated with pain. SF-36 mental health and pain scores, as well as NYHA class, explained 34.1% of the variance in QOL in patients with HF. These data suggest that pain is highly prevalent and has a significant impact on the QOL of patients with HF. However, additional research is warranted to determine the specific causes and characteristics of pain in these patients.

Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure

RATIONALE, AIMS AND OBJECTIVES

Heart failure (HF) is a severe chronic disease and impairs health-related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia.

METHODS

We recruited 89 patients (61.7+/-11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9+/-10.1%). The self-administered MacNew, the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's alpha), discriminative and evaluative validity were assessed.

RESULTS

Cronbach's alpha exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9+/-1.0 vs. 5.3+/-0.8, all P<0.001), with and without depression (4.2+/-1.2 vs. 5.2+/-0.9 all P<0.03) and by the SF-36 health transition item (deteriorate=4.39, no change=4.95, improve=5.45, all P<0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12-week outpatient rehabilitation programme.

CONCLUSIONS

The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential 'core' HRQL measure, at least in the German language.

Defining the role of palliative care in older adults with heart failure

While palliative care is often thought of as only being applicable to dying patients, its focus on symptom alleviation, patient function, and quality of life has much to offer older adults with chronic heart failure. Heart failure worsens patients' health status through patients' symptom burden, functional limitations, and reduced health-related quality of life. Moreover, older adults with heart failure have multiple other comorbidities and polypharmacy that further contribute to poor health status. Comorbid depression is a particularly important issue. In this patient population, prognosis is limited and often uncertain. Spouses and caregivers of patients report significant distress and depression. Through symptom management, depression and psychosocial care, assistance with defining goals of care and planning for the future, and caregiver support, palliative care has the potential to improve patient health status and reduce costs and hospitalizations. This care is complementary to contemporary heart failure care and can be provided concurrently at any point during the illness based on patient and caregiver needs.

Psychometric properties of the Minnesota Living with Heart Failure—Brazilian version—in the elderly

BACKGROUND

Heart failure (HF) has implications for the quality of life for any age range, more so for the elderly who simultaneously present other limitations imposed by multiple co-morbidities. Although there are several instruments to measure Health Related Quality of Life (HRQL), none is specific to the elderly with HF. Among disease-specific instruments, Minnesota Living with Heart Failure(LHFQ) has not been studied extensively among the elderly with respect to its psychometric properties.

OBJECTIVE

The purpose of this study was to evaluate the convergent, divergent and discriminative validity of the Brazilian version of LHFQ applied to elderly HF patients.

METHOD

One hundred and seventy (170) elderly were interviewed. LHFQ capacity to discriminate subjects among New York Heart Association (NYHA) Classes I, II and III/IV was analyzed. Convergent and divergent validity was evaluated through the correlation between the domains of LHFQ and the generic instrument, Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36).

RESULTS

The LHFQ total score and physical dimension sub-scale discriminated between the three sub-groups of NYHA Classes I, II and III/IV (P < .0001). The emotional dimension discriminated NYHA Classes I and III/IV (P = .0034). The physical and emotional dimensions of the LHFQ and SF-36 were significantly correlated (coefficients from .46 to .70 for physical dimension and from .31 to .65 for emotional dimension). However, contrary to expectations, the divergent validity was not totally confirmed as there was no difference in the magnitude of the correlations between the LHFQ emotional and physical dimensions and the SF-36 role physical, social functioning and role emotional. Thus, the results suggest that LHFQ seems to be a valid tool to measure HRQL in the elderly, but new studies remain necessary to gain a better understanding of its discriminative validity for more advanced NYHA functional classes and for its divergent validity.

Fatigue et maladies cardiovasculaires

Fatigue is a frequent complaint during cardiovascular disease and can sometimes constitute the first clinical manifestation of this disease. It is responsible for deterioration of the quality of life and prognosis. Although physical and mental fatigue are often intimately interrelated, these two aspects of fatigue correspond to different pathophysiological mechanisms and different clinical features and the neurobiological links between the two are only just beginning to be studied. Physical fatigue is related to loss of efficacy of the effector muscle, due to multiple causes: mismatch of cardiac output during exercise, muscle and microcirculatory deconditioning, neuroendocrine dysfunction, associated metabolic disorders. Mental fatigue corresponds to predominantly depressive mood disorders with a particular entity, vital exhaustion. The diagnostic approach is designed to eliminate other organic causes of fatigue. Functional tests investigating physical (exercise capacity) and mental dimensions (mood disorders) can be used to analyse their respective roles and to propose personalized management, in which rehabilitation has an essential place due to its global approach. The objective of this reduction of fatigue is threefold: to improve independence, to improve quality of life and to limit morbidity and mortality.

Quality-of-life measurement in chronic heart failure: do we take account of the patient perspective?

The modern management of chronic heart failure has led to improved life expectancy, functioning and health-related quality of life (HRQL). HRQL measures the effects of an illness or a treatment from the patient's perspective. It is now recognised that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. Although there are a number of quality-of-life measures, which can be separated into two types-generic and disease specific-many have been developed, with little or no account being taken of the patient's perspective. Because most of the widely used measures are not patient centred, they may lack sensitivity and specificity in determining those aspects of HRQL important to individual patients. This paper reviews the use of quality-of-life assessment tools in the evaluation of patients with heart failure.

The crucial role of patient education in heart failure

BACKGROUND

Deterioration of heart failure causes and complicates many hospital admissions in people aged over 65 years. Frequent readmissions cause an immense burden on the individual, the family and the health care system. Heart failure management programmes, in which patient education is an important component, have been shown to be effective in improving self-care and reducing readmissions.

AIM

This paper reviews the literature on the education of patients with heart failure. The paper addresses the level of knowledge in patients with heart failure, barriers to learning, learning needs, educational methods, goals and how the effects of patient education can be evaluated.

CONCLUSION

Many patients had low levels of knowledge and lacked a clear understanding of heart failure and self-care. Educational interventions need to be designed specifically for elderly patients and need to target barriers to learning such as functional and cognitive limitations, misconceptions, low motivation and self-esteem. Health care professionals need to be skilled in assessing the requirements and level of education given to the individual. New technologies such as computer-based education and telemonitoring can be used as tools to improve the education. Patient education is an important component of heart failure care and should be provided through effective and well-evaluated strategies.

Insuficiência Cardíaca: antiga síndrome, novos conceitos e a atuação do enfermeiro

Atualmente, a Insuficiência Cardíaca (IC) é causa de preocupação crescente em todo o mundo, frente a sua prevalência e incidência progressivas e sua repercussão socio-econômica, apontando para a necessidade de revisão do conceito da síndrome e de adoção de medidas para redução dos seus custos econômicos e sociais. Este artigo tem como finalidade contextualizar os avanços na compreensão da fisiopatologia e do tratamento da IC e a atuação de Enfermagem junto aos pacientes portadores desta síndrome.