1
|
Edmiston EA, Hardin HK, Dolansky MA. What are key characteristics of adults with advanced heart failure discharged from ICU? Nurs Crit Care 2024; 29:493-500. [PMID: 37036244 DOI: 10.1111/nicc.12914] [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: 10/27/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND As the number of people with heart failure and treatment complexity increases, many hospitals are implementing Advanced Heart Failure Intensive Care Units (AHFICU). However, little evidence concerning the clinical characteristics of people admitted to AHFICUs exists. Understanding the clinical characteristics of people admitted to the AHFICU will assist nurses with implementing tailored interventions to ensure high-quality care delivery. AIM The purpose of this study was to describe the clinical characteristics of people who are admitted to and discharged from an AHFICU. STUDY DESIGN Baseline data from a longitudinal descriptive study were collected on adults (N = 43) admitted to an AHFICU. Heart failure severity, self-management ability, cognition, sleep quality, and other clinical characteristics were assessed. RESULTS Most study participants were New York Heart Association functional class IV (n = 24) or class III (n = 14), indicating poor functional capacity. Over half had mild cognitive impairment and poor sleep quality was prevalent (92.7%). Participants had adequate levels of heart failure knowledge, but low levels of heart failure self-management decision-making and ability. CONCLUSIONS Interventions to address the unique clinical characteristics of AHFICU patients include sleep hygiene, integration of cognitive, sleep, and self-management assessments into the electronic medical record. Addressing the unique clinical needs of people with heart failure will lead to patient-centered, evidence-based, and safe care. RELEVANCE TO CLINICAL PRACTICE Understanding characteristics of this population addresses this evidence gap and targeted clinical interventions to address unique discharge needs of this population are proposed. Sleep quality education should be done throughout hospitalization on sleep strategies and self-management coaching to facilitate adoption of new sleep routines. Healthcare providers should ensure each patient has care support upon discharge and take cognitive status into consideration during teaching. Addressing self-management readiness should include providing scenarios as part of discharge preparation. Providers must include addressing comorbidities and how they may affect heart failure self-management, such as teaching about sleep apnea device use and encouraging compliance.
Collapse
Affiliation(s)
- Elizabeth A Edmiston
- VA Quality Scholars Program, Veterans Affairs Northeast Ohio Health System, Cleveland, Ohio, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Heather K Hardin
- School of Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Mary A Dolansky
- VA Quality Scholars Program, Veterans Affairs Northeast Ohio Health System, Cleveland, Ohio, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Cavalcante VN, Mesquita ET, Cavalcanti ACD, Miranda JSDS, Jardim PP, Bandeira GMDS, Guimarães LMR, Venâncio ICDDL, Correa NMC, Dantas AMR, Tress JC, Romano AC, Muccillo FB, Siqueira MEB, Vieira GCA. Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial. Arq Bras Cardiol 2023; 120:e20220768. [PMID: 37909602 PMCID: PMC10586813 DOI: 10.36660/abc.20220768] [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: 12/10/2022] [Revised: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.
Collapse
Affiliation(s)
- Vaisnava Nogueira Cavalcante
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | | | - Paola Pugian Jardim
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | | | | | | | - Angela Maria Rodrigues Dantas
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - João Carlos Tress
- Complexo Hospitalar de NiteróiNiteróiRJBrasilComplexo Hospitalar de Niterói (CHN), Niterói, RJ – Brasil
| | - Ana Catarina Romano
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Fabiana Bergamin Muccillo
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Marina Einstoss Barbosa Siqueira
- Universidade Federal FluminenseDepartamento de Fundamentos de Enfermagem e AdministraçãoRio de JaneiroRJBrasilUniversidade Federal Fluminense - Departamento de Fundamentos de Enfermagem e Administração, Rio de Janeiro, RJ – Brasil
| | - Glaucia Cristina Andrade Vieira
- Universidade Federal FluminenseDepartamento de Fundamentos de Enfermagem e AdministraçãoRio de JaneiroRJBrasilUniversidade Federal Fluminense - Departamento de Fundamentos de Enfermagem e Administração, Rio de Janeiro, RJ – Brasil
| |
Collapse
|
3
|
Amin A, Rahmani Gavanrudi M, Karami K, Raziani Y, Baharvand P. The role of aromatherapy with lavender in reducing the anxiety of patients with cardiovascular diseases: A systematic review of clinical trials. JOURNAL OF HERBMED PHARMACOLOGY 2022. [DOI: 10.34172/jhp.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Most studies have shown the positive effects of lavender inhalation in decreasing anxiety in patients with cardiovascular diseases. We aimed to systematically review the role of aromatherapy with lavender in these patients. By PRISMA standards, we explored the studies on the role of aromatherapy with lavender in reducing the anxiety of patients with cardiovascular diseases in English databases through the words and terms "aromatherapy", "lavender", "lavandula", "anxiety", "cardiovascular diseases". Out of 16 647 papers, 12 papers up to January 2022 encountered the inclusion criteria for involving in this systematic review. The majority of studies (7 studies, 70%) were used Spielberger Standard Questionnaire as a measurement scale for their studies. Lavender aromatherapy was mostly used for myocardial infarction (3 studies, 30%) and coronary artery bypass graft (CABG) surgery (3 studies, 30%) patients. We concluded that aromatherapy with lavender essential oil significantly ameliorated the anxiety signs in some cardiovascular diseases, e.g., CABG surgery, myocardial infarction, and cardiac ischemia; however, more studies are required in this field to obtain more specific evidence.
