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Polsook R, Aungsuroch Y. Factors influencing readmission among Thais with myocardial infarction. BELITUNG NURSING JOURNAL 2021; 7:15-23. [PMID: 37469799 PMCID: PMC10353658 DOI: 10.33546/bnj.1234] [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: 10/27/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 07/21/2023] Open
Abstract
Background Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (χ2 = 1.39, df = 2, p < 0.50, χ2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusion These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.
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Affiliation(s)
- Rapin Polsook
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Lin XX, Gao BB, Huang JY. Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys. J Affect Disord 2020; 274:774-783. [PMID: 32664014 DOI: 10.1016/j.jad.2020.05.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/05/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China. METHODS The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender. RESULTS Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%). CONCLUSIONS This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.
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Affiliation(s)
- Xiao-Xiao Lin
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Bei-Bei Gao
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Jin-Yu Huang
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine.
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Lee AA, Aikens JE, Janevic MR, Rosland AM, Piette JD. Functional support and burden among out-of-home supporters of heart failure patients with and without depression. Health Psychol 2020; 39:29-36. [PMID: 31535879 PMCID: PMC6901712 DOI: 10.1037/hea0000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Over 20% of patients with heart failure (HF) experience clinical depression, which is associated with higher rates of mortality, morbidity, and hospitalization. Support from family members or friends (whom we refer to as care partners [CPs]) can lower the risk of these outcomes. We examined whether HF patients with depression received assistance from CPs living outside of their homes. Further, we examined whether patient depression was associated with support-related strain among out-of-home CPs. METHOD We analyzed baseline survey data from 348 HF patients with reduced ejection fraction and their CPs. Patients with scores on the Center for Epidemiological Studies Depression Scale-10 (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993) of ≥10 were classified as having clinically significant depressive symptoms (i.e., depression). Outcomes included CP-reported hr per week helping with health care and talking with patients via telephone and scores on the Modified Caregiver Strain Index. Negative binomial regression models examined differences in the amount of in-person and telephone support for patients with and without depression, controlling for patients' comorbidities, living alone, CP geographic distance, and CP emotional closeness to the patient. RESULTS CPs provided more in-person support to HF patients with depression (M = 3.64 hr) compared with those without depression (M = 2.60 hr per week, incident rate ratio [IRR] = 1.40, p = .019). CPs provided more telephone support to patients with depression (M = 3.02 hr) compared with those without depression (M = 2.09 hr per week, IRR = 1.42, p < .001). Patient depression had no effect on caregiver burden (IRR = 1.00, p = .843). CONCLUSION Patients with clinically significant depressive symptoms receive more in-person assistance and telephonic support from CPs. Despite that additional contact, caregiver burden was not greater among the supporters of depressed patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Aaron A Lee
- Veterans Affairs Center for Clinical Management Research
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School
| | - Mary R Janevic
- Department of Health Behavior & Health Education, University of Michigan School of Public Health
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh Medical School
| | - John D Piette
- Veterans Affairs Center for Clinical Management Research
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Yin H, Liu Y, Ma H, Liu G, Guo L, Geng Q. Associations of mood symptoms with NYHA functional classes in angina pectoris patients: a cross-sectional study. BMC Psychiatry 2019; 19:85. [PMID: 30836983 PMCID: PMC6402172 DOI: 10.1186/s12888-019-2061-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/18/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored. METHODS In this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes. RESULTS Discrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient's condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed. CONCLUSIONS Mood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.
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Affiliation(s)
- Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Yuting Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China
| | - Guihao Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China. .,School of Medicine, South China University of Technology, Guangzhou, China.
