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Higa H, Lennie TA, Chung ML, Tsuchihashi-Makaya M. Associations of multidimensional fatigue with the physical, psychological, and situational factors in outpatients with heart failure: a cross-sectional study. Eur J Cardiovasc Nurs 2023; 22:647-654. [PMID: 36509707 DOI: 10.1093/eurjcn/zvac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
AIMS Fatigue, a distressing symptom in patients with heart failure (HF), is associated with progress and health outcomes. Fatigue has been identified as having multidimensions, but a few studies have used a multidimensional fatigue scale. Many factors related to HF, including physical, psychological, and situational factors, may impact fatigue. However, there is limited knowledge about how these HF-related factors are associated with multidimensional fatigue in outpatients with HF in Japan. The aim of this study was to identify HF-related factors [physical; clinical characteristics, New York Heart Association (NYHA) functional class and physical function, psychological; depressive symptoms and anxiety, situational; health literacy and perceived control] associated with the five dimensions of fatigue in outpatients with HF. METHODS AND RESULTS Outpatients with HF (N = 165, mean age = 69.5 years, 78.8% male) completed the survey and physical assessment of gait speed. Fatigue was assessed using five dimensions of the Multidimensional Fatigue Inventory-20. Multiple linear regression analysis was conducted for each dimension of fatigue. General fatigue was predicted by age, NYHA, and perceived control. Physical fatigue was predicted by NYHA, depressive symptoms, and perceived control. Reduced activity was predicted by NYHA, gait speed, depressive symptoms, communicative health literacy, and critical health literacy. The reduced motivation was predicted by depressive symptoms and perceived control. Mental fatigue was predicted by depressive symptoms. CONCLUSION Different factors were significantly associated with each fatigue dimension. Further research is needed to alleviate fatigue in patients with HF.
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Affiliation(s)
- Hiroko Higa
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
| | - Terry A Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Miyuki Tsuchihashi-Makaya
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
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Rodriguez-Torres RS, Uher D, Gay EL, Coratti G, Dunaway Young S, Rohwer A, Muni Lofra R, De Vivo DC, Hirano M, Glynn NW, Montes J. Measuring Fatigue and Fatigability in Spinal Muscular Atrophy (SMA): Challenges and Opportunities. J Clin Med 2023; 12:jcm12103458. [PMID: 37240564 DOI: 10.3390/jcm12103458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Fatigue, a common symptom, together with the characteristic of performance fatigability, are well-documented features of SMA that impact quality of life and function. Importantly, establishing associations between multidimensional self-reported fatigue scales and patient performance has proven difficult. This review was conducted to evaluate the various patient-reported fatigue scales applied in SMA, with the objective of considering the limitations and advantages of each measure. Variable use of fatigue-related nomenclature, including conflicting terminology interpretation, has affected assessment of physical fatigue attributes, specifically perceived fatigability. This review encourages the development of original patient-reported scales to enable perceived fatigability assessment, providing a potential complementary method of evaluating treatment response.
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Affiliation(s)
- Rafael S Rodriguez-Torres
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Uher
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10115, USA
| | - Emma L Gay
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Giorgia Coratti
- Pediatric Neurology Unit, Catholic University, 00135 Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Annemarie Rohwer
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 7RU, UK
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nancy W Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
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Lin Y, Cai H, Liu HH, Su XJ, Zhou CY, Li J, Tang YL, Jackson T, Xiang YT. Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis. Front Psychiatry 2023; 14:1084792. [PMID: 37009113 PMCID: PMC10060541 DOI: 10.3389/fpsyt.2023.1084792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundThis study was designed to investigate the prevalence and predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).MethodsThis cross-sectional, observational study was conducted in China between July 1, 2021, and May 17, 2022. Descriptive analysis was used to calculate depression prevalence. Univariate analyses were used to compare differences in demographic and clinical characteristics between depressed and non-depressed patients following pacemaker implantation. Binary logistic regression analysis was used to assess factors independently associated with depression. Network analysis “expected influence,” and flow function indexes were used to identify symptoms central to the depression network of the sample and depressive symptoms that were directly associated with QOL, respectively. Network stability was examined using a case-dropping bootstrap procedure.ResultsIn total, 206 patients implanted with a pacemaker met the study entry criteria and completed the assessment. The overall prevalence of depression (PHQ-9 total score ≥ 5) was 39.92% [95% confidence interval (CI) = 29.37−42.47%]. A binary logistic regression analysis revealed that patients with depression were more likely to report a poor health status (p = 0.031), severe anxiety symptoms (p < 0.001), and fatigue (p < 0.001). In the network model for depression, “Sad mood,” “Poor Energy,” and “Guilt” were the most influential symptoms. “Fatigue” had the strongest negative association with QOL, followed by “Sad mood” and “Appetite”.ConclusionDepression is common among patients having undergone pacemaker implantation during the COVID-19 pandemic. Anxiety, central symptoms of depression (i.e., “Sad mood”, “Poor Energy”, and “Guilt”) and depressive symptoms linked to QOL (i.e., “Sad mood”, “Appetite”, and “Fatigue”) identified in this study are promising targets for interventions and preventive measures for depression in patients who have undergone pacemaker implants.
