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Amirova A, Taylor L, Volkmer B, Ahmed N, Chater AM, Fteropoulli T. Informing behaviour change intervention design using systematic review with Bayesian meta-analysis: physical activity in heart failure. Health Psychol Rev 2023; 17:456-484. [PMID: 35701235 DOI: 10.1080/17437199.2022.2090411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 12/11/2022]
Abstract
Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).
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Affiliation(s)
- Aliya Amirova
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lauren Taylor
- Department of Psychology, University of Surrey, Guildford, UK
| | - Brittannia Volkmer
- Psychology department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- Mental Health Policy Research Unit, UCL Division of Psychiatry, London, UK
| | - Angel M Chater
- Centre for Behaviour Change, Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, UCL, London, UK
- Institute for Sport and Physical Activity Research (ISPAR), Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK
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Zhao Q, Mei J, Zhang X, Dong X, Zhang Y, Fan X. Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure. Clin Nurs Res 2023; 32:359-365. [PMID: 36068938 DOI: 10.1177/10547738221121437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (β = .222, p = .011) and physical symptoms (β = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (β = -.241, p < .01) and family functioning (β = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.
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Affiliation(s)
- Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | | | - Xiuting Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyu Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Kraemer KM, Kilgore K, Litrownik D, Jean-Laurent B, Wayne PM, Richardson CR, Moy ML, Yeh GY. A Web-Based Mind-Body Intervention (Mindful Steps) for Promoting Walking in Chronic Cardiopulmonary Disease: Insights From a Qualitative Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231212169. [PMID: 38050584 PMCID: PMC10693791 DOI: 10.1177/27536130231212169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 12/06/2023]
Abstract
Background Given the deleterious effects of physical inactivity in persons with chronic obstructive pulmonary disease (COPD) and/or heart failure (HF), interventions that promote long-term daily physical activity are needed. Mindful Steps, designed to promote walking behaviors in COPD and HF, is a multicomponent intervention that integrates mind-body content with other self-regulatory components. The aim of the current qualitative study was to characterize participants' experiences with Mindful Steps and understand the perceived influence of the intervention on walking and health. Method In the context of a pilot randomized controlled feasibility trial comparing the year-long Mindful Steps program to usual care among individuals with COPD and HF, semi-structured qualitative interviews were administered at 6- and 12-months. Interviews were audio recorded and transcribed. The constant comparative method was used to code transcripts, identify categories, and develop interrelated themes. Results Nineteen participants (63% female; Mage = 70.2 years, SD = 6.95) who were randomized to the intervention group completed the 6-month interview and 17 completed the 12-month interview. The pedometer with feedback, live group classes, and mind-body videos were described as the most helpful intervention components. Participants learned several strategies that helped their walking (e.g., breathing regulation and awareness, body awareness, mind-body techniques, pacing), described walking as enjoyable, and identified internal reasons for walking (e.g., to feel good). They also reported several physical and mental health benefits of the intervention. Some participants reported limited influence of the intervention on walking or health. Many participants continued to use the strategies they learned in the first half of the intervention at 12-months. Conclusions The mind-body content of Mindful Steps appeared to positively influence walking behaviors. Participants' experiences with the intervention helped to identify areas for future intervention refinement. Future quantitative work is needed to corroborate these qualitative findings and assess the efficacy of the intervention on long-term physical activity engagement. Trial Registration This trial is registered in Clinical Trials.gov, ID number NCT01551953.
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Affiliation(s)
- Kristen M. Kraemer
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Karen Kilgore
- University of Florida, Gainesville, FL, United States
| | - Daniel Litrownik
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, United States
| | | | - Peter M. Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, United States
| | | | - Marilyn L. Moy
- Harvard Medical School, Boston, MA, United States
- Veterans Administration Boston Healthcare System, Boston, MA, United States
| | - Gloria Y. Yeh
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, United States
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Klompstra L, Jaarsma T, Piepoli MF, Ben Gal T, Evangelista L, Strömberg A, Bäck M. Objectively measured physical activity in patients with heart failure: a sub-analysis from the HF-Wii study. Eur J Cardiovasc Nurs 2022; 21:499-508. [PMID: 34993536 DOI: 10.1093/eurjcn/zvab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Physical activity (PA) is important in patients with heart failure (HF) to improve health outcomes. The adherence to PA is low, and therefore, novel approaches are necessary to increase PA. We aimed to determine the difference in PA in patients with HF who have access to exergaming compared to patients who received motivational support and to explored predictors of a clinically relevant change in non-sedentary time between baseline and 3 months. METHODS AND RESULTS In total, 64 patients (mean age 69 ± 9 years, 27% female) wore an accelerometer 1 week before and 1 week after the intervention. Data were analysed using logistic regression analysis. Patients spent 9 h and 43 min (±1 h 23 min) during waking hours sedentary. There were no significant differences in PA between patients who received an exergame intervention or motivational support. In total, 30 of 64 patients achieved a clinically relevant increase in non-sedentary time. Having grandchildren [odds ratio (OR) 7.43 P = 0.03], recent diagnosis of HF (OR 0.93 P = 0.02), and higher social motivation (OR 2.31 P = 0.03) were independent predictors of a clinically relevant increase of non-sedentary time. CONCLUSION Clinicians should encourage their patients to engage in alternative approaches to improve PA and reduce sedentary habits. Future exergaming interventions should target individuals with chronic HF who have low social motivation and a low level of light PA that may benefit most from exergaming. Also (non-familial), intergenerational interaction is important to enabling patients in supporting patients in becoming more active.