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Hopelessness and cognitive impairment are risk markers for mortality in systolic heart failure patients. J Psychosom Res 2018; 109:12-18. [PMID: 29773147 DOI: 10.1016/j.jpsychores.2018.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression exacerbates the burden of heart failure and independently predicts mortality. The aim of this study was to investigate which specific symptoms of depression predict all-cause mortality in systolic heart failure patients. METHODS Consecutive outpatients with heart failure and impaired left ventricular ejection fraction (LVEF), attending an Australian metropolitan heart function clinic between 2001 and 2011, were enrolled. The Cardiac Depression Scale (CDS) was completed as a component of usual care. Baseline clinical characteristics were drawn from hospital databases. The primary end-point was all-cause mortality, obtained from the Australian National Death Index. RESULTS A total of 324 patients (68.5% male) were included (mean age at enrolment = 66.8 ± 14.36 years), with a median follow-up time of 6.7 years (95% CI 5.97-7.39) and a mortality rate of 50% by the census date. Mean LVEF = 31.0 ± 11.31%, with 25% having NYHA functional class of III or IV. Factor analysis of the CDS extracted six symptom dimensions: Hopelessness, Cognitive Impairment, Anhedonia/Mood, Irritability, Worry, and Sleep Disturbance. Cox regression analyses identified Hopelessness (HR 1.024, 95% CI 1.004-1.045, p = .018) and Cognitive Impairment (HR 1.048, 95% CI 1.005-1.093, p = .028) as independent risk markers of all-cause mortality, following adjustment of known prognostic clinical factors. CONCLUSION Hopelessness and cognitive impairment are stronger risk markers for all-cause mortality than other symptoms of depression in systolic heart failure. These data will allow more specific risk assessment and potentially new targets for more effective treatment and management of depression in this population.
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Direction of the Relationship Between Acceptance of Illness and Health-Related Quality of Life in Chronic Heart Failure Patients. J Cardiovasc Nurs 2018; 32:348-356. [PMID: 27685859 DOI: 10.1097/jcn.0000000000000365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study provides an in-depth insight into the relationships between illness acceptance and health-related quality of life (HRQoL) of chronic heart failure (CHF) patients. Although HRQoL is a well-established endpoint in CHF, little is known on illness acceptance in this group. AIMS The aim of this study is to critically reconsider the direction of a relationship between HRQoL and illness acceptance in CHF patients. METHODS The study included 204 patients (160 men and 44 women; mean age, 63 ± 11 years) with at least 6-month clinical evidence of CHF corresponding to New York heart Association (NYHA) classes I to IV. All the patients were examined with the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and Acceptance of Illness Scale (AIS). RESULTS Univariate analysis showed that the level of illness acceptance correlated inversely with patient age, and the level of HRQoL decreased with the severity of CHF (NYHA class). A relationship between illness acceptance and HRQoL was analyzed by structural equation modeling. Model 1 was based on the assumption that HRQoL is modulated by illness acceptance, and model 2 tested the opposite relationship. Both models included patient age and NYHA class as extrinsic determinants of AIS and MLHFQ scores, respectively. Model 2 proved to be well fitted (χ [df = 2] = 3.22, P = .20, root-mean-square error of approximation = 0.055). Scores on the AIS correlated inversely with age (bage->AIS = -0.15, SE = 0.05, P = .002) and HRQoL (bQoL->AIS = -0.15, SE = 0.02, P < .001), and an increase in NYHA class was reflected by an increase in HRQoL scores (bNYHA->QoL = 5.75, SE = 1.97, P = .004). CONCLUSION Patients with CHF may not accept their disease due to deteriorated HRQoL. As a result, they may be uninvolved in the therapeutic process, which leads to exacerbation of CHF, further deterioration of HRQoL, and inability to accept the illness.
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Husaini BA, Taira D, Norris K, Adhish SV, Moonis M, Levine R. Depression Effects on Hospital Cost of Heart Failure Patients in California: An Analysis by Ethnicity and Gender. Indian J Community Med 2018. [PMID: 29531440 PMCID: PMC5842475 DOI: 10.4103/ijcm.ijcm_151_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost. Objectives Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender. Methods Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF+D) versus HF without depression (HFND). Results HF cases (n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher (P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher (P < 0.001) compared to other groups. The cost for HF+D was 22% higher compared to HFND, across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization. Conclusion Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF+D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.