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Affiliation(s)
- Yun Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Yun Lin,
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Hong-Hong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xue-Jian Su
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chen-Yu Zhou
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jing Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
- Atlanta VA Medical Center, Atlanta, GA, United States
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
- *Correspondence: Yu-Tao Xiang,
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Hosseini SA, Karampourian A, Shamsizadeh M, Mohammadi Y. Application of Haddon strategy training on self-care behavior and disease consequences in heart failure. JOURNAL OF VASCULAR NURSING 2023. [DOI: 10.1016/j.jvn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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5
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Yiu EML, Lau GWH, Wang F. Fatigue-Related Change in Surface Electromyographic Activities of the Perilaryngeal Muscles. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:98-109. [PMID: 36580552 DOI: 10.1044/2022_jslhr-22-00283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This study set out to quantify the fatigue-related changes in surface electromyographic (sEMG) activities of the perilaryngeal muscles following a vocal loading task. METHOD Thirty-six young healthy participants (M age = 22.4 years) with normal voice performed karaoke singing for at least 100 min. Before the singing task, all participants underwent the sEMG measure and completed a Perceived Vocal Fatigue Score (P-VFS) questionnaire. After the singing task, all participants were immediately measured with the P-VFS again. Half of the participants were then measured for their sEMG immediately after their karaoke singing task, and the other half were given 20 min of rest before undertaking the sEMG measure. The P-VFS and the median frequency (MDF) of the sEMG signals collected from the suprahyoid, infrahyoid, and sternocleidomastoid muscles before and after the singing task were compared using a linear mixed-effects model. RESULTS All participants reported a perceived vocal fatigue after singing, with a significantly increased P-VFS. Compared with the presinging baseline, the MDF of the sEMG signals in perilaryngeal muscles was significantly lower immediately after the singing task. Such a significant difference was also found after 20 min following the singing task. CONCLUSIONS The MDF analysis of the sEMG signals could identify and quantify the performance vocal fatigue contributed by perilaryngeal muscles following a vocal loading task. The findings also showed that such fatigue in perilaryngeal muscles, as far as sEMG activities are concerned, can last for at least 20 min.
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Affiliation(s)
- Edwin M-L Yiu
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam
| | - Gary W H Lau
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam
| | - Feifan Wang
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam
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Impact of radiation therapy on fatigue at 1 year in breast cancer survivors in the prospective multicentre CANcer TOxicity cohort. Eur J Cancer 2022; 177:143-153. [PMID: 36356418 DOI: 10.1016/j.ejca.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fatigue is a common and disabling symptom after breast cancer (BC) treatment, significantly impacting patients' quality of life. We aimed to assess the impact of radiation therapy (RT) modalities on fatigue one year after treatment among patients with early-stage BC. METHODS We used CANTO-RT, a subcohort of CANcer TOxicity (CANTO; NCT01993498), a multicentric nationwide prospective cohort of stages I-III BC treated from 2012 to 2017. Our primary outcome was severe global fatigue 1 year after RT completion (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 score ≥40/100). The secondary outcomes included severe physical, emotional and cognitive fatigue (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-FA12). RT-related variables were used as independent variables. Multivariable logistic regression models assessed associations between RT-related variables and fatigue. RESULTS The final analytic cohort included 3295 patients. The prevalence of severe global fatigue 1 year after treatment was 33.3%. Internal mammary chain RT (adjusted odds ratio [OR] 1.48 [95% confidence interval [CI] 1.03-2.13; p = 0.0355]) and normofractionated RT (adjusted OR 1.88 [95% CI 1.06-3.31; p = 0.0298]) were associated with increased odds of severe global fatigue. In addition, there was a significant association between normofractionated RT (adjusted OR 1.849 [95% CI 1.04-3.3; p = 0.0354]) and an increased likelihood of severe physical fatigue. CONCLUSION We found a significant association between internal mammary chain RT (versus No), normofractionated RT (versus hypofractionated RT) and increased likelihood of persistent severe global fatigue. Our data add to the current understanding of treatment-related factors affecting fatigue after BC and could lead to personalised interventions to improve the prevention and management of this disabling symptom.
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Fatigue in Heart Failure. J Cardiovasc Nurs 2022. [DOI: 10.1097/jcn.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Donoghue P, O'Halloran A, Kenny RA, Romero-Ortuno R. Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13522.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in adverse events. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (<130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘below threshold (BT)’: <130/70 mmHg vs. ‘above threshold (AT)’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated BT and frail by FRAIL treated BT had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated BT also had increased risk of mortality by W2. The frail by FI treated AT had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have any increased risk of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Future hypertension management guidelines should consider incorporating specific frailty identification tools to help guide clinicians in making personalised BP medication treatment decisions.
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O'Donoghue P, O'Halloran A, Kenny RA, Romero-Ortuno R. Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in side effects including orthostatic hypotension, falls or fractures. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (<130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘low’: <130/70 mmHg vs. ‘high’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated low and frail by FRAIL treated low had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated low also had increased risk of mortality by W2. The frail by FI treated high had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have increased risk of any of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Hypertension management guidelines should specify which frailty identification tools clinicians should use to help them make personalised treatment decisions.
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Soto ME, Pérez-Torres I, Rubio-Ruiz ME, Manzano-Pech L, Guarner-Lans V. Interconnection between Cardiac Cachexia and Heart Failure—Protective Role of Cardiac Obesity. Cells 2022; 11:cells11061039. [PMID: 35326490 PMCID: PMC8946995 DOI: 10.3390/cells11061039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
Cachexia may be caused by congestive heart failure, and it is then called cardiac cachexia, which leads to increased morbidity and mortality. Cardiac cachexia also worsens skeletal muscle degradation. Cardiac cachexia is the loss of edema-free muscle mass with or without affecting fat tissue. It is mainly caused by a loss of balance between protein synthesis and degradation, or it may result from intestinal malabsorption. The loss of balance in protein synthesis and degradation may be the consequence of altered endocrine mediators such as insulin, insulin-like growth factor 1, leptin, ghrelin, melanocortin, growth hormone and neuropeptide Y. In contrast to many other health problems, fat accumulation in the heart is protective in this condition. Fat in the heart can be divided into epicardial, myocardial and cardiac steatosis. In this review, we describe and discuss these topics, pointing out the interconnection between heart failure and cardiac cachexia and the protective role of cardiac obesity. We also set the basis for possible screening methods that may allow for a timely diagnosis of cardiac cachexia, since there is still no cure for this condition. Several therapeutic procedures are discussed including exercise, nutritional proposals, myostatin antibodies, ghrelin, anabolic steroids, anti-inflammatory substances, beta-adrenergic agonists, medroxyprogesterone acetate, megestrol acetate, cannabinoids, statins, thalidomide, proteasome inhibitors and pentoxifylline. However, to this date, there is no cure for cachexia.