Collapse
Affiliation(s)
- Arash Amin
- Cardiovascular Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Kimia Karami
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yosra Raziani
- Department of Nursing, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region, Iraq
| | - Parastoo Baharvand
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
4
|
Burton D, King A, Bartley J, Petrie KJ, Broadbent E. The surgical anxiety questionnaire (SAQ): development and validation. Psychol Health 2018; 34:129-146. [DOI: 10.1080/08870446.2018.1502770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dominic Burton
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amy King
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jim Bartley
- Department of Otorhinolaryngology – Head and Neck Surgery, Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Asiri FY, Marchetti GF, Ellis JL, Otis L, Sparto PJ, Watzlaf V, Whitney SL. Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study. Physiother Theory Pract 2017; 33:943-953. [PMID: 28825517 DOI: 10.1080/09593985.2017.1360422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. METHODS A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. RESULTS Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R2 = 42%). CONCLUSIONS Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.
Collapse
Affiliation(s)
- Faisal Y Asiri
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA.,b Department of Rehabilitation Sciences, King Khalid University , Abha , Saudi Arabia
| | - Gregory F Marchetti
- c Department of Physical Therapy, Duquesne University , Pittsburgh , PA , USA
| | | | - Laurie Otis
- d Gentiva Health Services Inc , Atlanta , GA , USA
| | - Patrick J Sparto
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA
| | - Valerie Watzlaf
- e Department of Health Information Management, University of Pittsburgh , Pittsburgh , PA , USA
| | - Susan L Whitney
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA.,f King Saud University, Rehabilitation Research Chair , Riyadh , Saudi Arabia
| |
Collapse
|
6
|
Affiliation(s)
- Mehnosh Toback
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| | - Nancy Clark
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| |
Collapse
|
7
|
Somatic-Affective, But Not Cognitive-Depressive Symptoms are Associated With Reduced Health-Related Quality of Life in Patients With Congestive Heart Failure. PSYCHOSOMATICS 2017; 58:281-291. [PMID: 28189288 DOI: 10.1016/j.psym.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression has been associated with poor health-related quality of life (HRQoL) in patients with congestive heart failure (CHF). However, to date, whether somatic-affective and cognitive-depressive symptoms differently contribute to poor HRQoL and behavioral functional capacity in patients with CHF has yet to be investigated. OBJECTIVE To examine the differential influence of somatic-affective vs cognitive-depressive symptoms on HRQoL and behavioral functional capacity in CHF patients. METHOD Overall, 55 patients with CHF completed a psychologic evaluation, including the Minnesota Living with Heart Failure Questionnaire, the Beck Depression Inventory-II, and the Beck Anxiety Inventory for HRQoL, depressive, and anxiety symptoms, respectively. The patients completed the Instrumental Activities of Daily Living Questionnaire and the 6-minute walk test for behavioral functional capacity. Hierarchical regression analyses were used to predict HRQoL and behavioral functional capacity from Beck Depression Inventory-II and Beck Anxiety Inventory scores. RESULTS Somatic-affective depressive symptoms were associated with physical (β = 0.37, p = 0.005) and emotional (β = 0.39, p = 0.008) Minnesota Living with Heart Failure Questionnaire subscale scores. Likewise, somatic-affective depressive symptoms predicted Instrumental Activities of Daily Livings Scores (β = 0.43, p = 0.004) and distance ambulated during the 6-minute walk test (β = -0.36, p = 0.029). By contrast, cognitive-depressive symptoms and anxiety were unrelated to HRQoL and behavioral functional capacity (all p > 0.05). CONCLUSIONS These findings showed that somatic-affective depressive symptoms, but not cognitive-depressive symptoms and anxiety, are associated with poor HRQoL and behavioral functional capacity independent of age, clinical functional status, and medical comorbidities. This study suggests that patients with CHF with somatic-affective rather than cognitive-depressive symptoms or anxiety may be at greater risk of poor HRQoL and behavioral functional capacity.