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Affiliation(s)
- Baqar A Husaini
- Center for Prevention Research, Tennessee State University, Nashville, TN, USA
| | - Deborah Taira
- Department of Pharmacy Practice, Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, Hawaii, USA
| | - Keith Norris
- Department of Health Sciences, University of California, Los Angeles, CA, USA
| | - S Vivek Adhish
- Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India
| | - Majaz Moonis
- Department of Neurology, University of Massachusetts, Worcester, MA, USA
| | - Robert Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Abstract
PURPOSE/AIM The aim of this study was to investigate whether health literacy, self-efficacy, and medication adherence can explain or predict the variance in health outcomes (measured as perceived physical or mental health status [HS]) in persons with chronic heart failure (HF). DESIGN A nonexperimental cross-sectional survey study used data gathered from 175 patients with chronic HF from urban cardiology practices in the northeast United States. METHODS The Paasche-Orlow and Wolf Causal Pathways conceptual model and Bandura's self-efficacy theory were used to select and test variables in the study. A demographic questionnaire, the Short Test of Functional Health Literacy, the Self-Efficacy for Appropriate Medication Use Scale, the Morisky Medication Adherence Scale, and the Short Form-12 version 2 assessing perceived physical and mental HS were completed. Multiple hierarchical regression analyses were used to analyze relationships among the variables. RESULTS Significant associations between health literacy and self-efficacy and between health literacy and perceived mental HS were found (P < .05). High self-efficacy was the strongest predictor of physical HS (P < .01). The strongest predictor of mental HS was medication adherence (P < .01). CONCLUSIONS Support of self-efficacy and medication adherence may improve HS. Including health literacy strategies in clinical practice may support improvements in HS in people with chronic HF.
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Affiliation(s)
- June M Como
- Author Affiliation: Assistant Professor of Nursing, Graduate and Clinical Doctorate in Nursing Practice Programs Coordinator, and Fellow of the New York Academy of Medicine, College of Staten Island, City University of New York
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Faller H, Strahl A, Richard M, Niehues C, Meng K. Symptoms of depression and anxiety as predictors of physical functioning in breast cancer patients. A prospective study using path analysis. Acta Oncol 2017; 56:1677-1681. [PMID: 28595474 DOI: 10.1080/0284186x.2017.1333630] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although symptoms of depression and anxiety are linked to health-related quality of life (HRQoL), the nature of this relationship remained unclear. We therefore aimed to examine, in a prospective study, both possible directions of impact in this relationship. To avoid conceptual and measurement overlap between depressive and anxiety symptoms, on the one hand, and HRQoL, on the other hand, we focused on the physical functioning component of HRQoL. MATERIAL AND METHODS We conducted a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51 years). Both at baseline and after 12 months, we measured symptoms of depression and anxiety with the four-item Patient Heath Questionnaire (PHQ-4) and physical functioning with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Using path analysis, we estimated (1) the predictive value of symptoms of depression/anxiety for subsequent physical functioning and (2) the predictive value of physical functioning for subsequent symptoms of depression/anxiety, in the same model. RESULTS Baseline symptoms of depression/anxiety predicted 1-year levels of physical functioning (depression: standardized β = -.09, p = .024; anxiety: standardized β = -.10, p = .009), while the reciprocal paths linking baseline physical functioning to subsequent depressive and anxiety symptoms were not significant, adjusting for the baseline scores of all outcome variables. CONCLUSIONS Depressive and anxiety symptoms were predictors of the physical functioning component of HRQoL. Thus, if this relation is causal, treating breast cancer patients' depressive and anxiety symptoms may have a favorable impact on their self-reported physical functioning.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - André Strahl
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Matthias Richard
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christiane Niehues
- Reha-Zentrum Ückeritz, Klinik Ostseeblick, Ückeritz, Germany
- Deutsche Rentenversicherung Bund, Berlin, Germany
| | - Karin Meng
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Moser DK, Arslanian-Engoren C, Biddle MJ, Chung ML, Dekker RL, Hammash MH, Mudd-Martin G, Alhurani AS, Lennie TA. Psychological Aspects of Heart Failure. Curr Cardiol Rep 2016; 18:119. [DOI: 10.1007/s11886-016-0799-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Factors affecting nurses' intent to assess for depression in heart failure patients. Dimens Crit Care Nurs 2016; 33:320-6. [PMID: 25280199 DOI: 10.1097/dcc.0000000000000073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The association between depression and cardiovascular disease has been well established and has been shown to decrease patients' quality of life and increase the risk of mortality, frequency and duration of hospitalization, and health care costs. The inpatient setting provides a potentially valuable opportunity to assess and treat depression among patients with acute cardiac illness, allowing for daily monitoring of treatment side effects. Although systematic depression screening appears to be feasible, efficient, and well accepted on inpatient cardiac units, the current lack of consistent inpatient assessment for depression in heart failure patients suggests the presence of barriers influencing the effective diagnosis and treatment of depression among inpatients with heart failure. The theory of planned behavior describes the cognitive mechanism by which behavioral intent is formed, giving some insight into how nurses' attitudes and beliefs affect their performance of routine depression screening. In addition, application of this cognitive theory suggests that nurses may be influenced to adopt more positive attitudes and beliefs about depression through educational intervention, leading to greater likelihood of routine assessment for depression, ultimately leading to more timely diagnosis and treatment and improved patient outcomes.