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Affiliation(s)
- María Elena Soto
- Department of Immunology, Instituto Nacional de Cardiología “Ignacio Chávez”, México City 14080, Mexico;
| | - Israel Pérez-Torres
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología “Ignacio Chávez”, México City 14080, Mexico; (I.P.-T.); (L.M.-P.)
| | - María Esther Rubio-Ruiz
- Department of Physiology, Instituto Nacional de Cardiología “Ignacio Chávez”, México City 14080, Mexico;
| | - Linaloe Manzano-Pech
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología “Ignacio Chávez”, México City 14080, Mexico; (I.P.-T.); (L.M.-P.)
| | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología “Ignacio Chávez”, México City 14080, Mexico;
- Correspondence:
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Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health. J Card Fail 2022; 28:283-315. [PMID: 34329719 PMCID: PMC8795245 DOI: 10.1016/j.cardfail.2021.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health. METHODS AND RESULTS A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue. CONCLUSIONS Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
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Ternrud L, Hlebowicz J, Sandberg C, Johansson B, Sparv D. Prevalence of fatigue in adults with congenital heart disease. Cardiol Young 2021; 32:1-8. [PMID: 34714224 DOI: 10.1017/s1047951121004297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS The aim of this cross-sectional study was to examine the prevalence of the multidimensional phenomenon of fatigue in adults with congenital heart disease. BACKGROUND Adults with congenital heart disease are a growing population, and patient-reported outcomes can provide valuable information about the patient's experience of living with CHD. Fatigue is a multidimensional phenomenon that can be described as an overwhelming feeling of exhaustion with a reduced capacity of mental and physical work. Fatigue can be observed clinically in adults with congenital heart disease, but the actual prevalence is unknown. METHODS Fatigue was assessed by the Multidimensional Fatigue Inventory which enables the respondent to report the presence of fatigue according to five dimensions: "general fatigue," "physical fatigue," "mental fatigue," "reduced motivation," and "reduced activity." The questionnaire was sent to 463 patients in Lund and Umeå. Four groups with complex CHD and two groups with moderately complex CHD were included. The reliability (internal consistency) of the Multidimensional Fatigue Inventory was tested for all dimensions and groups of diagnosis. RESULTS The response rate was 56.6% (n= 262). In patients with complex CHD, 40.0-59.4% reported severe to very severe general fatigue, and patients with a single ventricle reported the highest prevalence (59.4%). Among patients with complex CHD, 29.2-40.0% reported severe to very severe mental fatigue. The Multidimensional Fatigue Inventory had a high reliability measured with Cronbach's alpha. CONCLUSIONS The study findings show a relatively high prevalence of fatigue in adults with congenital heart disease, and general fatigue was the most prevalent. Further studies are needed regarding fatigue and its causes and consequences in adults with congenital heart disease. RELEVANCE TO CLINICAL PRACTICE The Multidimensional Fatigue Inventory proved to be an instrument with high reliability and low internal loss, which suggests that the instrument may be suitable to use as a patient-reported outcome in the care of adults with congenital heart disease, preferably at repeated occasions.
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Affiliation(s)
- Linda Ternrud
- Department of Cardiology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Joanna Hlebowicz
- Department of Cardiology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - David Sparv
- Department of Cardiology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
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Cavalcante VN, Cavalcanti ACD, Tinoco JDMVP, Figueiredo LDS, Mesquita ET. Effectiveness of Mindfulness Meditation Programs in the Promotion of Quality of Life in Patients with Heart Failure: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sethares KA, Viveiros JD, Ayotte B. Uncertainty levels differ by physical heart failure symptom cluster. Appl Nurs Res 2021; 60:151435. [PMID: 34247783 DOI: 10.1016/j.apnr.2021.151435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF. AIMS Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster. METHODS Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group. RESULTS One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033). CONCLUSIONS Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.
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Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States.
| | - Jennifer D Viveiros
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States
| | - Brian Ayotte
- Department of Psychology, College of Arts and Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd., North Dartmouth, MA 02747, United States
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The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure: Multiple Mediating Effects of Perceived Stress and Coping Strategies. J Cardiovasc Nurs 2021; 37:257-265. [PMID: 33764941 DOI: 10.1097/jcn.0000000000000799] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous investigators have demonstrated that uncertainty in illness is associated with quality of life (QoL) in patients with chronic illness. However, little is known about the mechanism underlying the relationship in patients with heart failure. OBJECTIVE The aim of this study was to examine the multiple mediating effects of perceived stress and coping strategies on the relationship between uncertainty in illness and QoL in patients with heart failure. METHODS We conducted a cross-sectional study in 302 patients with heart failure recruited at a general hospital in China from October 2016 to September 2017. Uncertainty in illness, perceived stress, coping strategies, and QoL were assessed using self-reported questionnaires. The multiple mediation model was tested using the PROCESS macro for SPSS. RESULTS Of the 302 patients, 51.7% had poor physical QoL and 45.7% had poor mental QoL (physical component summary or mental component summary score of <50 points). Uncertainty in illness had a significantly negative indirect effect on mental QoL through perceived stress and acceptance-resignation (indirect effect, -0.02; 95% confidence interval, -0.04 to -0.01). Uncertainty in illness also had a significantly negative indirect effect on mental QoL via perceived stress only (indirect effect, -0.18; 95% confidence interval, -0.26 to -0.09). CONCLUSIONS Poor QoL is prevalent in patients with heart failure. Perceived stress and acceptance-resignation are important mediating factors between uncertainty in illness and mental QoL in patients with heart failure. Interventions aimed at reducing perceived stress and acceptance-resignation coping may be beneficial for improving mental QoL in patients with heart failure.
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Sense of Coherence and Quality of Life in Patients Treated with Antivitamin K Oral Anticoagulants: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041668. [PMID: 33572412 PMCID: PMC7916212 DOI: 10.3390/ijerph18041668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze the correlation between the participants’ self-reported quality of life and their sense of coherence in a sample (n = 85) of patients on treatment with oral antivitamin K anticoagulants. A cross-sectional design was used. The measurement instruments included a questionnaire on sociodemographic variables, the Spanish version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF), an oral-anticoagulant-treatment-specific quality-of-life questionnaire, and the sense-of-coherence (SOC) scale. We analyzed the correlations between the participants’ characteristics and the results from the quality-of-life and SOC scales. Age, level of education, employment status, living arrangement, and treatment length were the determinants of the quality of life in people treated with oral anticoagulants. We found a significant association between the four domains of the WHOQOL-BREF questionnaire and general treatment satisfaction (p < 0.01); no significant correlations were found between the SOC subscales and the oral-anticoagulant-treatment-specific quality of life in our sample. Women had a worse level of self-management than men. Nursing interventions should be tailored to the needs of the populations on treatment with oral anticoagulants in order to facilitate a higher level of self-management.