Collapse
|
8
|
Lopes JDL, Barbosa DA, Nogueira-Martins LA, Barros ALBLD. Orientação de enfermagem sobre o banho no leito para redução da ansiedade. Rev Bras Enferm 2015; 68:437-43, 497-503. [DOI: 10.1590/0034-7167.2015680317i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/11/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMOObjetivo:avaliar a efetividade de um protocolo de orientação de enfermagem para redução da ansiedade de pacientes com síndrome coronária aguda, submetidos ao banho no leito e a relação dos sinais vitais com a Ansiedade-Estado.Método:ensaio clínico randomizado. A amostra foi constituída por 120 pacientes. O grupo intervenção recebeu um protocolo de orientação de enfermagem sobre o banho no leito e o grupo controle as informações rotineiras da unidade. A ansiedade foi avaliada por meio do Inventário de Ansiedade-Estado em três momentos: imediatamente após informar ao paciente sobre a necessidade do banho no leito, imediatamente após as intervenções e imediatamente após o banho.Resultados:o grupo intervenção teve uma redução significativamente maior da ansiedade quando comparado ao grupo controle (p<0,001) após a intervenção.Conclusão:a orientação de enfermagem foi efetiva para reduzir a ansiedade dos pacientes com síndrome coronária aguda que se submetem ao banho no leito.
Collapse
|
9
|
Najafi Z, Taghadosi M, Sharifi K, Farrokhian A, Tagharrobi Z. The effects of inhalation aromatherapy on anxiety in patients with myocardial infarction: a randomized clinical trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e15485. [PMID: 25389481 PMCID: PMC4222007 DOI: 10.5812/ircmj.15485] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/02/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
Background: Anxiety is an important mental health problem in patients with cardiac disease. Anxiety reduces patients’ quality of life and increases the risk of different cardiac complications. Objectives: The aim of this study was to investigate the effects of inhalation aromatherapy on anxiety in patients with myocardial infarction. Patients and Methods: This was a randomized clinical trial conduced on 68 patients with myocardial infarction hospitalized in coronary care units of a large-scale teaching hospital affiliated to Kashan University of Medical Sciences, Kashan, Iran in 2013. By using the block randomization technique, patients were randomly assigned to experimental (33 patients receiving inhalation aromatherapy with lavender aroma twice a day for two subsequent days) and control (35 patients receiving routine care of study setting including no aromatherapy) groups. At the beginning of study and twenty minutes after each aromatherapy session, anxiety state of patients was assessed using the Spielberger’s State Anxiety Inventory. Data was analyzed using SPSS v. 16.0. We used Chi-square, Fisher’s exact, independent-samples T-test and repeated measures analysis of variance to analyze the study data. Results: The study groups did not differ significantly regarding baseline anxiety mean and demographic characteristics. However, after the administration of aromatherapy, anxiety mean in the experimental group was significantly lower than the control group. Conclusions: Inhalation aromatherapy with lavender aroma can reduce anxiety in patients with myocardial infarction. Consequently, healthcare providers, particularly nurses, can use this strategy to improve postmyocardial infarction anxiety management.
Collapse
Affiliation(s)
- Zahra Najafi
- Department of Health Management, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohsen Taghadosi
- Department of Medical Surgical Nursing, Faculty of Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Khadijeh Sharifi
- Department of Health Management, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Alireza Farrokhian
- Department of Internal Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zahra Tagharrobi
- Department of Health Management, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Zahra Tagharrobi, Department of Health Management, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9131613899, Fax: +98-3615556633, E-mail:
| |
Collapse
|
10
|
Suzuki T, Shiga T, Kuwahara K, Kobayashi S, Suzuki S, Nishimura K, Suzuki A, Minami Y, Ishigooka J, Kasanuki H, Hagiwara N. Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure. J Cardiol 2014; 64:456-62. [PMID: 24755202 DOI: 10.1016/j.jjcc.2014.02.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/02/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anxiety is often present in patients with depression. The aim of this study was to evaluate the impact of clustered depression and anxiety on mortality and rehospitalization in hospitalized patients with heart failure (HF). METHODS A total of 221 hospitalized patients with HF, who completed the questionnaires, were analyzed in this prospective study (mean age 62±13 years; 28% female). One-third patients had implanted cardiac devices. Depression was defined as a Zung Self-Rating Depression Scale index score of ≥60 and anxiety was defined as a State-Trait Anxiety Inventory score of ≥40 (male) or ≥42 (female). The primary outcome was the composite of death from any cause or rehospitalization due to worsened HF and refractory arrhythmia. RESULTS Of the 221 HF patients, 29 (13%) had depression alone, 80 (36%) had anxiety alone, and 46 patients (21%) had both depression and anxiety. During an average follow-up of 41±21 months, patients with depression alone and those with clustered depression and anxiety were at an increased risk of the primary outcome [hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.17-4.28, p=0.01 and HR 2.75, 95% CI: 1.51-4.99, p=0.01, respectively] compared to patients with no symptoms. Multivariate analysis after adjusting for age, gender, New York Heart Association functional class, B-type natriuretic peptide, device implantation, renal dysfunction, and left ventricular dysfunction showed clustered depression and anxiety, but not depression alone or anxiety alone, was an independent predictor of the primary outcome (HR 1.96, 95% CI: 1.00-3.27, p=0.04). CONCLUSIONS Our results showed that clustered depression and anxiety were associated with worse outcomes in patients with HF.