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Affiliation(s)
- Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Massimo F Piepoli
- UO Scompenso e Cardiomiopatie, Ospedale G da Saliceto, Piacenza, Italy
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Objectively assessed physical activity and sedentary behavior and global cognitive function in older adults: a systematic review. Mech Ageing Dev 2021; 198:111524. [PMID: 34181963 DOI: 10.1016/j.mad.2021.111524] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both physical activity (PA) and sedentary behavior (SB) are important factors for healthy ageing. This systematic review aimed to determine the association of objectively assessed (instrumented) PA and SB with global cognitive function in older adults. METHODS PubMed, Embase, the Cochrane Library (via Wiley), CINAHL, PsychINFO, and SPORTDiscus (via EBSCO) were searched from inception to June 21, 2020 for articles that described associations of objectively assessed PA/SB with global cognitive function in older adults aged 60 years and older. Results were synthesized using an effect direction heat map and albatross plots portrayed estimated effect sizes (standardized regression coefficients (βs)), which were summarized in boxplots. RESULTS In total, 45 articles were included representing a total of 15,817 older adults (mean/median age ranged from 65 to 88 years; 49.5% female). Longitudinal studies (n = 7) showed that higher moderate-to-vigorous and light PA (MVPA and LPA, respectively) and lower SB were associated with better global cognitive function. Standardized βs of cross-sectional studies (n = 38) showed that lower SB (median [IQR], β = 0.078 [0.004-0.184] and higher LPA (β = 0.096 [0.046-0.188]), activity counts (β = 0.131 [0.049-0.224]), number of steps (β = 0.155 [0.096-0.246]), MVPA (β = 0.163 [0.069-0.285]) and total PA (TPA) (β = 0.174 [0.147-0.255]) were associated with better global cognitive function. CONCLUSIONS Higher PA and lower SB are associated with better global cognitive function in older adults. The greatest estimated effect sizes were found for moderate-to-vigorous and TPA, suggesting that greater duration of any PA, and high intensity PA could be most beneficial for global cognitive function.
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Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rich MW. Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210006. [PMID: 33954261 PMCID: PMC8096199 DOI: 10.20900/jpbs.20210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart failure (HF) is a common cause of hospitalization and mortality in older adults. HF is almost always embedded within a larger pattern of multimorbidity, yet many studies exclude patients with complex psychiatric and medical comorbidities or cognitive impairment. This has left significant gaps in research on the problems and treatment of patients with HF. In addition, HF is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities that may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. The syndemics framework has yielded important insights into other disorders such as HIV/AIDS, but it has not been applied to the complex psychosocial problems of patients with HF. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims are: (1) to determine the coprevalence of psychiatric and medical comorbidities in patients with HF (n = 535); (2) to determine whether coprevalent comorbidities have synergistic effects on readmissions, mortality, self-care, and global health; (3) to identify vulnerable subpopulations of patients with HF who have high coprevalences of syndemic comorbidities; (4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes in vulnerable subgroups of patients with HF; and (5) to determine the effects of multimorbidity on readmissions, mortality, self-care, and global health.