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Self-efficacy and depression predicting the health-related quality of life of outpatients with chronic heart failure in Singapore. Appl Nurs Res 2016; 32:148-155. [PMID: 27969020 DOI: 10.1016/j.apnr.2016.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) remains as a debilitating disease that has high mortality among adults worldwide. CHF negatively impacts an individual's health-related quality of life (HRQoL), but only few studies have investigated such an impact in the Asian population. AIMS This study aims to investigate the HRQoL of outpatients with CHF and identify its predictors among this group of patients in Singapore. METHODS This was a cross-sectional, descriptive correlational study. A convenience sampling of 121 outpatients with CHF was recruited from a public hospital over 5 months. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), Short Form-Cardiac Depression Scale, Cardiac Self-Efficacy Scale, and Medical Outcomes Study Social Support Survey were used to measure the study variables. RESULTS There were significant differences in the HRQoL as assessed using the MLHFQ between gender, educational level, and primary caregiver status (p<0.05). Self-efficacy (β=0.637, p<0.001) and depression (β=-0.220, p<0.001) were found to be the predictors of the HRQoL in outpatients with CHF, accounting for 67.9% of variance. CONCLUSION The results of the study indicated that lower levels of self-efficacy and depression predicted poor HRQoL. Nursing care should focus on detecting depressive symptoms in patients with CHF. A program facilitating better self-care is important in CHF management.
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Celik E, Cay S, Sensoy B, Murat S, Oksuz F, Cankurt T, Ali Mendi M. Heart Failure Functional Class Associated with Depression Severity But Not Anxiety Severity. ACTA CARDIOLOGICA SINICA 2016; 32:55-61. [PMID: 27122931 DOI: 10.6515/acs20150509a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depression and anxiety are common in heart failure (HF) patients and associated with adverse clinical outcomes. However, there are little or no published data that focuses on the relationship between these commonly observed situations and HF classes. The aim of this study was to evaluate the relationship between these psychiatric co-morbidities and HF symptom classes. As a second objective of our study, the associations between patient characteristics and depression severity were also assessed. METHODS Our study enrolled a total of 420 HF study participants. The severity of depressive and anxiety symptoms was evaluated by Beck's depression and anxiety. The measured total scores were used to grade depression severity and anxiety as minimal/mild and moderate/severe. RESULTS According to NYHA Functional Classification, 228 patients (51%) had class I symptoms, 101 (23%) had class II symptoms, 31 (7%) had class III symptoms, and class IV symptoms were noted in the remaining 60 patients (19%). The mean Beck's depression and anxiety scores were 12.4 ± 11.1 and 13.4 ± 9.0, respectively. While no association between HF symptom classes and anxiety severity was observed, a significant positive relation between HF symptom class and depression score was found. CONCLUSIONS The results of our study suggested that HF symptom class was positively associated with severity of depression. On the other hand, there was no association between HF symptom class and anxiety score in a wide population of heart failure patients. KEY WORDS Anxiety; Depression; Heart failure.