Collapse
Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Kazue Kuwahara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinichi Suzuki
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
11
|
Perpiñá-Galvañ J, Cabañero-Martínez MJ, Richart-Martínez M. Reliability and validity of shortened state trait anxiety inventory in Spanish patients receiving mechanical ventilation. Am J Crit Care 2013; 22:46-52. [PMID: 23283088 DOI: 10.4037/ajcc2013282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND In order to measure anxiety in physically and cognitively debilitated patients, such as patients receiving invasive mechanical ventilation, the use of reliable and valid instruments is recommended; however, these instruments should be short. OBJECTIVE To analyze the reliability and validity of a short version of the state subscale from the Spielberger State-Trait Anxiety Inventory, developed by Chlan and colleagues and translated into Spanish (STAI-E6), in patients receiving invasive mechanical ventilation. METHODS An instrumental study was conducted of 80 patients receiving invasive mechanical ventilation in the intensive care unit at the Hospital of Alicante (Spain). The patients completed the 6-item STAI-E6 scale. Before the patients completed the scale, the interviewers indicated their impression of each patient's level of anxiety by using a linear scale. Internal consistency, construct validity, and convergent validity of the scale were analyzed. RESULTS The scale did not present a floor/ceiling effect, the Cronbach α was 0.79, and the single-factor structure of the original scale was maintained. Scores on the scale correlated positively with the subjective assessment of the health professional. Significant differences were found only between anxiety level and duration of intubation. CONCLUSIONS The 6-item version of the state subscale from the STAI-E6 shows satisfactory reliability and validity for Spanish patients receiving invasive mechanical ventilation.
Collapse
Affiliation(s)
- Juana Perpiñá-Galvañ
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - María José Cabañero-Martínez
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - Miguel Richart-Martínez
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
| |
Collapse
|
12
|
Castillo MI, Aitken LM, Cooke ML. Study protocol: Intensive Care Anxiety and Emotional Recovery (Icare)-a prospective study. Aust Crit Care 2012; 26:142-7. [PMID: 23158029 DOI: 10.1016/j.aucc.2012.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/18/2012] [Accepted: 10/16/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. PURPOSE The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a statistical model to determine the relationship between state anxiety during ICU stay and symptoms of anxiety, depression and PTSD at three occasions; after ICU discharge but prior to hospital discharge and at the third and sixth months post ICU discharge. METHODS Prospective study including adult patients admitted to the ICU of a tertiary metropolitan Australian hospital for ≥24 h who are able to: (1) communicate verbally or nonverbally; (2) understand English and (3) open their eyes spontaneously or in response to voice to respond to the Faces Anxiety Scale (state anxiety assessment). One hundred and seventy patients will be assessed for their levels of state anxiety during their ICU stay to achieve a sample size of about 104 patients six months after discharge. The outcomes of the ICARe study will include symptoms of anxiety, depression and PTSD assessed by standardised questionnaires widely used in intensive care research. Demographic, clinical, and social support information will also be collected. RESULTS The projected sample size will provide sufficient power to evaluate the association between state anxiety and adverse emotional outcomes, as well as a variety of variables that will be entered into a multivariate regression analysis. CONCLUSION This study will provide new evidence to improve care during critical illness and reduce adverse outcomes during recovery with the potential to decrease unnecessary suffering, promote comfort and improve long-term recovery.