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Affiliation(s)
- Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Judith A. Skala
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Robert M. Carney
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Brian C. Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Michael W. Rich
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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Kim YJ, Joshi V, Wu Q. Subjective factors of depressive symptoms, ambulation, pain, and fatigue are associated with physical activity participation in cardiac arrest survivors with fatigue. Resusc Plus 2021; 5:100057. [PMID: 34223329 PMCID: PMC8244480 DOI: 10.1016/j.resplu.2020.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 02/08/2023] Open
Abstract
AIM This study aimed to examine the associations between participation in physical activities and objective and subjective factors modifiable by rehabilitation in cardiac arrest survivors with fatigue. METHODS Participants in a clinical feasibility study (N = 19) completed several subjective (patient-reported) and objective outcome measures on one occasion only. The associations between an individual's level of participation in physical activities (Participation Objective Participation Subjective) and their levels of cognition (Computer Assessment of Mild Cognitive Impairment), body movement (Keitel Functional Test), depressive symptoms (Center for Epidemiologic Studies Depression Scale), ambulation and pain (Health Utilities Index Mark 3), and fatigue impact (Modified Fatigue Impact Scale) were explored. Pearson's correlation coefficientr was calculated for all associations, except for body movement (Spearman's correlation coefficient rs ). RESULTS As hypothesized, we found weak-to-moderate, positive associations between participation in physical activities and objective factors of cognition (r = 0.370) and body movement (rs = 0.414) and a subjective factor of ambulation ability (r = 0.501). We found moderate, negative associations between participation in physical activities and subjective factors of depressive symptoms (r=-0.590), pain (r=-0.495), physical fatigue impact (r=-0.629), cognitive fatigue impact (r=-0.591), and psychosocial fatigue impact (r=-0.557). CONCLUSION The moderate, negative and positive associations between participation in physical activities and subjective factors suggest that subjective complaints of depressive symptoms, ambulation ability, pain, and fatigue impact may be important factors when seeking to improve participation in physical activities. In particular, addressing physical and cognitive endurance as well as perceptions of fatigue may hold the key to increasing physical activity in cardiac arrest survivors with fatigue.
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Affiliation(s)
- Young Joo Kim
- 600 Moye Blvd, MS668, HSB3305, Department of Occupational Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC, 27834, USA
| | - Vicky Joshi
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), University of Southern Denmark, and Odense University Hospital, Denmark
| | - Qiang Wu
- 600 Moye Blvd, 2209 East Carolina Heart Institute, Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, 27834, USA
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Brezing CA, Luo SX, Mariani JJ, Levin FR. Digital Clinical Trials for Substance Use Disorders in the Age of Covid-19. J Addict Med 2020; 14:e297-e302. [PMID: 32956164 PMCID: PMC7647443 DOI: 10.1097/adm.0000000000000733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
: As a result of the coronavirus 2019 (Covid-19) pandemic, clinical research for substance use disorders (SUDs) has been impeded due to widespread stay-at-home mandates limiting the operations of "non-essential" work. Although appropriate to proceed with an abundance of caution to prevent viral spread, there will be detrimental consequences for patients with SUDs if clinical trials research cannot adapt and continue uninterrupted. The field of digital health has strong evidence for its feasibility and effectiveness and offers tools that can facilitate the continuation of SUD clinical trials research remotely in accordance with Covid-19 precautions. Some digital tools have been used as components of SUD research in the past; however, no published clinical trial in SUDs to-date has been entirely virtual. This has important implications for disrupted clinical care, as providers seek guidelines for best digital practices. This paper provides a roadmap for integrating the fields of digital health and SUD clinical trials by proposing methods to complete recruitment, screening, informed consent, other study procedures, and internal lab operations digitally. The immediate future of SUD research depends on the ability to comply with social distancing. Investment in research of digital clinical trials for SUDs provides an opportunity to cultivate benefits for research and clinical care long-term as we can (1) define regulatory requirements for the implementation of digital systems, (2) develop consensus on system-wide standards and protocols in the appropriate use of technology, and (3) gain experience that can translate to the treatment of patients with SUDs through telehealth in the community.
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Affiliation(s)
- Christina A Brezing
- New York State Psychiatric Institute, Division of Substance Use Disorders, 1051 Riverside Drive, New York, NY(CB, SL, JM, FL); Department of Psychiatry, Columbia University Irving Medical Center, New York, NY (CB, SL, JM, FL)
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Chen AMH, Yehle KS, Plake KS, Rathman LD, Heinle JW, Frase RT, Anderson JG, Bentley J. The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model. Heart Lung 2020; 49:702-708. [PMID: 32861889 DOI: 10.1016/j.hrtlng.2020.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.
