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Ziegelstein RC, Kronish IM, Thombs BD. Depression screening to improve clinical outcomes in coronary heart disease patients. Am Heart J 2024; 271:109-111. [PMID: 38401648 DOI: 10.1016/j.ahj.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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2
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Wang Y, Yang Q, Liu Y, Zheng G, Fan F, Tian H, Zhang X. Psychosomatic mechanisms of heart failure symptoms on quality of life in patients with chronic heart failure: A multi-centre cross-sectional study. J Clin Nurs 2024; 33:1839-1848. [PMID: 38044710 DOI: 10.1111/jocn.16955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
AIMS To determine the contributions of different kinds of symptoms to the quality of life and mediating effect of psychological and physical symptoms between heart failure symptoms and quality of life. DESIGN A multi-centre cross-sectional study. METHODS 2006 chronic heart failure patients from four cities were recruited in China from January 2021 to December 2022. Patients' symptoms and quality of life were self-reported, and data were analysed using correlation analysis, dominance analysis and mediating effects analysis. RESULTS The dominance analysis revealed that the overall mean contributions of heart failure, psychological and physical symptoms were .083, .085 and .111; 29.5%, 30.2% and 39.5% of the known variance. And heart failure symptoms could negatively affect quality of life through psychological and physical symptoms, accounting for 28.39% and 22.95% of the total effect. Heart failure symptoms could also affect quality of life through the chain-mediated effect of physical and psychological symptoms, accounting for 16.74%. CONCLUSIONS Physiological symptoms had the strongest effect on quality of life and heart failure symptoms had the weakest. Most of the effect for heart failure symptoms on quality of life in chronic heart failure patients was mediated by psychological and physiological symptoms. RELEVANCE TO CLINICAL PRACTICE It is important to design non-pharmacological intervention plans for the enhancement of physical and psychological symptoms' management skills, to reduce the adverse impact of heart failure symptoms on quality of life. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. NO PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study.
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Affiliation(s)
- Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Qiaofang Yang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yancun Liu
- Structural Heart Disease Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Gaigai Zheng
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Fanghui Fan
- Coronary Care Unit, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Huan Tian
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xin Zhang
- Henan International Travel Health Care Center, Zhengzhou, China
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3
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Harris A, Parrish E, Keshavamurthy S, Saha S. The value of COPE therapy in the perioperative care of heart failure patients receiving left ventricular assist device implantation. Indian J Thorac Cardiovasc Surg 2023; 39:258-261. [PMID: 37124589 PMCID: PMC10140194 DOI: 10.1007/s12055-023-01493-9] [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: 11/01/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 03/07/2023] Open
Abstract
Purpose This pilot study implemented Creating Opportunities for Personal Empowerment (COPE), a cognitive behavioral therapy (CBT) intervention, in the perioperative care of patients with advanced heart failure awaiting left ventricular assist device (LVAD) implantation. Methods Using a quasi-experimental study design, the patients were screened for anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) screening tools. If patients scored 5 or greater on either tool, they received COPE. Patients were re-evaluated following intervention. Results Average scores for depression and anxiety symptoms pre-intervention were 10.6 and 10.2, respectively. Post intervention, scores decreased to an average of 5.4 and 3.2, respectively. Qualitative data suggests that they felt the intervention was helpful. Conclusion Results show that it is possible to implement a multi-session CBT intervention in this population. The improvements in the severity of depression and anxiety symptoms in the five participants with LVAD is interesting and needs to be verified in a study with a larger sample size. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01493-9.
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Affiliation(s)
- Aaron Harris
- University of Kentucky Healthcare Critical Care Services, 1000 South Limestone St, Lexington, KY 40536 USA
| | - Evelyn Parrish
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536 USA
| | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, 740 S. Limestone St, Lexington, KY 40536 USA
| | - Sibu Saha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, 740 S. Limestone St, Lexington, KY 40536 USA
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4
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Soares VL, Pereira C, Carvalho AC, Mota TP, Groehs RV, Bacal F, Matos LDNJD. Prevalence and Association Between Cognition, Anxiety, and Depression in Patients Hospitalized with Heart Failure. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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5
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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6
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Peterson LR, Coggan AR. Heart Failure With Reduced Ejection Fraction: “The Importance of Being Frail”. Circulation 2022; 146:91-93. [DOI: 10.1161/circulationaha.122.060467] [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: 11/16/2022]
Affiliation(s)
- Linda R. Peterson
- Washington University School of Medicine in Saint Louis, MO (L.R.P.)
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7
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Zou L, Li X, Chen Q, Lv F, Min S. Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission. BMC Anesthesiol 2022; 22:163. [PMID: 35619081 PMCID: PMC9134596 DOI: 10.1186/s12871-022-01686-6] [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: 01/01/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study explored the patient clinical characteristics that may affect electroconvulsive therapy (ECT) efficacy to enable improved focus during evaluations and preparation for ECT. Methods Patients were enrolled for ECT at the Department of Psychiatry and Anesthesiology of the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2019. The primary outcome in our study was defined as the development of nonremission. A multivariate logistic analysis was performed to identify the risk factors for nonremission. Results In total, 874 depressed patients were included in the study. After the ECT treatment, 255 cases (29.2%) exhibited nonremission. A multivariate logistic regression analysis of the variables was performed, and the results showed that atherosclerosis (OR 8.072, 95% CI 2.442 to 16.675; P = 0.001), COPD (OR 2.919, 95% CI 1.240 to 6.871; P = 0.014), diabetes (OR 2.202, 95% CI 1.115 to 4.348; P = 0.023) and smoking (OR 1.519, 95% CI 1.015 to 2.273; P = 0.042) were independent risk factors for nonremission. Conclusion In the retrospective analysis, we found that atherosclerosis, diabetes, COPD and smoking may be high-risk factors for nonremission. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01686-6.