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Almgren M, Lundqvist P, Lennerling A, Forsberg A. Fatigue after heart transplantation - a possible barrier to self-efficacy. Scand J Caring Sci 2020; 35:1301-1308. [PMID: 33369757 PMCID: PMC9291191 DOI: 10.1111/scs.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022]
Abstract
Rationale Recovery after heart transplantation is challenging and many heart recipients struggle with various transplant‐related symptoms, side‐effects of immunosuppressive medications and mental challenges. Fatigue has been reported to be one of the most common and distressing symptoms after heart transplantation and might therefore constitute a barrier to self‐efficacy, which acts as a moderator of self‐management. Aim To explore the prevalence of fatigue and its relationship to self‐efficacy among heart recipients 1–5 years after transplantation. Research method An explorative cross‐sectional design, including 79 heart recipients due for follow‐up 1–5 years after transplantation. Three different self‐assessment instruments were employed; The Multidimensional Fatigue Inventory‐19, Self‐efficacy for managing chronic disease 6‐Item Scale and The Postoperative Recovery Profile. Ethical approval The study was approved by the Regional Ethics Board of Lund (Dnr. 2014/670‐14/10) with supplementary approval from the Swedish Ethical Review Authority (Dnr. 2019‐02769). Results The reported levels of fatigue for the whole group were moderate in all dimensions of the Multidimensional Fatigue Inventory‐19, with highest ratings in the General Fatigue sub‐scale. Those most fatigued were the groups younger than 50 years; pretransplant treatment with Mechanical Circulatory Support; not recovered or had not returned to work. Self‐efficacy was associated with the sub‐dimensions Mental Fatigue (ρ = −0·.649) and Reduced Motivation (ρ = −0·617), which explained 40·1% of the variance when controlled for age and gender. Study limitations The small sample size constitutes a limitation. Conclusions The moderate levels of fatigue reported indicate that it is not a widespread problem. However, for those suffering from severe fatigue it is a troublesome symptom that affects the recovery process and their ability to return to work. Efforts should be made to identify those troubled by fatigue to enable sufficient self‐management support.
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Affiliation(s)
- Matilda Almgren
- Department of Health Sciences at Lund University, Lund, Sweden
| | - Pia Lundqvist
- Department of Health Sciences at Lund University, Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Forsberg
- Department of Health Sciences at Lund University, Lund, Sweden.,Department of Thoracic surgery at, Skåne University Hospital, Lund, Sweden
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Esquivel Garzón N, Díaz Heredia LP. Validez y confiabilidad del cuestionario Orientación ante la Vida de Antonovsky (SC-29 ítems), versión en español. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2020. [DOI: 10.11144/javeriana.ie22.vcco] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introducción: El cuestionario Orientación ante la Vida mide el sentido de coherencia, un concepto relacionado con el uso de los recursos de afrontamiento que influyen positivamente en una mejor calidad de vida y bienestar de aquellos adultos con enfermedad cardiovascular. Objetivo: Determinar la validez y confiabilidad del cuestionario Orientación ante la Vida de Antonovsky, en adultos con hipertensión arterial. Método: Estudio de tipo metodológico en el que se realizó la adaptación cultural y se determinó la validez facial, de contenido, de constructo y confiabilidad. En la adaptación cultural se siguió un proceso de traducción, consenso y retrotraducción. La validez facial y de contenido se cumplió mediante el juicio de expertos, utilizando las pruebas estadísticas de coeficiente kappa de Fleiss e índice de Lawshe modificado. En la validez de constructo y prueba de confiabilidad participaron 220 personas. La confiabilidad se calculó mediante la prueba estadística de alfa de Cronbach. Resultados: En la validez facial, el instrumento reportó un índice kappa de Fleiss mayor a 0,41, interpretado como un acuerdo moderado. El índice de validez de contenido fue satisfactorio con 0,87, el análisis factorial exploratorio reportó tres factores con una varianza total explicada del 36,21 %. El alfa de Cronbach fue de 0,82 para la escala total. Conclusiones: La versión en español del instrumento Orientación ante la Vida presenta un adecuado índice de validez de contenido y confiabilidad para uso en el contexto local. Es necesario continuar su aplicación en otros grupos y momentos para continuar refinando su validez.
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19
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Garzón NE, Heredia LPD. SALUTOGENESIS AND CARDIOVASCULAR HEALTH IN ADULTS: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify and synthesize evidence that relates the salutogenic theory proposed by Antonovsky with cardiovascular disease in adults. Methods: we conducted a scoping review as proposed by Arksey and O’Malley. Bibliographic databases were searched for original research articles about salutogenesis and cardiovascular health. The search yielded 29 studies that met the previously defined inclusion criteria. The results were evaluated and summarized in the form of a narrative. Results: the findings of the studies pointed to a correlation among a strong sense of coherence, high quality of life and a greater likelihood of adopting healthy behaviors. Furthermore, the articles showed that social support improves perceived health and well-being of adults with cardiovascular disease. Conclusions: as a central concept of the salutogenic theory, a sense of coherence represents a topic of interest for nursing professionals. Through their interventions, nurses can strengthen and improve people’s skills in the quest for and maintenance of their own health.
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20
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Boisvert S, Francoeur J, Gallani MC. Cross-Cultural Adaptation and Reliability of the French–Canadian Version of the European Heart Failure Self-Care Behaviour Scale-9. J Nurs Meas 2019; 27:458-477. [DOI: 10.1891/1061-3749.27.3.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeThe purposes of this methodological study were to adapt the European Heart Failure Self-care Behaviour Scale-9 to the French–Canadian population and to evaluate its reliability.MethodsThe adaptation process consisted of translation, back-translation, evaluation by an expert committee, and pretesting. Reliability was evaluated with stability criteria (test–retest) and internal consistency.ResultsPretesting led to testing of two response formats: 5-point Likert scale and the frequency scale. Both demonstrated good levels of agreement between the test–retest, although the values were higher with the frequency format. The Cronbach's alpha coefficients ranged from 0.71 to 0.78 (Likert scale) and 0.70 to 0.83 (frequency scale).ConclusionThe French–Canadian version of the EHFScB-9, in both formats, demonstrated good evidence of reliability.