Collapse
Affiliation(s)
- Maria I Castillo
- NHMRC Centre of Research Excellence, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | | | | |
Collapse
|
13
|
Eastwood JA, Moser DK, Riegel BJ, Albert NM, Pressler S, Chung ML, Dunbar S, Wu JR, Lennie TA. Commonalities and differences in correlates of depressive symptoms in men and women with heart failure. Eur J Cardiovasc Nurs 2012; 11:356-65. [PMID: 22414584 PMCID: PMC4014068 DOI: 10.1177/1474515112438010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE (i) To compare the prevalence and severity of depressive symptoms between men and women enrolled in a large heart failure (HF) registry. (ii) To determine gender differences in predictors of depressive symptoms from demographic, behavioral, clinical, and psychosocial factors in HF patients. METHODS In 622 HF patients (70% male, 61 ± 13 years, 59% NYHA class III/IV), depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). Potential correlates were age, ethnicity, education, marital and financial status, smoking, exercise, body mass index (BMI), HF etiology, NYHA class, comorbidities, functional capacity, anxiety, and perceived control. To identify gender-specific correlates of depressive symptoms, separate logistic regression models were built by gender. RESULTS Correlates of depressive symptoms in men were financial status (p = 0.027), NYHA (p = 0.001); functional capacity (p < 0.001); health perception (p = 0.043); perceived control (p = 0.002) and anxiety (p < 0.001). Correlates of depressive symptoms in women were BMI (p = 0.003); perceived control (p = 0.013) and anxiety (p < 0.001). CONCLUSIONS In HF patients, lowering depressive symptoms may require gender-specific interventions focusing on weight management in women and improving perceived functional capacity in men. Both men and women with HF may benefit from anxiety reduction and increased control.
Collapse
Affiliation(s)
- Jo-Ann Eastwood
- University of California Los Angeles School of Nursing, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Vinader-Caerols C, Monleón S, Carrasco C, Parra A. Effects of Alcohol, Coffee, and Tobacco, Alone or in Combination, on Physiological Parameters and Anxiety in a Young Population. JOURNAL OF CAFFEINE RESEARCH 2012; 2:70-76. [PMID: 24761267 DOI: 10.1089/jcr.2012.0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective was to evaluate the effects of a single dose of alcohol, caffeine, and nicotine, alone or in combination, on physiological parameters (systolic and diastolic blood pressure [SBP and DBP] and heart rate [HR]) and state-trait anxiety in healthy young volunteers. METHOD The procedure reproduces the conditions under which the subjects (n=76) usually ingest alcohol (through an alcoholic beverage), caffeine (through a cup of coffee), and nicotine (by smoking a cigarette), separately or in combination, according to their consumption habits of each individual. SBP and DBP, HR, and state anxiety (SA) were registered before (phase 1) and after (phase 2) treatment. RESULTS Intake of alcohol or alcohol-nicotine reduced DBP. Comparisons between control and combined treatment (coffee-alcohol-nicotine) groups revealed a decrease in HR in the former group but not in the latter. The coffee consumers alone exhibited a tendency toward an increase in SA, while the control group showed a tendency toward a decrease in this measure. When Phase 1 and Phase 2 were compared, a decrease was observed in SBP (alcohol and coffee-alcohol groups), DBP (alcohol and alcohol-nicotine groups), HR (all groups, except coffee-alcohol and coffee-alcohol-nicotine groups), and SA (coffee-alcohol-nicotine group). CONCLUSIONS (i) A low dose of alcohol, either alone or in combination with a cigarette, decreases DBP but not SBP; (ii) the polyconsumption of coffee, alcohol, and nicotine blocks the adaptation response (the reduction in HR in control subjects in the second phase); (iii) an increase of SA is observed after consuming coffee, while the opposite occurs in control subjects (a decrease of SA).
Collapse
Affiliation(s)
| | - Santiago Monleón
- Department of Psychobiology, University of Valencia , Valencia, Spain
| | - Carmen Carrasco
- Department of Psychobiology, University of Valencia , Valencia, Spain
| | - Andres Parra
- Department of Psychobiology, University of Valencia , Valencia, Spain
| |
Collapse
|
15
|
Psychosocial Concerns and Interventions for Patients and Their Identified Support Givers to Help Cope With Acute Manifestations of Advanced Coronary Artery Diseases. J Cardiovasc Nurs 2012; 27:132-46. [DOI: 10.1097/jcn.0b013e318239f647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Perpiñá-Galvañ J, Richart-Martínez M, Cabañero-Martínez MJ, Martínez-Durá I. Content validity of the short version of the subscale of the State-Trait Anxiety Inventory (STAI). Rev Lat Am Enfermagem 2012; 19:882-7. [PMID: 21876939 DOI: 10.1590/s0104-11692011000400005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 03/04/2011] [Indexed: 01/21/2023] Open
Abstract
The goal was to describe the content validity of a short version of the state subscale of Spielberger's "State-Trait Anxiety Inventory (STAI)", based on the original version adapted to Spanish, in Spanish patients receiving invasive mechanical ventilation (IMV). The sample consisted of 16 patients receiving IMV at the Alicante Hospital (Spain), who selected the items from the full Spanish version of the STAI-state that were most relevant to them. Items 1, 5, 9, 10, 12 and 20 from the original scale are the most relevant for the Spanish patients receiving IMV and 5 of these are included in the short version of the scale (83.3% agreement). The short scale has shown adequate content validity for Spanish patients receiving IMV.