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Affiliation(s)
- Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao Li
- Departments of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Khodneva Y, Goyal P, Levitan EB, Jackson EA, Oparil S, Sterling MR, Cherrington AL, Durant R, Safford MM. Depressive Symptoms and Incident Hospitalization for Heart Failure: Findings From the REGARDS Study. J Am Heart Assoc 2022; 11:e022818. [PMID: 35322678 PMCID: PMC9075424 DOI: 10.1161/jaha.121.022818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
Background Depressive symptoms are risk factors for several forms of cardiovascular disease including coronary heart disease (CHD). However, it is unclear whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). Methods and Results Among 26 268 HF-free participants in the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, a prospective biracial cohort of US community-dwelling adults ≥45 years, baseline depressive symptoms were defined as a score ≥4 on the 4-item Center for Epidemiologic Studies Depression scale. Incident HF hospitalizations were expert-adjudicated and categorized as HFpEF (EF ≥50%) and HFrEF, including mid-range EF (EF<50%). Over a median of 9.2 [IQR 6.2-10.9] years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 (95% CI 4.0-5.9) for participants with depressive symptoms versus 3.2 (95% CI 3.0-3.5) for those without depressive symptoms (P<0.001). For overall HF, the elevated risk became attenuated after controlling for covariates. When HFpEF was assessed separately, depressive symptoms were associated with incident hospitalization after controlling for all covariates (hazard ratio [HR] 1.48, 95% CI 1.00-2.18) among those without baseline CHD. In contrast, depressive symptoms were not associated with incident HFrEF hospitalizations. Conclusions Among individuals free of CHD at baseline, depressive symptoms were associated with incident hospitalization for HFpEF, but not for HFrEF, or among those with baseline CHD.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Parag Goyal
- Division of Internal Medicine Weill Cornell University New York NY
- Division of Cardiology Weill Cornell University New York NY
| | - Emily B Levitan
- Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Elizabeth A Jackson
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Suzanne Oparil
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | | | - Andrea L Cherrington
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Raegan Durant
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Monika M Safford
- Division of Internal Medicine Weill Cornell University New York NY
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Rojas Sánchez LZ, Trujillo-Cáceres SJ, Hernández Vargas JA, Jurado AM, Echeverría LE, Gómez-Ochoa SA, Roa-Díaz ZM. Validación de constructo de la escala Zung en pacientes con falla cardíaca. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2022. [DOI: 10.11144/javeriana.ie23.vcez] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introducción: La escala Zung para depresión ha sido previamente utilizada en pacientes con falla cardíaca; sin embargo, en nuestro conocimiento no se encuentra evidencia de su validez para la versión en español y su uso en población adulta con falla cardíaca en Colombia. Objetivo: Determinar la validez de constructo de la escala Zung para depresión en su versión original y proponer una versión abreviada para pacientes adultos con falla cardíaca.
Materiales y Métodos: Estudio de corte transversal, realizado en 200 pacientes de una clínica de falla y trasplante cardiaco, en quienes se aplicó Zung Self-Rating Depression Scale. Se evaluó la consistencia interna por medio del alfa de Cronbach y el análisis factorial fue utilizado para identificar las dimensiones del instrumento.
Resultados: La consistencia interna de la versión original de la escala (20 ítems) fue de α=0.811. El análisis de factores mostró una estructura compuesta por tres factores que explican el 51.59% de la varianza total. La nueva versión abreviada (13 ítems) obtuvo un α=0.819 y los ítems correlacionaron con un único factor que explicó el 33.54% de la varianza total.
Discusión: Nuestros hallazgos son similares a los encontrados por otros autores en diferentes poblaciones a la estudiada.
Conclusiones: Se evidenció validez de constructo tanto para la escala Zung para depresión en su versión original como para la abreviada creada en la población estudiada. Sin embargo, se requieren estudios adicionales que verifiquen estos hallazgos en una muestra representativa y que otros aspectos de la psicometría sean evaluados.
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Satici S, Iyngkaran P, Battersby M, Andrew S, De Courten M. Defining Vulnerable Patients with Heart Failure: Opportunistic Lessons from Covid-19. Curr Cardiol Rev 2022; 18:e280921196849. [PMID: 34602040 PMCID: PMC9893135 DOI: 10.2174/1573403x17666210928121625] [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: 02/20/2021] [Revised: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022] Open
Abstract
Congestive Heart Failure is a chronic disease that can be associated with poor outcomes. Some patients are more vulnerable, while others who are vulnerable appear absent or silent to health services. COVID-19 pandemic is a good opportunity to explore this important area. This review focuses on chronic disease, heart failure and those who require greater consideration.
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Affiliation(s)
- Sakine Satici
- General Physician and Master of Research student, Victoria University, Melbourne, Victoria, Australia
| | - Pupalan Iyngkaran
- Cardiologist (Heart Failure & Cardiac Imaging) and Adjunct Senior Lecturer, Werribee Mercy Sub School, School of Medicine, University of Notre Dame, Sydney, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Senior Consultant Psychiatrist, Southern Adelaide Local Health Network, Mental Health Division, Flinders Medical Centre, Flinders Drive, Bedford Park SA 5042, GPO Box 2100, Adelaide SA 5001
| | - Sharon Andrew
- Nursing and Adjunct Mitchell Institute, Victoria University, PO Box 14428 Melbourne, Victoria 8001, Australia
| | - Maximilian De Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne 3000, Victoria, Australia
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Fomicheva A, Andreev D, Lyubavskaya A, Simonov A, Volel B. Clinical and psychopathological aspects of nosogenic reactions in chronic heart failure. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:86-94. [DOI: 10.17116/jnevro202212209186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Lin CY, Hammash M, Miller JL, Schrader M, Mudd-Martin G, Biddle MJ, Moser DK. Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events. Eur J Cardiovasc Nurs 2021; 20:454-463. [PMID: 33580784 DOI: 10.1093/eurjcn/zvaa032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023]
Abstract
AIMS The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death. METHODS AND RESULTS We studied 153 patients hospitalized with an exacerbation of HF. Potential predictors of delay including demographic, clinical, psychosocial, cognitive, and behavioural variables were collected. Patients were followed for 3 months after discharge to determine time to the first cardiac rehospitalization or death. The median delay time was 134 h (25th and 75th percentiles 49 and 364 h). Non-linear regression showed that New York Heart Association functional class III/IV (P = 0.001), worse depressive symptoms (P = 0.004), better HF knowledge (P = 0.003), and lower perceived somatic awareness (P = 0.033) were predictors of delay time from patient perception of worsening HF to subsequent hospital admission. Cox regression revealed that patients who delayed longer (more than 134 h) had a 1.93-fold higher risk of experiencing cardiac events (P = 0.044) compared to non-delayers. CONCLUSIONS Care-seeking delay in patients with worsening HF symptoms was significantly associated with an increased risk of rehospitalization and mortality after discharge. Intervention strategies addressing functional status, psychological state, cognitive and behavioural factors are essential to reduce delay and thereby improve outcomes.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Jennifer L Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Melanie Schrader
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
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Nwosu WO, Rajani R, McDonaugh T, Driscoll E, Hughes LD. Patients' and carers' perspective of the impact of heart failure on quality of life: a qualitative study. PSYCHOL HEALTH MED 2021; 27:1381-1396. [PMID: 33947277 DOI: 10.1080/13548506.2021.1922719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) is a syndrome associated with high mortality and morbidity. HF patients tend to be at a high risk of poor clinical and psychosocial outcomes. This study aimed to capture patients' and carers perspectives of HF, the impact on their health reported QoL, and the factors associated with their poor health outcomes. To explore HF patients' and carers' views on their QoL since diagnosis. This study used a cross-sectional, qualitative design with semi-structured interviews conducted with participating patients and carers. Thirteen adults (> 18 years) with HF and 21 carers were interviewed over the telephone, following a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using inductive thematic analysis. Three main themes were identified, with an overarching theme . Themes included impact on patients' lifestyle including diet, smoking and inability to part-take in social activities, adjusting to HF diagnosis and co-morbidity management, and psychological/mental health issues such as anxiety and depression. Patients with HF are at high-risk of various issues which can negatively impact their QoL. Additionally, Carers play a vital role in the management of HF patients. Effective patient centred care and better communication between patients, carers and healthcare professionals is vital in HF management.