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21
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Wallström S, Ali L, Ekman I, Swedberg K, Fors A. Effects of a person-centred telephone support on fatigue in people with chronic heart failure: Subgroup analysis of a randomised controlled trial. Eur J Cardiovasc Nurs 2019; 19:393-400. [PMID: 31782661 DOI: 10.1177/1474515119891599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Fatigue is a prevalent symptom that is associated with various conditions. In patients with chronic heart failure (CHF), fatigue is one of the most commonly reported and distressing symptoms and it is associated with disease progression. Person-centred care (PCC) is a fruitful approach to increase the patient's ability to handle their illness. AIM The aim of this study was to evaluate the effects of PCC in the form of structured telephone support on self-reported fatigue in patients with CHF. METHOD This study reports a subgroup analysis of a secondary outcome measure from the Care4Ourselves randomised intervention. Patients (n=77) that were at least 50 years old who had been hospitalized due to worsening CHF received either usual care (n=38) or usual care and PCC in the form of structured telephone support (n=39). Participants in the intervention group created a health plan in partnership with a registered nurse. The plan was followed up and evaluated by telephone. Self-reported fatigue was assessed using the Multidimensional Fatigue Inventory 20 (MFI-20) at baseline and at 6 months. Linear regression was used to analyse the change in MFI-20 score between the groups. RESULTS The intervention group improved significantly from baseline to the 6-month follow-up compared with the control group regarding the 'reduced motivation' dimension of the MFI-20 (Δ -1.41 versus 0.38, p=0.046). CONCLUSION PCC in the form of structured telephone support shows promise in supporting patients with CHF in their rehabilitation, improve health-related quality of life and reduce adverse events. TRIAL REGISTRATION ISRCTN.com ISRCTN55562827.
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Affiliation(s)
- Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College, London, UK
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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22
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Fatigue in heart failure outpatients: levels, associated factors, and the impact on quality of life. ACTA ACUST UNITED AC 2019; 4:e103-e112. [PMID: 31211277 PMCID: PMC6555087 DOI: 10.5114/amsad.2019.85406] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022]
Abstract
Introduction Heart failure (HF) patients experience various psychosocial issues and physical symptoms such as fatigue, which adversely affect their quality of life (QoL). The aim of the study was to assess levels of fatigue in HF outpatients and the associated factors, as well as to explore the correlation between fatigue and QoL. Material and methods One hundred and thirty patients were enrolled in the study. Data collection was performed by the completion of “Minnesota Living With Heart Failure” questionnaire (MLHFQ) and the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek). Data also included self-reported patients’ characteristics. Results Of the 130 HF outpatients, 50% scored above 69 (median) in total fatigue and above 41 and 29 (median) in physical and mental fatigue, respectively. Furthermore, 50% scored above 66 (median) in total QoL and above 32.5 and 13 (median) in the physical and mental state, respectively. These values indicate moderate to high impact of HF on fatigue and on patients’ QoL. Total fatigue was statistically significantly associated with NYHA stage (p = 0.001), confidence to acknowledge health deteriorations (p = 0.004), decrease in appetite (p = 0.001), dyspnoea at night (p = 0.001), oedema in lower limbs (p = 0.023), relation with health professionals (p = 0.031), and whether patients had limited daily activities (p = 0.002), social contacts (p = 0.014), and if they had financial worries (p = 0.003). Finally, as the score of fatigue increased, so the QoL score also increased. Conclusions A broader understanding of this distressing symptom in HF may contribute to the development of suitable interventions with the ultimate goal of improving QoL.
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23
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Polikandrioti M, Tzirogiannis K, Zyga S, Gerogianni G, Stefanidou S, Tsami A, Panoutsopoulos G. Assessment of fatigue in patients with a permanent cardiac pacemaker: prevalence and associated factors. Arch Med Sci Atheroscler Dis 2018; 3:e166-e173. [PMID: 30775608 PMCID: PMC6374640 DOI: 10.5114/amsad.2018.81085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Fatigue is a debilitating symptom of subjective nature which lacks effective therapy. The aim of the study was to assess levels of fatigue and the associated factors among patients with permanent cardiac pacemaker (PCM). MATERIAL AND METHODS This was a cross-sectional study carried out in Athens. The study sample consisted of 250 patients with a PCM. RESULTS Data indicated moderate to low levels of fatigue. Furthermore, women (median: 24, p = 0.001), those with primary school education (median: 21, p = 0.001), those who were "a little-not at all" informed about PCM (median: 31, p = 0.001), those who had someone to help them in daily activities (median: 23, p = 0.001), those who did not believe that PCM solved their cardiac problem (median: 36, p = 0.001), and those who did not believe that their quality of life was improved (median: 35, p = 0.001) had high levels of fatigue. Moreover, high levels of fatigue were felt by those who characterized themselves as anxious and those who reported to be very anxious about their heart rate and the proper function of PCM (medians: 21.5, 25 and 25 respectively). Additionally, more fatigue was felt by participants who did not smoke after implantation and did not exercise at all (medians: 20 and 24 respectively). Finally, older patients felt more fatigue (rho = 0.248) while the later the implantation device was inserted the more fatigue the patients felt (rho = 0.274). CONCLUSIONS The present results will help clinicians to acquire an in-depth knowledge of factors associated with fatigue after implantation.
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Affiliation(s)
| | - Konstantinos Tzirogiannis
- Laboratory of Physiology and Pharmacology, Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
| | | | | | - Athanasia Tsami
- University General Hospital of Athens “Laiko”, Athens, Greece
| | - Georgios Panoutsopoulos
- Laboratory of Physiology and Pharmacology, Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
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24
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Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One 2018; 13:e0205953. [PMID: 30427855 PMCID: PMC6235604 DOI: 10.1371/journal.pone.0205953] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/04/2018] [Indexed: 01/26/2023] Open
Abstract
Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel's theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel's theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.