Collapse
|
17
|
De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
Collapse
Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Impact of prehospital delay in treatment seeking on in-hospital complications after acute myocardial infarction. J Cardiovasc Nurs 2011; 26:184-93. [PMID: 21116191 DOI: 10.1097/jcn.0b013e3181efea66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown. OBJECTIVE The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling. METHODS Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record. RESULTS Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001). CONCLUSION Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.
Collapse
|
19
|
Abed MA, Hall LA, Moser DK. Spielberger's state anxiety inventory: development of a shortened version for critically ill patients. Issues Ment Health Nurs 2011; 32:220-7. [PMID: 21355756 DOI: 10.3109/01612840.2010.546493] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The length of Spielberger's State Anxiety Inventory (SAI) makes its use difficult for critically ill populations. To shorten it, exploratory factor analysis was used with data from 530 acute myocardial infarction patients. The resulting 6-item shortened version demonstrated good internal reliability consistency with a Cronbach's alpha of .84. Construct validity of the shortened version was supported by strong correlations with the original SAI and the Brief Symptom Inventory (BSI), another measure of state anxiety, and through support of known hypotheses. This study offered a short version of the SAI with excellent psychometric properties that can be used in critically ill patients.
Collapse
Affiliation(s)
- Mona A Abed
- Hashemite University, College of Nursing, Zarqa, Jordan.
| | | | | |
Collapse
|
20
|
Shen BJ, Eisenberg SA, Maeda U, Farrell KA, Schwarz ER, Penedo FJ, Bauerlein EJ, Mallon S. Depression and Anxiety Predict Decline in Physical Health Functioning in Patients with Heart Failure. Ann Behav Med 2010; 41:373-82. [DOI: 10.1007/s12160-010-9251-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
21
|
Affiliation(s)
- Sitaramesh Emani
- The Ohio State University Division of Cardiovascular Medicine and the Dorothy Davis Heart and Lung Research Institute, 473 W 12th Ave, Columbus, OH 43210-1252, USA
| | | |
Collapse
|
22
|
Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed. Int J Cardiol 2010; 149:147-151. [PMID: 21040986 DOI: 10.1016/j.ijcard.2010.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 06/09/2010] [Accepted: 10/05/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. AIM To describe various aspects of chest pain in the pre-hospital setting with the emphasis on a) treatment and b) presumed acute coronary syndrome. METHODS In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. RESULTS Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. CONCLUSION Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.
Collapse
|
23
|
Perpiñá-Galvañ J, Richart-Martínez M. Scales for evaluating self-perceived anxiety levels in patients admitted to intensive care units: a review. Am J Crit Care 2009; 18:571-80. [PMID: 19880959 DOI: 10.4037/ajcc2009682] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. METHODS The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación mecánica for the Spanish-language databases. Information was extracted from 18 selected articles on the level of anxiety experienced by patients and the psychometric properties of the instruments used to measure anxiety. RESULTS Moderate levels of anxiety were reported. Levels were higher in women than in men, and higher in patients undergoing positive pressure ventilation regardless of sex. Most multi-item instruments had high coefficients of internal consistency. The reliability of instruments with only a single item was not demonstrated, even though the instruments had moderate-to-high correlations with other measurements. CONCLUSION Midlength scales, such the anxiety subscale of the Brief Symptom Inventory or the shortened state version of the State-Trait Anxiety Inventory are best for measuring anxiety in critical care patients.