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Affiliation(s)
- Winifred Onyinyechi Nwosu
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Ronak Rajani
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, London, UK
| | - Theresa McDonaugh
- Cardiology Department, King's College Hospital NHS Foundation Trust London, London, UK
| | - Elizabeth Driscoll
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
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Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life. J Cardiovasc Nurs 2020; 36:539-545. [PMID: 33136703 DOI: 10.1097/jcn.0000000000000756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital. OBJECTIVE The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite. METHODS Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life. RESULTS A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates. CONCLUSIONS Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.
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Zhang X, Zou H, Hou D, He D, Fan X. Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure. J Adv Nurs 2020; 76:3363-3371. [PMID: 32932558 DOI: 10.1111/jan.14522] [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: 02/16/2020] [Revised: 06/15/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
AIMS The decline of nutritional status and depressive symptoms are pandemic in heart failure patients and functional status may play a pivotal role between these. This study aimed to determine whether nutritional status is associated with depressive symptoms and whether functional status mediates this relationship in heart failure patients. DESIGN This was a secondary analysis of a cross-sectional study. METHODS The data were collected from November 2015-April 2016. Heart failure patients (N = 254) being hospitalized were included in this secondary analysis. The Depression Sub-Scale of the Hospital Anxiety and Depression Scale and the Duke Activity Status Index were used to assess patients' depressive symptoms and functional status. The nutritional status of patients was calculated using the Geriatric Nutritional Risk Index. RESULTS In this study, the average scores of depressive symptoms, nutritional status and functional status were 4.91 (SD 3.12), 102.38 (SD 6.57) and 20.58 (SD 8.96) respectively. Out of the 254 patients, 46 patients (18.1%) had significant depressive symptoms (the score of Depression Sub-Scale of the Hospital Anxiety and Depression Scale ≥ 8) and 55 (21.7%) suffered from malnutrition (the score of Geriatric Nutritional Risk Index ≤ 98). In the multiple regression analyses, nutritional status was negatively associated with depressive symptoms (β = -0.142, p = .02) and functional status mediated the relationship between nutritional status and depressive symptoms. CONCLUSIONS Many patients with heart failure have malnutrition and depressive symptoms. Functional status plays a mediating role in the relationship between nutritional status and depressive symptoms. IMPACT To relieve depressive symptoms in patients with heart failure, it is of importance to improve the functional status, especially for those with poor nutritional status.
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Affiliation(s)
- Xiuting Zhang
- School of Nursing, Shandong University, Jinan, China
| | - Huijing Zou
- School of Nursing, Shandong University, Jinan, China
| | - Danhua Hou
- School of Nursing, Shandong University, Jinan, China
| | - Dengxin He
- School of Nursing, Shandong University, Jinan, China
| | - Xiuzhen Fan
- School of Nursing, Shandong University, Jinan, China
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16
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Puckett C, Goodlin SJ. A Modern Integration of Palliative Care Into the Management of Heart Failure. Can J Cardiol 2020; 36:1050-1060. [DOI: 10.1016/j.cjca.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
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Yang P, He J. Chinese Herbal Medicines and Conventional Chronic Heart Failure Treatment for the Management of Chronic Heart Failure Complicated with Depression: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:8627928. [PMID: 32382309 PMCID: PMC7193286 DOI: 10.1155/2020/8627928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/08/2020] [Accepted: 03/30/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Combination therapy with Chinese herbal medicines (CHMs) and conventional medical treatment (CMT) was proposed as a therapeutic strategy for chronic heart failure (CHF) patients complicated with depression. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess effects of this combination therapy on CHF complicated with depression. METHODS RCTs comparing the combination of CHMs and CMT to CMT were retrieved in seven electrical databases till March 30, 2019. The effective rate of cardiac function and Hamilton depression scale (HAMD) were marked as the primary outcomes. Left ventricular ejection fraction (LVEF) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were marked as the secondary outcomes. The methodological quality of eligible RCTs used the Cochrane bias risk assessment tool. Stata 13.0 and Review Manager 5.3 were preferred for synthesizing the results if the results were appropriate. RESULTS Thirteen RCTs enrolling 1022 subjects met the inclusion criteria. The majority of the retrieved RCTs were evaluated to be of low methodological quality. The pooled results of the meta-analysis showed that CHMs plus CMT group created better outcomes compared to CMT alone therapy, as evidenced by the fact that the overall effects of combination therapy strategy were significantly greater than the control group in increasing effective rate of cardiac function (risk ratio (RR) = 1.28; 95% CI: 1.16 to 1.42), in improving depressive symptoms (HAMD) (standard mean difference (SMD) = -1.31; 95% CI: -1.68 to -0.95) and quality of life (MLHFQ) (weighted mean difference (WMD) = -8.42; 95% CI: -10.08 to -6.76), in increasing LVEF scores (WMD = 5.33; 95% CI: 4.30 to 6.35). CONCLUSION The combination of CHMs and CMT increased the effective rate of cardiac function and LVEF scores and reduced HAMD and MLHFQ scale scores, which was a potential therapeutic strategy that improved the management of CHF patients complicated with depression. Future trials were needed to verify the above results since abnormal heterogeneity and poor quality of literature have existed in the included studies.