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Affiliation(s)
- Ting-Yu Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- National Defense Medical Center, School of Medicine, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
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Changes in Heart Failure Symptoms are Associated With Changes in Health-related Quality of Life Over 12 Months in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:460-466. [DOI: 10.1097/jcn.0000000000000493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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26
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Moons P, Norekval TM. Why some people do well and others don’t. The role of sense of coherence in disease adaptation. Eur J Cardiovasc Nurs 2018; 17:672-674. [DOI: 10.1177/1474515118787416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Tone M Norekval
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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27
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Goldstein CM, Gathright EC, Gunstad J, A Dolansky M, Redle JD, Josephson R, Moore SM, Hughes JW. Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. J Behav Med 2017; 40:602-611. [PMID: 28190133 PMCID: PMC5873320 DOI: 10.1007/s10865-017-9829-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Abstract
Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, 02903, USA.
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Mary A Dolansky
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joseph D Redle
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, 44106, USA
| | - Shirley M Moore
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
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Norman J, Fu M, Ekman I, Björck L, Falk K. Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study. Eur J Cardiovasc Nurs 2017. [PMID: 28639841 PMCID: PMC5751854 DOI: 10.1177/1474515117715843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients (n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care (n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness (p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) (p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.
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Affiliation(s)
- Jonna Norman
- 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,2 The Gothenburg University Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden
| | - Michael Fu
- 3 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,2 The Gothenburg University Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden
| | - Lena Björck
- 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,3 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,2 The Gothenburg University Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden
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Ekman I, Wolf A, Vaughan Dickson V, Bosworth HB, Granger BB. Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study. Eur J Cardiovasc Nurs 2017; 16:646-654. [DOI: 10.1177/1474515117707669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | | | - Hayden B Bosworth
- Center for Health Services Research in Primary Care and Research, VA Medical Center, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Medicine, Duke University, USA
| | - Bradi B Granger
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health Systems, Durham, NC, USA
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Williams BA. The clinical epidemiology of fatigue in newly diagnosed heart failure. BMC Cardiovasc Disord 2017; 17:122. [PMID: 28490326 PMCID: PMC5426047 DOI: 10.1186/s12872-017-0555-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF). This study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients from the community. METHODS This retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Incident HF, fatigue, and other study variables were derived from coded data within EMRs. A collection of 87 candidate predictors were evaluated to ascertain the strongest independent predictors of fatigue using logistic regression. Patients were followed for all-cause mortality for an average of 4.8 years. The associations between fatigue and 6-month, 12-month, and overall mortality were evaluated via Cox proportional hazards regression models. RESULTS Clinically documented fatigue was found in 4827 (39%) newly diagnosed HF patients. Depression demonstrated the strongest association with fatigue. Fatigue was often part of a symptom cluster, as other HF symptoms including dyspnea, chest pain, edema, syncope, and palpitations were significant predictors of fatigue. Volume depletion, lower body mass index, and abnormal weight loss were also strong predictors of fatigue. Fatigue was not significantly associated with either 6-month (HR = 1.12, p = 0.16) or overall mortality (HR = 1.00, p = 0.89) in adjusted models. CONCLUSIONS Fatigue is a commonly documented symptom among newly diagnosed HF patients, and its origins may lie in both psychologic and physiologic factors. Though fatigue did provide a prognostic signal in the short-term, this was largely explained by physiologic confounders. Proper therapeutic remediation of fatigue in HF relies on identifying underlying factors.
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Affiliation(s)
- Brent A Williams
- Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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Norberg EB, Löfgren B, Boman K, Wennberg P, Brännström M. A client-centred programme focusing energy conservation for people with heart failure. Scand J Occup Ther 2017; 24:455-467. [PMID: 28052703 DOI: 10.1080/11038128.2016.1272631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF). METHODS The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed. RESULTS The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice. CONCLUSIONS This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.
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Affiliation(s)
- Eva-Britt Norberg
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Britta Löfgren
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Kurt Boman
- b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden
| | - Patrik Wennberg
- c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden
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Personal growth, symptoms, and uncertainty in community-residing adults with heart failure. Heart Lung 2017; 46:54-60. [DOI: 10.1016/j.hrtlng.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022]
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Moreira RSL, Bassolli L, Coutinho E, Ferrer P, Bragança ÉO, Carvalho ACC, de Paola AA, Luna Filho B. Reproducibility and Reliability of the Quality of Life Questionnaire in Patients With Atrial Fibrillation. Arq Bras Cardiol 2016; 106:171-81. [PMID: 27027365 PMCID: PMC4811271 DOI: 10.5935/abc.20160026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Studies have shown the impact of atrial fibrillation (AF) on the patients' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added. OBJECTIVE To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being. METHODS We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's alpha test. RESULTS The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach's alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2. CONCLUSION The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.