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Affiliation(s)
- Aleda M H Chen
- Assistant Dean and Associate Professor, Cedarville University School of Pharmacy, 251N. Main St., Cedarville, OH 45314, USA.
| | - Karen S Yehle
- Professor Emerita, Purdue University, School of Nursing, 502N. University Street, West Lafayette, IN, 47907, USA.
| | - Kimberly S Plake
- Associate Head of Professional Education, Associate Professor, Director, Purdue University Academic and Ambulatory Care Fellowship Program, Faculty Associate, Center for Aging and the Life Course, 575 Stadium Mall Dr., West Lafayette, IN, 47907, USA.
| | - Lisa D Rathman
- Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health/PENN Medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA.
| | - J Wes Heinle
- At time of project: Research Assistant, The Heart Group of Lancaster General Health/PENN medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA
| | - Robert T Frase
- Graduate Student, Purdue University, Department of Sociology, 700W. State Street, West Lafayette, IN 47907, USA.
| | - James G Anderson
- Purdue University, Department of Medical Sociology and Health Communication, 700W. State Street, West Lafayette, IN 47907, USA.
| | - John Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Faser Hall 225, University, MS, 38677, USA.
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Vetrovsky T, Clark CCT, Bisi MC, Siranec M, Linhart A, Tufano JJ, Duncan MJ, Belohlavek J. Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations. ESC Heart Fail 2020; 7:2021-2031. [PMID: 32618431 PMCID: PMC7524133 DOI: 10.1002/ehf2.12781] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Accelerometers are becoming increasingly commonplace for assessing physical activity; however, their use in patients with cardiovascular diseases is relatively substandard. We aimed to systematically review the methods used for collecting and processing accelerometer data in cardiology, using the example of heart failure, and to provide practical recommendations on how to improve objective physical activity assessment in patients with cardiovascular diseases by using accelerometers. Methods and results Four electronic databases were searched up to September 2019 for observational, interventional, and validation studies using accelerometers to assess physical activity in patients with heart failure. Study and population characteristics, details of accelerometry data collection and processing, and description of physical activity metrics were extracted from the eligible studies and synthesized. To assess the quality and completeness of accelerometer reporting, the studies were scored using 12 items on data collection and processing, such as the placement of accelerometer, days of data collected, and criteria for non‐wear of the accelerometer. In 60 eligible studies with 3500 patients (of those, 536 were heart failure with preserved ejection fraction patients), a wide variety of accelerometer brands (n = 27) and models (n = 46) were used, with Actigraph being the most frequent (n = 12), followed by Fitbit (n = 5). The accelerometer was usually worn on the hip (n = 32), and the most prevalent wear period was 7 days (n = 22). The median wear time required for a valid day was 600 min, and between two and five valid days was required for a patient to be included in the analysis. The most common measures of physical activity were steps (n = 20), activity counts (n = 15), and time spent in moderate‐to‐vigorous physical activity (n = 14). Only three studies validated accelerometers in a heart failure population, showing that their accuracy deteriorates at slower speeds. Studies failed to report between one and six (median 4) of the 12 scored items, with non‐wear time criteria and valid day definition being the most underreported items. Conclusions The use of accelerometers in cardiology lacks consistency and reporting on data collection, and processing methods need to be improved. Furthermore, calculating metrics based on raw acceleration and machine learning techniques is lacking, opening the opportunity for future exploration. Therefore, we encourage researchers and clinicians to improve the quality and transparency of data collection and processing by following our proposed practical recommendations for using accelerometers in patients with cardiovascular diseases, which are outlined in the article.
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Affiliation(s)
- Tomas Vetrovsky
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Cain C T Clark
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Maria Cristina Bisi
- Department of Electrical, Electronic and Information Engineering 'Guglielmo Marconi', DEI, University of Bologna, Bologna, Italy
| | - Michal Siranec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - James J Tufano
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michael J Duncan
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103738. [PMID: 32466242 PMCID: PMC7277615 DOI: 10.3390/ijerph17103738] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022]
Abstract
Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.