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Affiliation(s)
- Etem Celik
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Serkan Cay
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Baris Sensoy
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Sani Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Fatih Oksuz
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Tayyar Cankurt
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Mehmet Ali Mendi
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
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14
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Moryś JM, Bellwon J, Höfer S, Rynkiewicz A, Gruchała M. Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure. Arch Med Sci 2016; 12:326-33. [PMID: 27186176 PMCID: PMC4848348 DOI: 10.5114/aoms.2014.47881] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/14/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Quality of life measures are useful when interventions or treatments are indicated for several reasons such as improvement of physical functioning, pain relief, to estimate the effectiveness of therapies or to predict mortality. The aim of the current study was to describe quality of life in patients with stable coronary artery disease, myocardial infarction and heart failure and to evaluate the relationship between depression and health-related quality of life. MATERIAL AND METHODS Patients after STEMI, with stable coronary artery disease, and heart failure (n = 332) completed the MacNew Heart Disease Health-related Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. RESULTS Patients with myocardial infarction had significantly higher scores than patients with stable coronary artery disease or heart failure on the MacNew global scale (p < 0.001) and the physical (p < 0.001), emotional (p < 0.001) and social (p < 0.001) subscales. The anxiety scores were significantly higher in the group of patients with stable coronary artery disease than in patients with myocardial infarction (p < 0.05). The depression scores were significantly higher in patients with heart failure (p < 0.01). CONCLUSIONS In patients with stable CAD, anxiety correlated mainly with symptoms, i.e. angina, than with the history of MI. Patients with symptoms of angina react to the illness with anxiety more than depression, whereas patients with heart failure with dyspnea react to the illness with depressive symptoms more than anxiety. In patients after MI and with stable CAD, cognitive-behavioral techniques could be useful to quickly reduce the level of anxiety, while patients with heart failure require long-term support therapy to reduce the risk of depressive symptoms.
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Affiliation(s)
- Joanna M. Moryś
- Department of Clinical Psychology, Medical University of Gdansk, Gdansk, Poland
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy Bellwon
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
| | - Stefan Höfer
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, Division of Cardiology and Internal Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Gruchała
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
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Utility of Patient-Reported Outcome Instruments in Heart Failure. JACC-HEART FAILURE 2016; 4:165-75. [DOI: 10.1016/j.jchf.2015.10.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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16
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Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients. Qual Life Res 2015; 25:1461-74. [DOI: 10.1007/s11136-015-1182-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
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17
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Staniute M, Brozaitiene J, Burkauskas J, Kazukauskiene N, Mickuviene N, Bunevicius R. Type D personality, mental distress, social support and health-related quality of life in coronary artery disease patients with heart failure: a longitudinal observational study. Health Qual Life Outcomes 2015; 13:1. [PMID: 25608461 PMCID: PMC4311474 DOI: 10.1186/s12955-014-0204-2] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/26/2014] [Indexed: 12/21/2022] Open
Abstract
Background The relationship between Type D personality and health related quality of life (HRQoL) in coronary artery disease patients is becoming more established, however, the factors that may explain this association remain unclear. The objective of the study was to examine the mediating effects of mental distress and social support on the relationship between the Type D personality and HRQoL in CAD patients with heart failure. Methods A total of 855 CAD patients with heart failure were assessed on Type D personality, mental distress, perceived social support and HRQoL with the following self-administered questionnaires: the Type D personality scale - 14, the Hospital Anxiety and Depression scale, the Multidimensional Scale of Perceived Social Support and the Minnesota Living with Heart Failure Questionnaire. Results The prevalence of Type D personality within the study population was 33.5%. Type D personality, anxiety symptoms, depressive symptoms and social support were all found to be determinants of decreased HRQoL (p’s < 0.001), once age, gender, NYHA functional class and acute myocardial infarction were adjusted for. Anxiety, depressive symptoms and social support were found to mediate the relationship between Type D personality and HRQoL. Type D personality exerted a stable effect on HRQoL over 24 months follow-up period. Conclusions Type D personality has an independent significant effect on the HRQoL in CAD patients with heart failure, and this relation is mediated by anxiety and depressive symptoms, social support.
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Affiliation(s)
- Margarita Staniute
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Julija Brozaitiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Julius Burkauskas
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Nijole Kazukauskiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Narseta Mickuviene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Robertas Bunevicius
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
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18
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Samartzis L, Dimopoulos S, Manetos C, Agapitou V, Tasoulis A, Tseliou E, Pozios I, Kaldara E, Terrovitis J, Nanas S. Neuroticism personality trait is associated with Quality of Life in patients with Chronic Heart Failure. World J Cardiol 2014; 6:1113-1121. [PMID: 25349656 PMCID: PMC4209438 DOI: 10.4330/wjc.v6.i10.1113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/07/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate Quality of life (QoL) in chronic heart failure (CHF) in relation to Neuroticism personality trait and CHF severity.