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Affiliation(s)
- Peidan Yang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jun He
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
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Patel N, Chakraborty S, Bandyopadhyay D, Amgai B, Hajra A, Atti V, Das A, Ghosh RK, Deedwania PC, Aronow WS, Lavie CJ, Di Tullio MR, Vaduganathan M, Fonarow GC. Association between depression and readmission of heart failure: A national representative database study. Prog Cardiovasc Dis 2020; 63:585-590. [PMID: 32224112 DOI: 10.1016/j.pcad.2020.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Depression is a recognized predictor of adverse outcomes in patients with heart failure (HF) and is associated with poor quality of life, functional limitation, increased morbidity and mortality, decreased adherence to treatment, and increased rehospitalization. To understand the impact of depression on HF readmission, we conducted a retrospective cohort study using the Nationwide Readmission Database (NRD) 2010-2014. METHODS We identified all patients with the primary discharge diagnosis of HF by ICD-9-CM codes. The primary outcome of the study was to identify 30-day all-cause readmission and causes of readmission in patients with and without depression. Multivariate Cox regression analysis was used to estimate the adjusted hazard ratio for the primary and secondary outcomes. RESULTS Among, 3,500,570 patients admitted with HF, 9.7% had concomitant depression. Patients with depression were more likely to be readmitted within 30 days (19.7% vs. 18.5%; P < 0.001). Concomitant depression was associated with higher risk of all-cause readmissions within 30 days and 90 days [P < 0.001] but was not associated with increased readmissions due to cardiovascular (CV) cause at 30 days and 90 days. The hazard of psychiatric causes of readmission was higher in patients with depression, both at 30 days [P < 0.001], and 90 days [P < 0.001]. Most of the readmissions were due to CV causes, with HF being the most common cause. CONCLUSION Among patients hospitalized with HF, the presence of depression is associated with increased all-cause readmission driven mainly by psychiatric causes but not CV-related readmission. Standard interventions targeted toward HF are unlikely to modify this portion of all-cause readmission.
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Affiliation(s)
| | | | | | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Avash Das
- University of Texas Southwestern Medical Center, TX, USA
| | - Raktim K Ghosh
- Case Western Reserve University, Heart and Vascular Institute, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Wilbert S Aronow
- Westchester Medical Center and New York Medical College, New York, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
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19
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Shabu S, Jayasekara R. Effectiveness of cognitive behavior therapy for patients with heart failure and depression: A systematic review protocol. Nurs Health Sci 2020; 22:14-19. [PMID: 31499596 DOI: 10.1111/nhs.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 08/31/2023]
Abstract
The objective of this review is to determine the effectiveness of cognitive behavior therapy for patients with heart failure and depression, aged ≥18 years, in institutionalized healthcare settings. More specifically, the review aims to identify which cognitive behavior therapy strategy/strategies, including the method of delivery, is the most effective for the management of depression in hospitalized patients with heart failure. The review question is as follows: Is cognitive behavior therapy effective in reducing symptoms of depression in patients with heart failure? This systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. This review only includes randomized controlled trials assessing the effectiveness of cognitive behavior therapy as a treatment for depression in adults (aged ≥18 years) with heart failure, compared with usual care, which might include medications.
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Affiliation(s)
- Shancy Shabu
- Cardiac Step Down Ward, The Queen Elizabeth Hospital, Adelaid, South Australia, Australia
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Rasika Jayasekara
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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20
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Arnold ER, White-Williams C, Miltner RS, Hites L, Su W, Shirey MR. Transitional Care Home Visits Among Underserved Patients With Heart Failure. Nurs Adm Q 2020; 44:268-279. [PMID: 32511186 DOI: 10.1097/naq.0000000000000426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Heart failure (HF), a global public health problem affecting 26 million people worldwide, significantly impacts quality of life. The prevalence of depression associated with HF is 3 times higher than that of the general population. Evidence, though, supports the use of transitional care as a method to enhance functional status and improve rates of depression in patients with HF. This article discusses the findings of a quality improvement project that evaluated health outcomes in underserved patients with HF who participated in a transitional care home visitation program. The visitation program exemplifies the role of leadership in facilitating transitions across the health care continuum. The 2-year retrospective review included 79 participants with HF. Comparisons of outcomes were made over 6 months. Although not statistically significant, clinically significant differences in health outcomes were observed in participants who received a home visit >14 days compared with ≤14 days after hospital discharge. A home visitation program for underserved patients with HF offers opportunities to enhance care across the continuum. Ongoing evaluation of the existing home visitation program is indicated over time with the goal of offering leaders data to enhance patient and family-centered transitional care coordination.
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Affiliation(s)
- Erica R Arnold
- University of Alabama at Birmingham Hospital (Dr Arnold); Center for Nursing Excellence, and Heart Failure Transitional Care Services for Adults (HRTSA) Clinic, University of Alabama at Birmingham Hospital (Dr White-Williams); The University of Alabama at Birmingham School of Nursing (Drs White-Williams and Miltner); Community Medicine & Population Health, College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa (Dr Hites); The University of Alabama at Birmingham School of Public Health (Dr Su); and Clinical and Global Partnerships, Jane H. Brock-Florence Nightingale Endowed Professor in Nursing, The University of Alabama at Birmingham School of Nursing (Dr Shirey)
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21
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Spaderna H, Hoffman JM, Hellwig S, Brandenburg VM. Fear of Physical Activity, Anxiety, and Depression. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract. Background: Physical activity (PA) is recommended by heart failure treatment guidelines. Adherence to exercise prescriptions is low and not much is known about everyday PA in this patient group. Aims: This study describes objectively assessed everyday PA/sedentary behavior in men and women with chronic heart failure and examines associations of potential barriers for engaging in PA, namely fear of physical activity (FoPA), general anxiety, and depression, with indicators of PA and sedentary behavior. Method: In 61 outpatients with heart failure (67.5 ± 10.7 years of age) the impact of FoPA, trait anxiety, and depression on 6-day accelerometer measures was evaluated using linear regression models. Results: Sedentary behavior was prevalent in men and women alike, with lying down and sitting/standing as predominant activity classes during daytime. Men had higher PA energy expenditure (726 vs. 585 kcal/d, Cohen’s effect size d = 0.74) and walked up/down more often (0.21% vs. 0.12% of total PA, d = 0.56) than women. FoPA did not differ between sexes. FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates (β-values between −0.26 and −0.44, p-values < 0.024). Limitations: The self-selected sample included few women. Medical data were assessed via self-reports. Conclusion: FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates. These preliminary findings highlight FoPA as a barrier to everyday PA in patients with heart failure.