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12
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Chen MF, Ke SR, Liu CL, Wu TC, Yu YM, Chiou AF. Associated factors and impacts of sedentary behaviour in patients with heart failure: A longitudinal study. Eur J Cardiovasc Nurs 2020; 19:609-618. [PMID: 32338530 DOI: 10.1177/1474515120912381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sedentary behaviours may be related to factors such as self-efficacy, mood and social support. However, there is a paucity of longitudinal follow-up studies examining factors related to sedentary behaviour from physical-psychosocial perspectives in patients with heart failure. AIMS The purpose of this study was to explore the multidimensional associated factors and impacts of sedentary behaviour in heart failure patients. METHODS A longitudinal design was used. A convenience sample of 128 heart failure patients recruited from two large medical centres in northern Taiwan was obtained. Patients were interviewed with structured questionnaires to assess physical activity, symptom distress, exercise self-efficacy, anxiety and depression, social support, sleep quality and quality of life before discharge and at 3 and 6 months after discharge. RESULTS Heart failure patients reported low physical activity and tended to be sedentary. Sedentary behaviour was gradually reduced from hospitalization to 6 months after discharge. Sleep quality, quality of life, analgesic use, symptom distress and exercise self-efficacy were significant associated factors that explained 42.1-51% of the variance in sedentary behaviour. Patients with high sedentary behaviour had significantly greater depression and poorer sleep and quality of life than those with low sedentary behaviour at hospitalization and showed a significant improvement in depression at 3 and 6 months after discharge. CONCLUSION Sedentary behaviour is common in heart failure patients and has impacts on depression and quality of life. An appropriate physical activity programme focusing on disease self-management and enhancing self-efficacy is needed for heart failure patients to improve their sedentary behaviour and quality of life.
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Affiliation(s)
- Mei-Fang Chen
- Department of Nursing, Far Eastern Memorial Hospital, Taiwan
| | - Shin-Rong Ke
- Cardiovascular Medicine Department, Far Eastern Memorial Hospital, Taiwan.,General Education Center, Chihlee University of Technology, Taiwan
| | - Chih-Ling Liu
- Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Tao-Cheng Wu
- Division of Cardiology, Taipei Veterans General Hospital, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taiwan
| | - Ya-Mei Yu
- Department of Nursing, Far Eastern Memorial Hospital, Taiwan
| | - Ai-Fu Chiou
- School of Nursing, National Yang-Ming University, Taiwan
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13
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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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The Association Between Depressive Symptoms and N-Terminal Pro-B-Type Natriuretic Peptide With Functional Status in Patients With Heart Failure. J Cardiovasc Nurs 2019; 33:378-383. [PMID: 29438191 DOI: 10.1097/jcn.0000000000000470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) and depressive symptoms are each associated with functional status in patients with heart failure (HF), but their association together with functional status has not been examined. OBJECTIVE The aim of this study was to determine whether functional status scores differ as a function of depressive symptoms and NT-proBNP levels considered together. METHODS We studied 284 patients with HF who were divided into 4 groups based on the median split of NT-proBNP levels and cut point for depressive symptoms (Beck Depression Inventory ≥ 14): (1) low NT-proBNP of 562.5 pg/mL or less without depressive symptoms, (2) low NT-proBNP of 562.5 pg/mL or less with depressive symptoms, (3) high NT-proBNP of greater than 562.5 pg/mL without depressive symptoms, and (4) high NT-proBNP of greater than 562.5 pg/mL with depressive symptoms. The Duke Activity Status Index was used to assess functional status. RESULTS Nonlinear regression demonstrated that patients without depressive symptoms were more than twice as likely to have higher (better) functional status scores than patients with depressive symptoms regardless of NT-proBNP levels after controlling for age, gender, prescribed antidepressants, and body mass index. Functional status levels of patients with low NT-proBNP did not differ from those with high NT-proBNP in the presence of depressive symptoms. CONCLUSION When examined together, depressive symptoms rather than NT-proBNP levels predicted functional status. CLINICAL IMPLICATIONS Adequate treatment of depressive symptoms may lead to better functional status regardless of HF severity.
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Walter FA, Gathright E, Redle JD, Gunstad J, Hughes JW. Depressive Symptoms are Associated with Heart Rate Variability Independently of Fitness: A Cross-Sectional Study of Patients with Heart Failure. Ann Behav Med 2019; 53:955-963. [PMID: 30958884 PMCID: PMC6779069 DOI: 10.1093/abm/kaz006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is associated with reduced heart rate variability (HRV) in healthy and cardiac samples, which may be accounted for by physical fitness. In a small sample of cardiac patients, activity and fitness levels attenuated the relationship between HRV and depression. In the current study of heart failure (HF) patients, we hypothesized that depressive symptoms and HRV would be inversely related and physical fitness would attenuate this association. PURPOSE To determine if previous associations among depressive symptoms, physical fitness, and HRV would replicate in a sample of HF patients. METHODS The sample consisted of HF patients (N = 125) aged 68.55 ± 8.92 years, 68.8% male, and 83.2% Caucasian. The study was cross-sectional and a secondary analysis of a nonrandomized clinical trial (Trial Identifier: NCT00871897). Depressive symptoms were evaluated using the Beck Depression Inventory (BDI)-II, fitness with the 2 min step test (2MST), and HRV during a 10 min resting laboratory psychophysiology protocol. The dependent variable in hierarchical linear regressions was the root mean square of successive differences. RESULTS Controlling for sex, age, β-blocker use, hypertension, and diabetes, higher BDI-II scores significantly predicted lower HRV, β = -.29, t(92) = -2.79, p < .01. Adding 2MST did not attenuate the relationship in a follow-up regression. CONCLUSION Depressive symptoms were associated with lower HRV in HF patients, independent of physical fitness. Given the prevalence of depression and suppressed HRV common among HF patients, interventions addressing depressive symptoms and other predictors of poor outcomes may be warranted.