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Affiliation(s)
| | - Lucas Bassolli
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Enia Coutinho
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Paloma Ferrer
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Aho AC, Hultsjö S, Hjelm K. Health perceptions of young adults living with recessive limb-girdle muscular dystrophy. J Adv Nurs 2016; 72:1915-25. [DOI: 10.1111/jan.12962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Anna Carin Aho
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - Sally Hultsjö
- Psychiatric Clinic; County Hospital; Ryhov; Jönköping Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies; University of Linköping; Campus Norrköping Sweden
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Schjoedt I, Sommer I, Bjerrum MB. Experiences and management of fatigue in everyday life among adult patients living with heart failure. ACTA ACUST UNITED AC 2016; 14:68-115. [DOI: 10.11124/jbisrir-2016-2441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Matura LA, Shou H, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Dubow D, Palevsky HI, Sommers MS, Kawut SM. Physical Activity and Symptoms in Pulmonary Arterial Hypertension. Chest 2016; 150:46-56. [PMID: 26892602 DOI: 10.1016/j.chest.2016.02.633] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in patients with pulmonary arterial hypertension (PAH); however, the impact of fatigue on daily physical activity in PAH is unknown. Accelerometry is a validated measure for assessing physical activity. We hypothesized that patients with PAH reporting higher levels of fatigue would have lower daily physical activity measured by accelerometry. METHODS We performed a prospective cohort study of 15 women with PAH. On day 1, subjects completed the Multidimensional Fatigue Inventory (MFI), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR), and a 6-min walk test. Subjects wore the accelerometer on their dominant hip and completed an activity diary for 7 days. On day 15, subjects repeated the MFI and the US CAMPHOR, and then wore the accelerometer and completed an activity diary for an additional 7 days. All multivariate analyses were adjusted for age, BMI, and PAH type. RESULTS The mean age was 50.5 years, and 53% had idiopathic or heritable PAH. During the 2 weeks, subjects were mostly sedentary (85% of the time), although 10% of their time was spent performing low-level activity. Lower average daily counts were associated with worse self-reported energy levels, whereas less day-to-day physical activity variability was associated with more self-reported mental fatigue, physical fatigue, and total activity. Higher percentage of activity bouts was also associated with worse energy. CONCLUSIONS Women with PAH may spend most of their time being sedentary, and lower self-reported energy levels are associated with less daily activity. Interventions to improve symptoms such as fatigue may also increase physical activity levels in PAH.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
| | - Haochang Shou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jason S Fritz
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - K Akaya Smith
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Anjali Vaidya
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Diane Pinder
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Christine Archer-Chicko
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Danielle Dubow
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Harold I Palevsky
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Nijrolder I, Leone SS, van der Horst HE. Explaining fatigue: an examination of patient causal attributions and their (in)congruence with family doctors' initial causal attributions. Eur J Gen Pract 2015; 21:164-9. [PMID: 26134092 DOI: 10.3109/13814788.2015.1055556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue. OBJECTIVE To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients' attributions, and fatigue characteristics and other illness perceptions. METHODS Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient's visit. Fatigue severity was measured using the checklist individual strength. RESULTS Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9). CONCLUSION Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.
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Affiliation(s)
- Iris Nijrolder
- a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands
| | - Stephanie S Leone
- b Department of Public Mental Health , Netherlands Institute of Mental Health and Addiction , Utrecht , the Netherlands
| | - Henriette E van der Horst
- a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands
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Granger BB, Ekman I, Hernandez AF, Sawyer T, Bowers MT, DeWald TA, Zhao Y, Levy J, Bosworth HB. Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients. Am Heart J 2015; 169:539-48. [PMID: 25819861 PMCID: PMC5058442 DOI: 10.1016/j.ahj.2015.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF. METHODS Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point. RESULTS Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P = .0007). CONCLUSIONS A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.
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Affiliation(s)
- Bradi B Granger
- Duke University School of Nursing, Durham, NC; Duke University Health Systems, Durham, NC.
| | - Inger Ekman
- Institute of Health and Care Sciences, Centre for Person-Centred Care, University of Gothenburg, Göteborg, Sweden
| | | | | | - Margaret T Bowers
- Duke University School of Nursing, Durham, NC; Duke University Health Systems, Durham, NC
| | | | | | - Janet Levy
- Duke University School of Nursing, Durham, NC
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC
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Factors influencing self-care behaviors of African Americans with heart failure: A photovoice project. Heart Lung 2015; 44:33-8. [DOI: 10.1016/j.hrtlng.2014.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022]
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Lockhart E, Foreman J, Mase R, Heisler M. Heart failure patients' experiences of a self-management peer support program: a qualitative study. Heart Lung 2014; 43:292-8. [PMID: 24863072 DOI: 10.1016/j.hrtlng.2014.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Explore the experiences of patients with heart failure in a self-management support program to inform the development of future interventions that support and motivate patients to engage in self-management. BACKGROUND Peer-support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for heart failure patients. Yet, among patients recently hospitalized for heart failure, over half had no or minimal engagement with a reciprocal peer support program. METHODS Qualitative semi-structured interviews with a purposive sample of 28 patients (mean age 72; 71% Female; 21% African-American; 75% Caucasian) with different levels and types of engagement in a heart failure self-management support program. RESULTS Key themes that emerged included the importance of heart failure specific-social support, sharing information, comparing self to others, depression, and functional status. CONCLUSIONS Useful services for heart failure patients provide comfort, restore confidence, and offer practical solutions.
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Affiliation(s)
- Elizabeth Lockhart
- University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
| | - Jane Foreman
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, USA
| | - Rebecca Mase
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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MacIver J, Rao V, Ross HJ. Quality of life for patients supported on a left ventricular assist device. Expert Rev Med Devices 2014; 8:325-37. [DOI: 10.1586/erd.11.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ameringer S, Elswick RK, Smith W. Fatigue in adolescents and young adults with sickle cell disease: biological and behavioral correlates and health-related quality of life. J Pediatr Oncol Nurs 2014; 31:6-17. [PMID: 24378816 PMCID: PMC3982311 DOI: 10.1177/1043454213514632] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This descriptive, correlational study examined fatigue and potential biological and behavioral correlates in adolescents and young adults with sickle cell disease. Sixty adolescents and young adults with sickle cell disease completed the Brief Fatigue Inventory, Multidimensional Fatigue Symptom Inventory-Short Form, Patient Reported Outcomes Measurement Information System (PROMIS) fatigue short form and measures of pain, sleep quality, anxiety, depressive mood, stress, disease severity, and quality of life. Blood samples were obtained for hemoglobin and cytokines. Fatigue scores were mostly moderate in severity. Fatigue interfered to a moderate degree with daily activities and correlated significantly with pain, sleep quality, state and trait anxiety, depressive mood, stress, and quality of life. Fatigue was correlated with hemoglobin on the PROMIS measure. Fatigue was not correlated with cytokines or age, nor differed by disease severity. Fatigue was common in these adolescents and young adults, interfered with daily activities such as school, work and exercise, and significantly correlated with several potentially modifiable factors. As life expectancy increases in sickle cell disease, research is needed to test interventions to reduce fatigue.