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Affiliation(s)
- Heike Spaderna
- Division of Health Psychology, Department of Nursing Science, Trier University, Germany
| | - Jeremia M. Hoffman
- Division of Health Psychology, Department of Nursing Science, Trier University, Germany
| | - Susan Hellwig
- Division of Method Teaching and Psychological Diagnostics, University of Wuppertal, Germany
| | - Vincent M. Brandenburg
- Department of Cardiology, Nephrology, and Internal Intensive Care Medicine, Rhein-Maas Klinikum, Germany
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22
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Buttà C, Roberto M, Tuttolomondo A, Petrantoni R, Miceli G, Zappia L, Pinto A. Old and New Drugs for Treatment of Advanced Heart Failure. Curr Pharm Des 2019; 26:1571-1583. [PMID: 31878852 DOI: 10.2174/1381612826666191226165402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Advanced heart failure (HF) is a progressive disease with high mortality and limited medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard treatments for these patients; however, access to these therapies is limited by the advanced age and multiple comorbidities of affected patients, as well as by the limited number of organs available. METHODS Traditional and new drugs available for the treatment of advanced HF have been researched. RESULTS To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous loop diuretic therapy and inotropic support. However, many patients with advanced HF experience loop diuretics resistance and alternative therapeutic strategies to overcome this problem have been developed, including sequential nephron blockade or use of the hypertonic saline solution in combination with high-doses of furosemide. As classic inotropes augment myocardial oxygen consumption, new promising drugs have been introduced, including levosimendan, istaroxime and omecamtiv mecarbil. However, pharmacological agents still remain mainly short-term or palliative options in patients with acute decompensation or excluded from mechanical therapy. CONCLUSION Traditional drugs, especially when administered in combination, and new medicaments represent important therapeutic options in advanced HF. However, their impact on prognosis remains unclear. Large trials are necessary to clarify their therapeutic potential and prognostic role in these fragile patients.
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Affiliation(s)
- Carmelo Buttà
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Marco Roberto
- Servizio di Cardiologia, Cardiocentro Ticino Lugano, Lugano, Switzerland
| | - Antonino Tuttolomondo
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Rossella Petrantoni
- Pronto Soccorso, Fondazione Istituto G. Giglio di Cefalù, 90015 Cefalù PA, Italy
| | - Giuseppe Miceli
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Zappia
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Antonio Pinto
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
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Johansson P, Jaarsma T, Andersson G, Lundgren J. The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure: A secondary analysis of a randomised controlled trial. Int J Nurs Stud 2019; 116:103454. [PMID: 31727306 DOI: 10.1016/j.ijnurstu.2019.103454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. OBJECTIVES To investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DESIGN A secondary analysis of data collected in a pilot randomized controlled study. SETTING 50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden. METHODS Patients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. RESULTS No significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). CONCLUSION Improvement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.
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Affiliation(s)
- Peter Johansson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundgren
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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24
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Chavanon ML, Meyer T, Belnap BH, Huang Y, Abebe KZ, Rollman BL, Herrmann-Lingen C. Emotion regulation in patients with heart failure: Its relationship with depressive symptoms and rehospitalization. J Psychosom Res 2019; 125:109811. [PMID: 31450124 PMCID: PMC6752733 DOI: 10.1016/j.jpsychores.2019.109811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the role of emotion regulation and its relationship to mental and physical health in patients with heart failure (HF). METHODS Patients hospitalized with HF were screened for depressive symptoms with the two-item Patient Health Questionnaire (PHQ-2) and classified as screen-positive if endorsing ≥1 item and otherwise as screen-negative. One month after hospital discharge, the Emotion Regulation Questionnaire (ERQ) was administered to assess suppression and reappraisal as emotion regulation strategies. In all participants who completed the ERQ (N = 394), all-cause rehospitalization and depressive symptoms using the PHQ-9 were assessed at 1-, 3-, and 6-months after hospital discharge. RESULTS Overall, PHQ-9 scores decreased by 6-months (-0.13 points/month, p = .003), and although suppression showed a small association with depression, neither strategy modulated the slope of the decline in depressive symptoms. Multivariable-adjusted Cox models showed that reappraisal and suppression were not related to all-cause rehospitalization in the entire cohort. However, increasing reappraisal reduced rehospitalization risk by 24% for screen-positive patients (N = 311, HR = 0.76, p = .02), but increased it by 94% in screen-negative patients (N = 83, HR = 1.94, p = .009). CONCLUSION Suppression and reappraisal showed specific and divergent associations in patients with HF: Suppression may relate to depressive symptoms. Reappraisal was associated with rehospitalization, but differently for patients with a positive vs. negative depression screen. Further studies are needed to examine whether emotion-regulation skill training can improve mental and physical health in depressed patients with HF or ameliorate depression in those at-risk.
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Affiliation(s)
- Mira-Lynn Chavanon
- Philipps-Universität Marburg, Department of Psychology, Marburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; Center for Behavioral Health and Smart Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yan Huang
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaleab Z Abebe
- Center for Clinical Trials and Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Rollman
- Center for Behavioral Health and Smart Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany.