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Affiliation(s)
- Fawn A Walter
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Emily Gathright
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Joseph D Redle
- Summa Health Systems, Cardiovascular Institute, Akron City Hospital, Akron, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Abstract
Cognitive behavioral therapy has emerged as an important approach to alleviate the depression of patients with heart failure. However, the use of cognitive behavioral therapy for heart failure has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of cognitive behavioral therapy for alleviating depression for heart failure.PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of cognitive behavioral therapy on heart failure are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model.Eight RCTs involving 480 patients are included in the meta-analysis. Compared with control intervention for heart failure, cognitive behavioral therapy can substantially decrease depression scale (Std. MD = -0.27; 95% CI = -0.47 to -0.06; P = 0.01), but has no substantial influence on the quality of life (Std. MD = 0.21; 95% CI = -0.01 to 0.42; P = 0.06), self-care scores (Std. MD = 0.12; 95% CI = -0.18 to 0.42; P = 0.44), and 6-minute walk test distance (Std. MD = 0; 95% CI = -0.28 to 0.28; P = 0.99).Cognitive behavioral therapy is associated with significantly decreased depression scale, but with no substantial impact on the quality of life, self-care scores, and 6-minute walk test distance for heart failure.
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Affiliation(s)
- Yan Peng
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Junjie Fang
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
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Haedtke CA, Moser DK, Pressler SJ, Chung ML, Wingate S, Goodlin SJ. Influence of depression and gender on symptom burden among patients with advanced heart failure: Insight from the pain assessment, incidence and nature in heart failure study. Heart Lung 2019; 48:201-207. [PMID: 30879736 PMCID: PMC7582916 DOI: 10.1016/j.hrtlng.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/07/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients with advanced heart failure (HF) experience many burdensome symptoms that increase patient suffering. METHODS Comparative secondary analysis of 347 patients with advanced HF. Symptom burden was measured with the Memorial Symptom Assessment Scale-HF. Depression was measured using the Patient Health Questionnaire-9. RESULTS Mean number of symptoms was 13.6. The three most frequent symptoms were non-cardiac pain, shortness of breath, and lack of energy. Patients with depression reported higher symptom burden. Symptom burden differed when compared by gender. Women reported higher symptom burden for other pain, dry mouth, swelling of the arms and legs, sweats, feeling nervous, nausea, and vomiting. Men reported higher symptom burden with sexual problems. CONCLUSIONS Given the high rates of symptoms and distress, interventions are needed to alleviate the symptom burden of patients with advanced HF. Reported symptom burden in patients with advanced heart failure was higher when depressive symptoms were present. Women reported varied number and severity of symptoms than men.
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Affiliation(s)
- Christine A Haedtke
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Debra K Moser
- University of Kentucky College of Nursing, 2201 Regency Road, Suite 403, Lexington, KY 40503, United States
| | - Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Misook L Chung
- University of Kentucky College of Nursing, 2201 Regency Road, Suite 403, Lexington, KY 40503, United States
| | - Sue Wingate
- National Institutes of Health, Building 10 Room 2-1339, Bethesda, MD 20892, United States
| | - Sarah J Goodlin
- Patient-Centered Education and Research Portland, OR and Salt Lake City, UT, United States
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Tan MKH, Wong JKL, Bakrania K, Abdullahi Y, Harling L, Casula R, Rowlands AV, Athanasiou T, Jarral OA. Can activity monitors predict outcomes in patients with heart failure? A systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:11-21. [PMID: 30215706 DOI: 10.1093/ehjqcco/qcy038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
Actigraphy is increasingly incorporated into clinical practice to monitor intervention effectiveness and patient health in congestive heart failure (CHF). We explored the prognostic impact of actigraphy-quantified physical activity (AQPA) on CHF outcomes. PubMed and Medline databases were systematically searched for cross-sectional studies, cohort studies or randomised controlled trials from January 2007 to December 2017. We included studies that used validated actigraphs to predict outcomes in adult HF patients. Study selection and data extraction were performed by two independent reviewers. A total of 17 studies (15 cohort, 1 cross-sectional, 1 randomised controlled trial) were included, reporting on 2,759 CHF patients (22-89 years, 27.7% female). Overall, AQPA showed a strong inverse relationship with mortality and predictive utility when combined with established risk scores, and prognostic roles in morbidity, predicting cognitive function, New York Heart Association functional class and intercurrent events (e.g. hospitalisation), but weak relationships with health-related quality of life scores. Studies lacked consensus regarding device choice, time points and thresholds of PA measurement, which rendered quantitative comparisons between studies difficult. AQPA has a strong prognostic role in CHF. Multiple sampling time points would allow calculation of AQPA changes for incorporation into risk models. Consensus is needed regarding device choice and AQPA thresholds, while data management strategies are required to fully utilise generated data. Big data and machine learning strategies will potentially yield better predictive value of AQPA in CHF patients.