METHODS: Thirty six consecutive, outpatients with Chronic Heart Failure (6 females and 30 males, mean age: 54 ± 12 years), with a left ventricular ejection fraction ≤ 45% at optimal medical treatment at the time of inclusion, were asked to answer the Kansas City Cardiomyopathy Questionnaire (KCCQ) for Quality of Life assessment and the NEO Five-Factor Personality Inventory for personality assessment. All patients underwent a symptom limited cardiopulmonary exercise testing on a cycle-ergometer, in order to access CHF severity. A multivariate linear regression analysis using simultaneous entry of predictors was performed to examine which of the CHF variables and of the personality variables were correlated independently to QoL scores in the two summary scales of the KCCQ, namely the Overall Summary Scale and the Clinical Summary Scale.
RESULTS: The Neuroticism personality trait score had a significant inverse correlation with the Clinical Summary Score and Overall Summary Score of the KCCQ (r = -0.621, P < 0.05 and r = -0.543, P < 0.001, respectively). KCCQ summary scales did not show significant correlations with the personality traits of Extraversion, Openness, Conscientiousness and Agreeableness. Multivariate linear regression analysis using simultaneous entry of predictors was also conducted to determine the best linear combination of statistically significant univariate predictors such as Neuroticism, VE/VCO2 slope and VO2 peak, for predicting KCCQ Clinical Summary Score. The results show Neuroticism (β = -0.37, P < 0.05), VE/VCO2 slope (β = -0.31, P < 0.05) and VO2 peak (β = 0.37, P < 0.05) to be independent predictors of QoL. In multivariate regression analysis Neuroticism (b = -0.37, P < 0.05), the slope of ventilatory equivalent for carbon dioxide output during exercise, (VE/VCO2 slope) (b = -0.31, P < 0.05) and peak oxygen uptake (VO2 peak), (b = 0.37, P < 0.05) were independent predictors of QoL (adjusted R2 = 0.64; F = 18.89, P < 0.001).
CONCLUSION: Neuroticism is independently associated with QoL in CHF. QoL in CHF is not only determined by disease severity but also by the Neuroticism personality trait.
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The Effect of Educational Intervention on Nurses' Attitudes and Beliefs about Depression in Heart Failure Patients. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:257658. [PMID: 25525516 PMCID: PMC4265535 DOI: 10.1155/2014/257658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
Systematic depression screening is feasible, efficient, and well accepted; however the lack of consistent assessment in heart failure inpatients suggests barriers preventing its effective diagnosis and treatment. This pilot study assessed the impact of an educational intervention on nurses' beliefs about depression and their likelihood of routinely screening heart failure patients. Registered nurses (n = 35) from adult medical-surgical units were surveyed before and after an educational intervention to assess their beliefs about depression prevalence and screening in heart failure patients. There was no significant influence on nurses' beliefs about depression, but the results suggested an increased likelihood that nurses would routinely screen for depression. The moderately significant correlation between beliefs and intent to screen for depression indicates that educational intervention could ultimately have a positive influence on patient outcomes through early detection and treatment of depression in patients with cardiovascular disease; however the observed increase in the intent to screen without a corresponding change in beliefs indicates other influences affecting nurses' intent to screen heart failure patients for depression.
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Knackstedt C, Arndt M, Mischke K, Marx N, Nieman F, Kunert HJ, Schauerte P, Norra C. Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy. Heart Vessels 2013; 29:364-74. [PMID: 23732755 DOI: 10.1007/s00380-013-0372-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.