Collapse
Affiliation(s)
- Juana Perpiñá-Galvañ
- Juana Perpiñá-Galvañ is a registered nurse with a master of science degree in nursing and Miguel Richart-Martínez is a doctor in psychology in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - Miguel Richart-Martínez
- Juana Perpiñá-Galvañ is a registered nurse with a master of science degree in nursing and Miguel Richart-Martínez is a doctor in psychology in the Nursing Department, Universidad de Alicante, Alicante, Spain
| |
Collapse
|
24
|
Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, Gurvitz MZ, Havranek EP, Lee CS, Lindenfeld J, Peterson PN, Pressler SJ, Schocken DD, Whellan DJ. State of the Science. Circulation 2009; 120:1141-63. [DOI: 10.1161/circulationaha.109.192628] [Citation(s) in RCA: 638] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
25
|
Evangelista LS, Ter-Galstanyan A, Moughrabi S, Moser DK. Anxiety and depression in ethnic minorities with chronic heart failure. J Card Fail 2009; 15:572-9. [PMID: 19700133 PMCID: PMC2763587 DOI: 10.1016/j.cardfail.2009.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/09/2009] [Accepted: 03/20/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Considerable evidence confirms the high prevalence of anxiety and depression in the patients with heart failure (HF). However, little is known about the relationship of race/ethnicity to psychosocial variables in this population. The purpose of this study was to examine and compare the incidence of anxiety and depression in a cohort of non-Hispanic blacks, Hispanics, and non-Hispanic whites with advanced systolic HF. METHODS AND RESULTS Two-hundred forty-one patients (7% non-Hispanic blacks, 22.8% Hispanics, 60.7% non-Hispanic whites) mean age 56.7+/-13.0 years, male (70%), married (81%), retired (75%), New York Heart Association (NYHA) Class III (53.9%), and mean ejection fraction 31.2+/-5.4%) from a single heart transplant facility were asked to complete a series of questionnaires to assess anxiety, depression, perceived control, social support, and financial stability. Non-Hispanic blacks had higher levels of anxiety (P=.048) and depression (P=.026) compared with Hispanics; a similar trend was noted when comparing non-Hispanic blacks and non-Hispanic whites, but these differences were not statistically significant. Perceived control was highest among Hispanics and lowest among non-Hispanic whites (P=.046). In a multivariate model race/ethnicity, perceived control, and social support accounted for 30% of the variance in anxiety while race/ethnicity, NYHA Class, perceived control, and social support accounted for 41% of the variance in depression. CONCLUSIONS Our findings reveal that non-Hispanic blacks are more likely to be anxious and depressed than their counterparts. Because patient perceptions of control and social support are related to dysphorias known to influence morbidity and mortality, clinicians should regularly assess patients' concerns and assist in accessing appropriate services and treatments tailored to individual needs. Non-Hispanic blacks warrant increased scrutiny.
Collapse
|
26
|
Chung ML, Moser DK, Lennie TA, Rayens MK. The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: testing dyadic dynamics using Actor-Partner Interdependence Model. J Psychosom Res 2009; 67:29-35. [PMID: 19539816 PMCID: PMC2732117 DOI: 10.1016/j.jpsychores.2009.01.009] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient-spouse dyads using an innovative dyadic analysis technique, the Actor-Partner Interdependence Model (APIM). METHOD A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% +/-11, 43% in New York Heart Association III-IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL. RESULT Depressive symptoms exhibited actor effect of both patients (P<.001) and spouses (P<.001) and only partner effect of patients (P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms. CONCLUSION Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses.
Collapse
Affiliation(s)
- Misook L. Chung
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Debra K. Moser
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Terry A. Lennie
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, Lexington, Kentucky
| |
Collapse
|
27
|
Psychological, social and spiritual distress at the end of life in heart failure patients. Curr Opin Support Palliat Care 2008; 1:260-6. [PMID: 18685372 DOI: 10.1097/spc.0b013e3282f283a3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs. RECENT FINDINGS The high prevalence of depression (9-77.5%) among chronic heart failure patients is well documented. Clinical assessment and treatment of depression and anxiety are key to good patient care, although no model for assessment has been agreed. Evidence suggests that social support and spiritual belief are important coping resources, but there is a dearth of research into social and spiritual distress in chronic heart failure. Patients rarely access social services support, and family carers experience considerable burden. Little is known about how psychosocial and spiritual variables influence each other, and the impact of social and spiritual distress on outcomes such as quality of life. SUMMARY We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.
Collapse
|
28
|
Pelle AJM, Gidron YY, Szabó BM, Denollet J. Psychological predictors of prognosis in chronic heart failure. J Card Fail 2008; 14:341-50. [PMID: 18474348 DOI: 10.1016/j.cardfail.2008.01.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 01/03/2008] [Accepted: 01/11/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is an increasingly prevalent condition with high mortality and morbidity rates. This review examines the role of depression, anxiety, and social support on prognosis in CHF. METHOD AND RESULTS Prospective studies that examined mortality as an outcome, and assessed depression, anxiety, or social support as associates were included. Methodological qualities were evaluated. In total, 25 studies were identified. Concerning depression, 6 of 15 studies of inpatients, 10 of 11 studies of outpatients, and 1 study of a mixed sample found associations between depression and prognosis, with greater associations rendered by depressive symptomatology in outpatients. Anxiety was not associated with prognosis in one inpatient study and one outpatient study. There was a univariable trend in one outpatient study for anxiety to be associated with prognosis. In two of six studies of inpatients and in two of four studies of outpatients, social support was associated with prognosis. On the basis of methodological quality, studies on depression showed mixed results, no conclusions could be drawn for anxiety because this association was not investigated soundly, and the quality of the social network was not associated with outcome. CONCLUSION Evidence suggests that depressive symptoms and social support might be associated with prognosis in CHF outpatients, independently of biomedical risk factors. With respect to anxiety, no conclusions can be drawn. Future studies are warranted to disentangle associations with psychological factors.