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25
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Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJA, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res 2019; 116:12-27. [DOI: 10.1093/cvr/cvz200] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
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Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen Georg August University, Robertkochstrasse 40, 37075 Göttingen, Germany
| | - David C Currow
- University of Technology Sydney, Broadway, Ultimo, Sydney, 2007 New South Wales, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Sarah J Goodlin
- Department of Medicine-Geriatrics, Portland Veterans Affairs Medical Center and Patient-cantered Education and Research, 3710 SW US Veterans Rd, Portland, 97239 OR, USA
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Kraków, Śniadeckich 10, Poland
| | | | - Daisy J A Janssen
- Department of Research and Education, CIRO, Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Carlo Leget
- University of Humanistic Studies, Chair Care Ethics, Kromme Nieuwegracht 29, Utrecht, The Netherlands
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Matteo Moroni
- S.S.D. Cure Palliative, sede di Ravenna, AUSL Romagna, Via De Gasperi 8, 48121 Ravenna, Italy
| | - Paul S Mueller
- Mayo Clinic Health System, Mayo Clinic Collage of Medicine and Science, 700 West Avennue South, La Crosse, 54601 Wisconsin, USA
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland St. Vincent’s University Hospital Dublin,Belfield, Dublin 4, Ireland
| | - Steffen T Simon
- Department of Palliative Medicine, Medical Faculty of the Universityof Cologne, Köln, Germany
- Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty ofthe University of Cologne, Kerpener Strasse 62, 50924 Köln, Germany
| | | | - Philip J Larkin
- Service des soins palliatifs Lausanne University Hospital, CHUV, Centre hospitalier univeritaire vaudois, Lausanne Switzerland
- Institut universitaire de formation et de recherche en soins – IUFRS, Faculté de viologie et de medicine – FBM, Lausanne, Switzerland
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de Lucia C, Gambino G, Petraglia L, Elia A, Komici K, Femminella GD, D'Amico ML, Formisano R, Borghetti G, Liccardo D, Nolano M, Houser SR, Leosco D, Ferrara N, Koch WJ, Rengo G. Long-Term Caloric Restriction Improves Cardiac Function, Remodeling, Adrenergic Responsiveness, and Sympathetic Innervation in a Model of Postischemic Heart Failure. Circ Heart Fail 2019. [PMID: 29535114 DOI: 10.1161/circheartfailure.117.004153] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Caloric restriction (CR) has been described to have cardioprotective effects and improve functional outcomes in animal models and humans. Chronic ischemic heart failure (HF) is associated with reduced cardiac sympathetic innervation, dysfunctional β-adrenergic receptor signaling, and decreased cardiac inotropic reserve. We tested the effects of a long-term CR diet, started late after myocardial infarction on cardiac function, sympathetic innervation, and β-adrenergic receptor responsiveness in a rat model of postischemic HF. METHODS AND RESULTS Adult male rats were randomly assigned to myocardial infarction or sham operation and 4 weeks later were further randomized to a 1-year CR or normal diet. One year of CR resulted in a significant reduction in body weight, heart weight, and heart weight/tibia length ratio when compared with normal diet in HF groups. At the end of the study period, echocardiography and histology revealed that HF animals under the CR diet had ameliorated left ventricular remodeling compared with HF rats fed with normal diet. Invasive hemodynamic showed a significant improvement of cardiac inotropic reserve in CR HF rats compared with HF-normal diet animals. Importantly, CR dietary regimen was associated with a significant increase of cardiac sympathetic innervation and with normalized cardiac β-adrenergic receptor levels in HF rats when compared with HF rats on the standard diet. CONCLUSIONS We demonstrate, for the first time, that chronic CR, when started after HF established, can ameliorate cardiac dysfunction and improve inotropic reserve. At the molecular level, we find that chronic CR diet significantly improves sympathetic cardiac innervation and β-adrenergic receptor levels in failing myocardium.
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Affiliation(s)
- Claudio de Lucia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Giuseppina Gambino
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Laura Petraglia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Andrea Elia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Klara Komici
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Grazia Daniela Femminella
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Maria Loreta D'Amico
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Roberto Formisano
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Giulia Borghetti
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Daniela Liccardo
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Maria Nolano
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Steven R Houser
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Dario Leosco
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Nicola Ferrara
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Walter J Koch
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.).
| | - Giuseppe Rengo
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.).
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Abstract
Heart failure is one of the most prevalent long-term physical health conditions. It is suggested that up to 26 million people are living with it worldwide including approximately 920 000 people in the UK. Evidence has consistently demonstrated the links between cardiac health and mental health; therefore, this article will explain depression and its presentation in heart failure, as these two conditions have been strongly and consistently linked. The prevalence of depression in heart failure will be reviewed from epidemiological studies and an overview of the impact of comorbid depression in heart failure will be provided, with a particular focus on mortality, morbidity and quality of life outcomes. The relationship between depression and heart failure will be discussed by examining pathophysiological and behavioural mechanisms, as well as evidence regarding the appropriate identification and subsequent management of heart failure depression will be reviewed.
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Affiliation(s)
- John Sharp
- Consultant Clinical Psychologist, Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Monica McCowat
- Assistant Psychologist, Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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Wen J, Cai Y, Sun W, Jiang C, Lin T, Jiang N, Luo C, Zhou C, Wu W. Nuanxin capsule for heart failure: A systematic review of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12667. [PMID: 30383627 PMCID: PMC6221618 DOI: 10.1097/md.0000000000012667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/06/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of Nuanxin capsule for patients with heart failure (HF). METHODS A systematic literature search was performed in 6 databases: PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan-fang Data Information Site, Chinese BioMedical Database (CBM), VIP Chinese Science and Technique Journals Database from the date of its inception up to November 2016. Review Manager 5.2 software was used for assessment of risk of bias, data synthesis and subgroup analysis. Begg and Egger tests were used for assessing symmetries of funnel plot by software Stata 12.0. We conducted the GRADE system to assess the quality of evidence. RESULTS 12 trials involving 1418 participants were eligible. Compared with western medicine (WM) alone, Nuanxin capsule plus WM showed statistical significance in total effective rate (RR 1.18, 95% condidence interval [CI] 1.13-1.25). According to subgroup analysis, the 6-months group and the 12-months group have better effect than the 3-month group. As for 6-minute walking distance (6MWT), Nuanxin capsule plus WM compared with WM has significantly increased walking distance (weighted mean difference [WMD] 42.56, 95% CI 34.27-50.85). Nuanxin capsule plus WM has significantly decreased in mortality (RR 0.29, 95% CI 0.18-0.46) and re-admission rate (RR 0.48, 95% CI 0.39-0.60) compared with WM. Nuanxin capsule plus WM was beneficial for B-type natriuretic peptide (-240.47, 95% CI -332.45-148.49). gger's and Begg's test showed that there was no publication bias exist (P = .937). Influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was very low to Moderate across the different outcomes. CONCLUSIONS Despite of the apparently positive findings, we cannot draw a sound conclusion that Nuanxin capsule has positive effect in patients with HF, because of the insufficient evidence.
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Affiliation(s)
- Junmao Wen
- Guangzhou University of Chinese Medicine
| | - Yinhe Cai
- Guangzhou University of Chinese Medicine
| | | | | | - Tong Lin
- Guangzhou University of Chinese Medicine
| | - Nan Jiang
- Guangzhou University of Chinese Medicine
| | - Chuanjin Luo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chi Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Wu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Do Depressed Elderly Heart Failure Patients Benefit From Yoga? A Future Direction for Research. J Cardiovasc Nurs 2018; 33:420-421. [PMID: 30095754 DOI: 10.1097/jcn.0000000000000512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chialà O, Vellone E, Klompstra L, Ortali GA, Strömberg A, Jaarsma T. Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure. Heart Lung 2018; 47:465-470. [PMID: 30087002 DOI: 10.1016/j.hrtlng.2018.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity. OBJECTIVES The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients. METHODS This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment. RESULTS The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT. CONCLUSIONS The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients.
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Affiliation(s)
- Oronzo Chialà
- University of Rome Tor Vergata, Via Battaglioni d'Assalto, Rome 24 - 00143, Italy.