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Affiliation(s)
- Matthew K H Tan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joanna K L Wong
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kishan Bakrania
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK
| | - Yusuf Abdullahi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Leanne Harling
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Roberto Casula
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, UK
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19
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Bendassolli IMF, Oliveira AG, Costa EC, Souza DLBD, Maia EMC. Sedentary behavior is associated with physical activity, functional capacity, and a history of stroke in patients with heart failure. A cross-sectional study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-657420180003e001418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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20
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Caring for Aging Populations: Examining Compassion Fatigue and Satisfaction. JOURNAL OF ADULT DEVELOPMENT 2018. [DOI: 10.1007/s10804-018-9315-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Haedtke C, Smith M, VanBuren J, Klein D, Turvey C. The Relationships Among Pain, Depression, and Physical Activity in Patients With Heart Failure. J Cardiovasc Nurs 2018; 32:E21-E25. [PMID: 28306701 PMCID: PMC5555784 DOI: 10.1097/jcn.0000000000000399] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Increasing patients' physical activity levels holds many opportunities to facilitate health and well-being among those with heart failure (HF) by improving HF symptoms and decreasing depression and pain. Given low exercise participation rates, an essential first step to increase exercise rates is to evaluate how pain and depression may further influence engagement in exercise programs. AIMS The aims of this study were to describe the level of physical activity and exercise that patients with HF with depression achieve and to investigate the relationships among pain, depression, total activity time, and sitting time. METHODS In this correlational cross-sectional study, we analyzed data from 61 participants with depression and New York Heart Association class II to IV HF. RESULTS AND CONCLUSIONS The total time spent being active was less than 1 hour per day. Depressed patients with HF have much lower physical activity levels than the general public. Decreasing sitting time and increasing light activity levels hold promise to improve pain and depression symptoms.
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Affiliation(s)
- Christine Haedtke
- Post-Doctoral Clinical Scholar in Cardiovascular Science, The University of Kentucky, College of Nursing, 2201 Regency Road, Suite 403 Lexington, KY 40503 USA, , Phone: 1(859)323-4883, Fax: 1(859)257-0554
| | - Marianne Smith
- Associate Professor and the Education Director for the Hartford Center of Geriatric Nursing Excellence, University of Iowa, College of Nursing, Iowa City, IA, 52242, USA,
| | - John VanBuren
- Assistant Professor, Department of Pediatrics - Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah 84132 USA,
| | - Dawn Klein
- Research Manager, University of Iowa, Psychiatry Research, Research Coordinator (Affiliate), Iowa City VA Health Care System, Iowa City, IA, 52242 USA,
| | - Carolyn Turvey
- Professor of Psychiatry and of Epidemiology, The University of Iowa Carver College of Medicine; Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, IA, 52242, USA,
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Ludwig VM, Bayley A, Cook DG, Stahl D, Treasure JL, Asthworth M, Greenough A, Winkley K, Bornstein SR, Ismail K. Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study. BMJ Open 2018; 8:e020942. [PMID: 29654044 PMCID: PMC5898324 DOI: 10.1136/bmjopen-2017-020942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Depressive symptoms are common but rarely considered a risk factor for unhealthy lifestyles associated with cardiovascular disease (CVD). This study investigates whether depressive symptoms are associated with reduced physical activity (PA) in individuals at high risk of developing CVD. DESIGN Secondary analysis of the cross-sectional baseline data from a randomised controlled trial of an intensive lifestyle intervention. SETTING 135 primary care practices in South London, UK. PARTICIPANTS 1742 adults, 49-74 years, 86% male at high (≥20%) risk of developing CVD in the next 10 years as defined via QRISK2 score. OUTCOME MEASURES The main explanatory variable was depressive symptoms measured via the Patient Health Questionnaire-9 (PHQ-9). The main outcome was daily step count measured with an accelerometer (ActiGraph GT3X) stratified by weekdays and weekend days. RESULTS The median daily step count of the total sample was 6151 (IQR 3510) with significant differences (P<0.001) in mean daily step count between participants with low (PHQ-9 score: 0-4), mild (PHQ-9 score: 5-9) and moderate to severe depressive symptoms (PHQ-9 score: ≥10). Controlling for age, gender, ethnicity, education level, body mass index (BMI), smoking, consumption of alcohol, day of the week and season, individuals with mild depressive symptoms and those with moderate to severe depressive symptoms walked 13.3% (95% CI 18.8% to 7.9%) and 15.6% (95% CI 23.7% to 6.5%) less than non-depressed individuals, respectively. Furthermore, male gender, white ethnicity, higher education level, lower BMI, non-smoking, moderate alcohol intake, weekdays and summer season were independently associated with higher step count. CONCLUSIONS People at high risk of CVD with depressive symptoms have lower levels of PA. TRIAL REGISTRATION ISRCTN84864870; Pre-results.