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Affiliation(s)
- Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands,
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22
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How are Depression and Type D Personality Associated with Outcomes in Chronic Heart Failure Patients? Curr Heart Fail Rep 2013; 10:244-53. [DOI: 10.1007/s11897-013-0139-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Son YJ, Song Y, Nam S, Shin WY, Lee SJ, Jin DK. Factors Associated With Health-Related Quality of Life in Elderly Korean Patients With Heart Failure. J Cardiovasc Nurs 2012; 27:528-38. [DOI: 10.1097/jcn.0b013e31823fa38a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Sin MK. Personal characteristics predictive of depressive symptoms in Hispanics with heart failure. Issues Ment Health Nurs 2012; 33:522-7. [PMID: 22849779 DOI: 10.3109/01612840.2012.687438] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression is a significant problem in heart failure (HF). The purposes of this study were to assess the prevalence of depressive symptoms in Hispanics with HF and to examine the personal characteristics predicting depressive symptoms at baseline and at 6-months follow-up in a telephone case management intervention. In this secondary data analysis based on 87 subjects, patient characteristics hypothesized to influence depressive symptoms included age, gender, education, living situation, co-morbidity, social support, New York Heart Association (NYHA) class, and acculturation. DSM-IV major depression was present in 39.1% (n = 35) of the participants at baseline and 1.1% (n = 1) at the 6-month follow-up. In regression analysis, factors associated with depressive symptoms at baseline were gender and NYHA class. At 6-month follow-up, acculturation, co-morbidity, and NYHA were significantly related to the presence of depressive symptoms. Depressive symptoms were highly prevalent in Hispanics with HF. Easily identifiable personal characteristics can be useful in designing interventions to reduce depression associated with HF.
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Affiliation(s)
- Mo-Kyung Sin
- Seattle University, College of Nursing, 901 12th Ave., Seattle, WA 98122-1090, USA.
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25
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Depressive symptom trajectory predicts 1-year health-related quality of life in patients with heart failure. J Card Fail 2012; 17:755-63. [PMID: 21872146 DOI: 10.1016/j.cardfail.2011.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND One-third of patients with heart failure (HF) experience depressive symptoms that adversely affect health-related quality of life (HRQOL). We aimed to describe depressive symptom trajectory and determine whether a change in depressive symptoms predicts subsequent HRQOL. METHODS AND RESULTS The sample consisted of 256 inpatients and outpatients with HF. Depressive symptoms were measured at baseline and 3 or 6 months with the Patient Health Questionnaire (PHQ-9). The Minnesota Living with HF Questionnaire was used to assess HRQOL at baseline, 3 to 6 months, and 1 year. Based on baseline and 3- to 6-month PHQ-9 scores, patients were categorized as depressive symptom-free (64%), depressive symptoms improved (15%), depressive symptoms developed (6%), or persistent depressive symptoms (15%). The groups differed in 1-year HRQOL levels (F = 36, P < .001); patients who were depressive symptom-free or whose depressive symptoms improved had better 1-year HRQOL than patients with persistent depressive symptoms (Tukey honestly significant difference, P < .01). Change in depressive symptoms was the strongest predictor of 1-year HRQOL (standardized β = .42, P < .001), after controlling for functional status, demographics, and clinical variables. CONCLUSIONS We found the trajectory of depressive symptoms predicts future HRQOL. Research is needed to determine whether interventions targeting depressive symptoms improve HRQOL in patients with HF.
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Somatic depression predicts mortality in chronic heart failure: can this be explained by covarying symptoms of fatigue? Psychosom Med 2012; 74:459-63. [PMID: 22511727 DOI: 10.1097/psy.0b013e31824ef2f4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Somatic symptoms of depression predict mortality in chronic heart failure (CHF), but symptoms of fatigue that are common to both conditions may confound this association. We therefore examined the contribution of fatigue to the association between somatic depression and increased risk of mortality in patients with CHF. METHODS At baseline, 380 consecutive patients with CHF were assessed for symptoms of depression, exertion fatigue, and general fatigue. Demographic and clinical data were obtained from the patients' medical records or the treating cardiologist. The primary end point was mortality after a median follow-up of 2.3 years (range = 0.15-4.76 years). RESULTS At follow-up, 63 patients (16.6%) had died. Exertion fatigue (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.01-1.06, p = .003), not general fatigue, was associated with an increased risk of mortality in CHF. Multivariate Cox regression analysis revealed that somatic symptoms of depression (HR = 1.41, 95% CI = 1.05-1.88, p = .02) were independently associated with increased mortality risk and that this association could not be explained by exertion fatigue (HR = 1.02, 95% CI = 0.97-1.05, p = .31). CONCLUSIONS The adverse effect of somatic depression on prognosis in CHF was not confounded by exertion fatigue. Behavioral interventions should focus not only on fatigue but also on other somatic manifestations of depression in patients with CHF.