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Leonie Klompstra
- Department of Social and Welfare studies, Division of Nursing, Linköping University, Linköping, Sweden
| | | | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, and Department of Cardiology, Linköping University, Linköping, Sweden and Program in Nursing Science, University of California Irvine, Irvine, United States
| | - Tiny Jaarsma
- Department of Social and Welfare studies, Division of Nursing, Linköping University, Linköping, Sweden and Mary McKillop Institute, Australian Catholic University, Melbourne Australia
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Auld JP, Mudd JO, Gelow JM, Lyons KS, Hiatt SO, Lee CS. Patterns of heart failure symptoms are associated with self-care behaviors over 6 months. Eur J Cardiovasc Nurs 2018; 17:543-551. [PMID: 29442523 PMCID: PMC6067986 DOI: 10.1177/1474515118759074] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time. AIMS To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time. METHOD Latent mixture analysis was used to identify subgroups based on physical symptoms of dyspnea, sleepiness and edema (using the heart failure somatic perception and Epworth sleepiness scales). Growth modeling was used to determine if symptom subgroups were associated with self-care behaviors (using the self-care in heart failure index) over 6 months. Sociodemographic and clinical variables predicting the likelihood of subgroup membership were identified using logistic regression. RESULTS The sample ( n=146) was on average 57 years old, 70% were men and 59% had class III/IV heart failure. Two symptom subgroups were identified (entropy 0.91): a high symptom group ( n=24; 16%) with no significant change in symptoms over time (high sustained), and a low symptom group ( n=122; 84%) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (odds ratio (OR) 3.67, P=0.023) and patients with more depressive symptoms (OR 1.16, P=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin-angiotensin-aldosterone system agent were less likely to be in the high symptom group (OR 0.17, P=0.015). CONCLUSION Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. The results of this study support symptoms as an important driver of self-care behaviors.
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Affiliation(s)
- Jonathan P. Auld
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - James O. Mudd
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Jill M. Gelow
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Karen S. Lyons
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Shirin O. Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
| | - Christopher S. Lee
- Oregon Health & Science University School of Nursing, Portland, OR, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
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Liu CH, Wang JH, Weng SC, Cheng YH, Yeh MK, Bai MY, Chang JC. Is Heart Failure Associated With Risk of Suicide? J Card Fail 2018; 24:795-800. [PMID: 30053581 DOI: 10.1016/j.cardfail.2018.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/26/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The high prevalence of heart failure (HF) in developed countries imposes a substantial burden on health care resources. Depression is widely recognized as a risk factor associated with HF. This study examined the relationship between suicide and HF after controlling for depression and other comorbidities. METHODS AND RESULTS The population comprised 52,749 adult patients who died from suicide from 2000 to 2012 and 210,996 living control subjects matched by age, sex, and residence area. Data were obtained from the Health and Welfare Data Science Center, Taiwan. Multivariable models were constructed to evaluate the relationship between HF and suicide. In the case and control groups 1624 (3.08%) and 4053 (1.92%) patients had HF, respectively, indicating that HF was associated with an increased risk of suicide (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.59-1.79). The risk of suicide was highest during the initial 6 months after HF (adjusted OR 7.04, 95% CI 5.37-9.22) and subsequently declined gradually. Among psychiatric disorders, mood disorders (adjusted OR 7.42, 95% CI 7.06-7.79) yielded the highest odds of suicide. CONCLUSIONS The risk of suicide is higher for patients with HF than for healthy individuals without HF. This risk is particularly high during the first 6 months after HF diagnosis. This study provides strong evidence that depression is a negative prognostic factor for patients with HF and increases the risk of suicide. The results suggest that early screening and treatment for depression and suicide risk should be conducted for patients with HF.
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Affiliation(s)
- Chao-Han Liu
- Biomedical Engineering Program, Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, Taiwan; Division of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu-Chuan Weng
- Bachelor Degree Program of Golden-Age Well-Being Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yen-Huang Cheng
- Division of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, National Defense Medical Center, Taiwan
| | - Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology & Adjunct Appoint to the Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan.
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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Liguori I, Russo G, Curcio F, Sasso G, Della-Morte D, Gargiulo G, Pirozzi F, Cacciatore F, Bonaduce D, Abete P, Testa G. Depression and chronic heart failure in the elderly: an intriguing relationship. J Geriatr Cardiol 2018; 15:451-459. [PMID: 30108618 PMCID: PMC6087518 DOI: 10.11909/j.issn.1671-5411.2018.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including: psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.
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Affiliation(s)
- Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gennaro Russo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Sasso
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Francesco Cacciatore
- Azienda Ospedaliera dei Colli, Monaldi Hospital, Heart Transplantation Unit, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Lugo LH, Navas CM, Plata JA, Ortiz SD, Caraballo D, Henao AC, García HI, Sénior JM. Ensayo clínico aleatorizado para evaluar el efecto de un programa de rehabilitación cardiaca supervisado con ejercicio en el consumo de oxígeno, la función y calidad de vida de pacientes con falla cardiaca crónica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ameri P, Canepa M, Anker MS, Belenkov Y, Bergler-Klein J, Cohen-Solal A, Farmakis D, López-Fernández T, Lainscak M, Pudil R, Ruschitska F, Seferovic P, Filippatos G, Coats A, Suter T, Von Haehling S, Ciardiello F, de Boer RA, Lyon AR, Tocchetti CG. Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge. Eur J Heart Fail 2018; 20:879-887. [PMID: 29464808 DOI: 10.1002/ejhf.1165] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/24/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Cancer and heart failure (HF) are common medical conditions with a steadily rising prevalence in industrialized countries, particularly in the elderly, and they both potentially carry a poor prognosis. A new diagnosis of malignancy in subjects with pre-existing HF is not infrequent, and challenges HF specialists as well as oncologists with complex questions relating to both HF and cancer management. An increased incidence of cancer in patients with established HF has also been suggested. This review paper summarizes the epidemiology and the prognostic implications of cancer occurrence in HF, the impact of pre-existing HF on cancer treatment decisions and the impact of cancer on HF therapeutic options, while providing some practical suggestions regarding patient care and highlighting gaps in knowledge.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Markus S Anker
- Department of Cardiology (CBF), Charité University Medicine, Berlin, Germany; AND Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia; Department of Internal Medicine & Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin, Germany
| | | | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris, France; U942 INSERM, BIOCANVAS (Biomarqueurs Cardiovasculaires), Paris, France;, Department of Cardiology, University of Paris VII Denis Diderot, Paris, France
| | - Dimitrios Farmakis
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Teresa López-Fernández
- Cardio-Oncology Unit, Cardiac Imaging Unit, Department of Cardiology, La Paz University Hospital, IdiPAz, Madrid, Spain
| | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Radek Pudil
- 1st Department of Medicine - Cardioangiology, Medical Faculty and University Hospital Hradec Kralove, Czech Republic
| | - Frank Ruschitska
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Gerasimos Filippatos
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Coats
- Monash University, Australia and University of Warwick, UK
| | - Thomas Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
| | - Stephan Von Haehling
- Klinik für Kardiologie und Pneumologie, Herzzentrum Göttingen, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany;, Deutsches Zentrum für Herz- und Kreislaufforschung, Standort Göttingen, Göttingen, Germany
| | - Fortunato Ciardiello
- Department of Clinical and Experimental Medicine "Flaviano Magrassi", Luigi Vanvitelli University of Campania, Naples, Italy
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Jiménez JA, Peterson CT, Mills PJ. Neuroimmune Mechanisms of Depression in Adults with Heart Failure. Methods Mol Biol 2018; 1781:145-169. [PMID: 29705847 DOI: 10.1007/978-1-4939-7828-1_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Heart failure (HF) is a major and costly public health concern, and its prognosis is grim-with high hospitalization and mortality rates. HF affects millions of individuals across the world, and this condition is expected to become "the epidemic" of the twenty-first century (Jessup et al., 2016). It is well documented that individuals with HF experience disproportionately high rates of depression and that those who are depressed have worse clinical outcomes than their nondepressed counterparts. The purpose of this chapter is to introduce the reader to the study of depression in HF, and how psychoneuroimmunologic principles have been applied to further elucidate mechanisms (i.e., neurohormonal and cytokine activation) linking these comorbid disorders.