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Affiliation(s)
| | - R. K. Elswick
- School of Nursing 1100 East Leigh Street, Richmond, VA, 23219 Virginia Commonwealth University
| | - Wally Smith
- Department of Internal Medicine PO Box 980306, Richmond, VA 23298 Virginia Commonwealth University
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Zambroski CH, Bekelman DB. Palliative symptom management in patients with heart failure. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992608x346206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Silarova B, Nagyova I, Rosenberger J, Studencan M, Ondusova D, Reijneveld SA, van Dijk JP. Sense of coherence as a predictor of health-related behaviours among patients with coronary heart disease. Eur J Cardiovasc Nurs 2013; 13:345-56. [PMID: 23828020 DOI: 10.1177/1474515113497136] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/19/2013] [Indexed: 11/15/2022]
Abstract
AIMS A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12-28 months after they had undergone different cardiac treatments. METHODS A total of 179 coronary heart disease patients (mean age 58.32±6.54 years, 19% female) were interviewed before coronary angiography and 12-28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses. RESULTS SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38-91) was 1.11 (1.03-1.19) and 1.09 (1.01-1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01-1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: -0.15, p<0.05). CONCLUSION Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.
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Affiliation(s)
- Barbora Silarova
- Graduate School Kosice Institute for Society and Health, Safarik University, Slovak Republic
| | - Iveta Nagyova
- Graduate School Kosice Institute for Society and Health, Safarik University, Slovak Republic Institute of Public Health - Department of Social Medicine, Safarik University, Slovak Republic
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Safarik University, Slovak Republic
| | - Martin Studencan
- Cardiology Clinic, East Slovakian Institute for Cardiac and Vascular Diseases, Slovak Republic
| | - Daniela Ondusova
- Cardiology Clinic, East Slovakian Institute for Cardiac and Vascular Diseases, Slovak Republic
| | - Sijmen A Reijneveld
- Department of Community & Occupational Health, University of Groningen, The Netherlands
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Safarik University, Slovak Republic Department of Community & Occupational Health, University of Groningen, The Netherlands
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Falk H, Ekman I, Anderson R, Fu M, Granger B. Older Patients’ Experiences of Heart Failure-An Integrative Literature Review. J Nurs Scholarsh 2013; 45:247-55. [DOI: 10.1111/jnu.12025] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Hanna Falk
- Post-doctoral Associate; Neuropsychiatric epidemiology; Institute of neuroscience and physiology; Department of Psychiatry and Neurochemistry; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Inger Ekman
- Professor, Institute of Health and care Sciences; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Ruth Anderson
- Professor, Duke University School of Nursing; Durham NC USA
| | - Michael Fu
- Professor, Institute of Medicine; Department of Molecular and Clinical Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Bradi Granger
- Associate Professor, Duke University School of Nursing; Durham NC USA
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Schjoedt I, Sommer I, Bjerrum M. Adult patients living with heart failure: Experiences and management of fatigue in everyday life - a systematic review protocol of qualitative evidence. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/01938924-201311040-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 2013; 80:409-16. [PMID: 23339207 DOI: 10.1212/wnl.0b013e31827f07be] [Citation(s) in RCA: 625] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado Denver, Aurora, USA.
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Hickey KT, Reiffel J, Sciacca RR, Whang W, Biviano A, Baumeister M, Castillo C, Talathothi J, Garan H. Correlating perceived arrhythmia symptoms and quality of life in an older population with heart failure: a prospective, single centre, urban clinic study. J Clin Nurs 2013; 22:434-44. [PMID: 23301579 PMCID: PMC3748605 DOI: 10.1111/j.1365-2702.2012.04307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
Abstract
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.
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Dudas K, Olsson LE, Wolf A, Swedberg K, Taft C, Schaufelberger M, Ekman I. Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. Eur J Cardiovasc Nurs 2013; 12:521-8. [PMID: 23303766 DOI: 10.1177/1474515112472270] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown. AIM To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF. METHODS Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care). RESULTS Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041). CONCLUSION Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.
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Affiliation(s)
- Kerstin Dudas
- 1Institute of Health and Care Science, Gothenburg, Sweden
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Shaffer JA, Davidson KW, Schwartz JE, Shimbo D, Newman JD, Gurland BJ, Maurer MS. Prevalence and characteristics of anergia (lack of energy) in patients with acute coronary syndrome. Am J Cardiol 2012; 110:1213-8. [PMID: 22835409 PMCID: PMC3470778 DOI: 10.1016/j.amjcard.2012.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 12/22/2022]
Abstract
Anergia, a commonly occurring syndrome in older adults and patients with cardiovascular diseases, is associated with functional and clinical limitations. To date, the prevalence and clinical-demographic characteristics of anergia in patients with acute coronary syndrome (ACS) have not been elucidated. We examined the prevalence and clinical-demographic characteristics of anergia in a multiethnic sample of patients with ACS. Hospitalized patients with ACS (n = 472), enrolled in the Prescription Usage, Lifestyle, and Stress Evaluation (PULSE) prospective cohort study, completed assessments of demographic, behavioral, and clinical characteristics within 7 days of hospitalization for an ACS event. Current depressive disorder was ascertained using a structured psychiatric interview 3 to 7 days after discharge. Anergia was assessed at baseline and defined using patients' binary responses (yes/no) to 7 items related to energy level. At least 1 complaint of anergia was reported by 79.9% of patients (n = 377) and 32% of patients (n = 153) met criteria for anergia. In a multivariable logistic regression model, anergia was independently associated with being a woman, being white (compared to black), having bodily pain, participating in exercise, having current depressive disorder, and having higher values on the Charlson Co-morbidity Index. In conclusion, anergia is a highly prevalent syndrome in patients with ACS. It is distinct from depression and is associated with modifiable clinical factors such as participation in exercise and bodily pain that may be appropriate targets for intervention.
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Affiliation(s)
- Jonathan A. Shaffer
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Karina W. Davidson
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
- Department of Psychiatry, Stony Brook University, New York, NY
| | - Daichi Shimbo
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jonathan D. Newman
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Barry J. Gurland
- Stroud Center for the Studies of Quality of Life, Columbia University, New York, NY
| | - Mathew S. Maurer
- Department of Medicine, Columbia University Medical Center, New York, NY
- Stroud Center for the Studies of Quality of Life, Columbia University, New York, NY
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