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Angermann CE, Gelbrich G, Störk S, Schowalter M, Deckert J, Ertl G, Faller H. Somatic correlates of comorbid major depression in patients with systolic heart failure. Int J Cardiol 2011; 147:66-73. [DOI: 10.1016/j.ijcard.2009.07.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 07/25/2009] [Indexed: 10/20/2022]
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28
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Peters-Klimm F, Kunz CU, Laux G, Szecsenyi J, Müller-Tasch T. Patient- and provider-related determinants of generic and specific health-related quality of life of patients with chronic systolic heart failure in primary care: a cross-sectional study. Health Qual Life Outcomes 2010; 8:98. [PMID: 20831837 PMCID: PMC2945966 DOI: 10.1186/1477-7525-8-98] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 09/13/2010] [Indexed: 12/21/2022] Open
Abstract
Background Identifying the determinants of health-related quality of life (HRQOL) in patients with systolic heart failure (CHF) is rare in primary care; studies often lack a defined sample, a comprehensive set of variables and clear HRQOL outcomes. Our aim was to explore the impact of such a set of variables on generic and disease-specific HRQOL. Methods In a cross-sectional study, we evaluated data from 318 eligible patients. HRQOL measures used were the SF-36 (Physical/Mental Component Summary, PCS/MCS) and four domains of the KCCQ (Functional status, Quality of life, Self efficacy, Social limitation). Potential determinants (instruments) included socio-demographical variables (age, sex, socio-economic status: SES), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, multimorbidity (CIRS-G)), depression (PHQ-9), behavioural (EHFScBs and prescribing) and provider (e.g. list size of and number. of GPs in practice) variables. We performed linear (mixed) regression modelling accounting for clustering. Results Patients were predominantly male (71.4%), had a mean age of 69.0 (SD: 10.4) years, 12.9% had major depression, according to PHQ-9. Across the final regression models, eleven determinants explained 27% to 55% of variance (frequency across models, lowest/highest β): Depression (6×, -0.3/-0.7); age (4×, -0.1/-0.2); multimorbidity (4×, 0.1); list size (2×, -0.2); SES (2×, 0.1/0.2); and each of the following once: no. of GPs per practice, NYHA class, COPD, history of CABG surgery, aldosterone antagonist medication and Self-care (0.1/-0.2/-0.2/0.1/-0.1/-0.2). Conclusions HRQOL was determined by a variety of established individual variables. Additionally the presence of multimorbidity burden, behavioural (self-care) and provider determinants may influence clinicians in tailoring care to individual patients and highlight future research priorities.
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Affiliation(s)
- Frank Peters-Klimm
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
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29
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Volz A, Schmid JP, Zwahlen M, Kohls S, Saner H, Barth J. Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects. J Behav Med 2010; 34:13-22. [PMID: 20658185 DOI: 10.1007/s10865-010-9282-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 07/12/2010] [Indexed: 01/24/2023]
Abstract
Psychological distress is common in patients with chronic heart failure. The impact of different psychological variables on prognosis has been shown but the comparative effects of these variables remain unclear. This study examines the impact of depression, anxiety, vital exhaustion, Type D personality, and social support on prognosis in chronic heart failure patients. One hundred eleven patients (mean age 57 ± 14 years) having participated in an exercise based ambulatory cardiac rehabilitation program were enrolled in a prospective cohort study. Psychological baseline data were assessed at program entry. Mortality, readmission, and health-related quality of life were assessed at follow up (mean 2.8 ± 1.1 years). After controlling for disease severity none of the psychological variables were associated with mortality, though severe anxiety predicted readmission [HR = 3.21 (95% CI, 1.04-9.93; P = .042)]. Health-related quality of life was independently explained by vital exhaustion, anxiety and either body mass index (physical dimension) or sex (emotional dimension). As psychological variables have a strong impact on health-related quality of life they should be routinely assessed in chronic heart failure patients` treatment.
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Affiliation(s)
- Andreas Volz
- Division of Social and Behavioral Health Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Pelle AJ, Pedersen SS, Schiffer AA, Szabó B, Widdershoven JW, Denollet J. Psychological distress and mortality in systolic heart failure. Circ Heart Fail 2010; 3:261-7. [PMID: 20071656 DOI: 10.1161/circheartfailure.109.871483] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure. METHOD AND RESULTS Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02). CONCLUSIONS Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.
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Affiliation(s)
- Aline J Pelle
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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