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Affiliation(s)
- Jessica A Jiménez
- Department of Psychology, College of Letters and Sciences, National University, La Jolla, CA, USA.
| | - Christine Tara Peterson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Paul J Mills
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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40
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Spaderna H, Zittermann A, Reichenspurner H, Ziegler C, Smits J, Weidner G. Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation. J Am Heart Assoc 2017; 6:JAHA.117.007016. [PMID: 29187384 PMCID: PMC5779021 DOI: 10.1161/jaha.117.007016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients. Methods and Results Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively). Conclusions Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.
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Affiliation(s)
- Heike Spaderna
- Division of Health Psychology, Department of Nursing Science, Trier University, Trier, Germany
| | - Armin Zittermann
- Department for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Hermann Reichenspurner
- University Heart Center at the University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Corinna Ziegler
- School of Education, Bergische Universitaet Wuppertal, Germany
| | - Jacqueline Smits
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Gerdi Weidner
- Department of Biology, San Francisco State University, San Francisco, CA
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Nordgren L, Söderlund A. Social support, self-rated health and low mood in people on sick leave due to heart failure: a cross-sectional study. Scand J Public Health 2017; 46:606-612. [PMID: 29160157 DOI: 10.1177/1403494817718070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate social support in relation to self-rated health and the prevalence of low mood in people on sick leave due to heart failure. METHODS A cross-sectional design was used, and 590 individuals on sick leave due to heart failure in Sweden responded to the postal questionnaire. The questions therein concerned received and needed functional and structural support from managers, work colleagues, families and friends. Multivariate analyses were conducted. RESULTS The variables of income and needed support from family contributed significantly and negatively to self-rated health. Those who perceived that they needed more support from their manager reported experiencing low mood more frequently. CONCLUSIONS The results showed a negative relation between manager support and low mood. Thus, support from managers and perceptions of low mood during sick leave are negatively associated, however, we do not know anything about the causality of this association. The results also indicated that needed support from family was negatively associated with self-rated health. The results also highlighted a multidimensional frailty in people with heart failure that needs to be recognized in future research as well as in clinical practice.
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Affiliation(s)
- Lena Nordgren
- 1 Centre for Clinical Research Sörmland, Uppsala University, Sweden.,2 Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anne Söderlund
- 3 School of Health, Care and Social Welfare, Mälardalen University, Sweden
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Kaar JL, Luberto CM, Campbell KA, Huffman JC. Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults. World J Cardiol 2017; 9:396-406. [PMID: 28603586 PMCID: PMC5442407 DOI: 10.4330/wjc.v9.i5.396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.
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43
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Moser DK. Heart Failure. West J Nurs Res 2017; 39:451-454. [DOI: 10.1177/0193945916687241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Berg SK, Rasmussen TB, Thrysoee L, Lauberg A, Borregaard B, Christensen AV, Ekholm O, Juel K, Svanholm JR. DenHeart: Differences in physical and mental health across cardiac diagnoses at hospital discharge. J Psychosom Res 2017; 94:1-9. [PMID: 28183396 DOI: 10.1016/j.jpsychores.2017.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe: (i) differences in patient reported physical and mental health outcomes at hospital discharge between a) cardiac diagnostic groups and b) cardiac patients and a national representative reference population and to describe (ii) in-hospital predicting factors for patient reported outcomes. METHODS A national cross-sectional survey combined with national register data. From April 2013 to April 2014 all patients (n=34,564) discharged or transferred from one of five Danish Heart Centres were invited to participate. 16,712 patients (51%) responded; 67% male and mean age 64years. All diagnostic groups were represented similar to real life proportions. Patient reported outcome measures included: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire, HeartQoL and Edmonton Symptom Assessment Scale. RESULTS Statistically significant differences were found in all patient reported outcomes across diagnostic groups. Listed from worst to best outcomes were heart failure, heart valve disease, ischemic heart disease, infectious heart disease, arrhythmia, congenital heart disease and heart transplant. Also "observation for cardiac disease" scored poorly on some aspects such as anxiety and treatment control. Compared to the reference population, cardiac patients had lower physical and mental health scores. Predicting factors for worse outcomes across diagnoses were female sex, older age, being unmarried, planned admission, longer hospital stay, and higher co-morbidity score. CONCLUSIONS This large nationwide study finds significant differences in patient reported outcomes across cardiac diagnostic groups, however the differences were small and did not reach minimal important difference. The total population of cardiac patients had significant and clinically relevant poorer scores on mental and physical health than the reference population. Predicting factors for poor outcomes were identified. It is the first study comparing all diagnostic groups within cardiology and it provides important benchmarks between diagnostic groups and future comparisons. This knowledge may help clinicians make better decisions about post-hospital care and prevention.
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Affiliation(s)
- Selina Kikkenborg Berg
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Astrid Lauberg
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Britt Borregaard
- Cardiothoracic- and Vascular Department, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Anne Vinggaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Jette Rolf Svanholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, 8200 Aarhus N, Denmark
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Affiliation(s)
- Mehnosh Toback
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| | - Nancy Clark
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
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