Collapse
Affiliation(s)
- Aline J M Pelle
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands
| | | | | | | |
Collapse
|
29
|
|
30
|
Abstract
Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers’ knowledge of anxiety assessment and providers’ practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients’ outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.
Collapse
Affiliation(s)
- Debra K. Moser
- Debra K. Moser is a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington
| |
Collapse
|
31
|
Affiliation(s)
- Marla J De Jong
- University of Kentucky, College of Nursing/United States Air Force, Lexington, Ky, USA.
| | | |
Collapse
|
32
|
Redeker NS. Somatic Symptoms Explain Differences in Psychological Distress in Heart Failure Patients vs a Comparison Group. ACTA ACUST UNITED AC 2006; 21:182-9. [PMID: 17170593 DOI: 10.1111/j.0889-7204.2006.05643.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychological distress is common among patients with heart failure (HF); however, somatic symptoms are also common and may confound its assessment. Understanding the contributions of symptoms to psychological distress may assist in focusing treatment. The purpose of this study was to evaluate differences between HF patients and a non-HF comparison group on psychological distress (anxiety and depression); the association of anxiety and depression with common somatic symptoms of HF (fatigue, sleep disturbance, dyspnea, and excessive daytime sleepiness); and the extent to which somatic symptoms and HF diagnosis explain psychological distress. In this cross-sectional study, 61 stable systolic HF outpatients and a comparison group of 57 persons recruited from the community completed the Centers for the Epidemiological Studies of Depression Scale, Profile of Mood States-Short Form, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Multidimensional Assessment of Fatigue Scale, and the Multidimensional Assessment of Dyspnea Scale. The HF patients scored higher on depression, as measured by the Centers for the Epidemiological Studies of Depression Scale, but not on the other depression or anxiety scales. Group-related differences in depression were explained by sleep disturbance, fatigue, and excessive daytime sleepiness, after accounting for the effects of age, sex, minority status, comorbidity, and physical function.
Collapse
Affiliation(s)
- Nancy S Redeker
- University of Medicine & Dentistry of New Jersey, School of Nursing, Newark, NJ 07101-1709, USA.
| |
Collapse
|
33
|
Konstam V, Moser DK, De Jong MJ. Depression and Anxiety in Heart Failure. J Card Fail 2005; 11:455-63. [PMID: 16105637 DOI: 10.1016/j.cardfail.2005.03.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 02/24/2005] [Accepted: 03/11/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although common among patients with heart failure, depression and anxiety have been relatively neglected by researchers and practitioners. Both depression and anxiety have been implicated in contributing independently to the poor outcomes seen in patients with heart failure. Emphasis in the literature is on physical symptom recognition and management, in contrast to the patient's perspective of the effects of heart failure on his or her daily life. METHODS AND RESULTS This review summarizes and integrates research findings on anxiety and depression and translates these findings to clinical practice. Depression and anxiety are prevalent among patients with heart failure and require assessment and intervention. Short-term nonpharmacologic approaches, in conjunction with drug therapy, hold promise for successful management of patients who are depressed or anxious. CONCLUSION Carefully designed clinical trials that are tailored to individual needs, yet are embedded within a systemic framework, are needed to inform clinicians regarding optimal practices for the treatment of patients with heart failure who suffer from depression or anxiety.
Collapse
Affiliation(s)
- Varda Konstam
- Department of Counseling and School Psychology, University of Massachusetts Boston, MA 02125, USA
| | | | | |
Collapse
|
34
|
De Jong MMJ, An K, McKinley S, Garvin BJ, Hall LA, Moser DK. Using a 0-10 Scale for Assessment of Anxiety in Patients With Acute Myocardial Infarction. Dimens Crit Care Nurs 2005; 24:139-46. [PMID: 15912064 DOI: 10.1097/00003465-200505000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) often experience anxiety, an emotion that predicts adverse physiologic outcomes. The purpose of this study was to determine whether a single-item anxiety assessment instrument, the Anxiety Level Index (ALI), is a valid alternative to the State Anxiety Index (SAI) or the anxiety subscale of the Brief Symptom Inventory (BSI) for assessing state anxiety for patients with AMI. In this prospective multicenter study, 243 inpatients with AMI rated their anxiety using the SAI, the anxiety subscale of the BSI, and the ALI. Anxiety Level Index scores were compared to SAI and BSI anxiety subscale scores. There were moderate, positive correlations between the SAI and the ALI (rs = 0.52, P < .001), and between the ALI and the anxiety subscale of the BSI (rs = 0.45, P < .001). Although ALI scores were moderately and significantly correlated with scores on the SAI and the BSI anxiety subscales, the results of the Bland-Altman method indicate a lack of construct validity of the single-item measure. The quest continues to construct a simple self-report measure of anxiety that is appropriate for critically ill patients with AMI.
Collapse
|