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Affiliation(s)
- Vera M Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet L Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Asthworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Anne Greenough
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Son YJ, Seo EJ. Depressive Symptoms and Physical Frailty in Older Adults With Chronic Heart Failure: A Cross-Sectional Study. Res Gerontol Nurs 2018; 11:160-168. [PMID: 29451933 DOI: 10.3928/19404921-20180207-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
Abstract
Depressive symptoms and physical frailty have been reported to be predictive of adverse outcomes in individuals with heart failure (HF). Depressive symptoms could be a predisposing factor of physical frailty in older adults. Despite the high prevalence of HF, few studies on the relationship between these two factors have been performed in older adults with HF. To identify the relationship between depressive symptoms and physical frailty in HF, 190 older adults with HF were recruited from an outpatient clinic at a tertiary hospital in South Korea. The prevalence of depressive symptoms and physical frailty in older adults with HF was 30% (n = 57) and 61.6% (n = 117), respectively. Multivariate logistic regression revealed that depressive symptoms most strongly increased the risk of physical frailty after adjusting for confounding factors. Early detection of depressive symptoms might be useful to identify the status of physical frailty at the illness trajectories of HF in older adults and for judicious allocation of disease management strategies. [Res Gerontol Nurs. 2018; 11(3):160-168.].
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Liljeroos M, Strömberg A, Årestedt K, Chung ML. Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners. Eur J Cardiovasc Nurs 2018; 17:527-534. [PMID: 29381082 DOI: 10.1177/1474515118755721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. AIM The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. METHODS In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. RESULTS We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. CONCLUSION Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.
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Affiliation(s)
- Maria Liljeroos
- 1 Division of Nursing Sciences, Linköping University, Sweden.,2 Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- 1 Division of Nursing Sciences, Linköping University, Sweden.,3 Department of Cardiology, Linköping University, Sweden
| | - Kristofer Årestedt
- 1 Division of Nursing Sciences, Linköping University, Sweden.,4 Faculty of Health and Life Sciences, Linnaeus University, Sweden.,5 Kalmar County Council, Sweden
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Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients With an Implantable Cardioverter Defibrillator. J Cardiopulm Rehabil Prev 2017; 37:130-138. [PMID: 28225475 DOI: 10.1097/hcr.0000000000000229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D. METHODS Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period. RESULTS In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P < .05). No significant changes were observed in the control group. CONCLUSION Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.
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Joven MH, Croghan IT, Quigg SM, Ebbert JO, Takahashi PY. Predictors of sedentary status in overweight and obese patients with multiple chronic conditions: a cohort study. Pragmat Obs Res 2017; 8:203-209. [PMID: 29042828 PMCID: PMC5633315 DOI: 10.2147/por.s139097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Walking may improve health in obese patients with multimorbidity. We aimed to identify predictors associated with achieving <5000 steps per day after 4 months. Patients and methods We conducted a cohort study of 125 adult patients with a body mass index >25 kg/m2 and ≥7 comorbidities. We evaluated potential predictors for <5000 steps per day using logistic regression and adjusting for age >65 years and sex. Results The mean (range) age was 63.6 (20.3–89.8) years. Daily step counts <5000 at baseline showed the highest risk of <5000 daily steps at 4 months (odds ratio [OR] 31.82, 95% confidence interval [CI]: 12.14–95.50). Other significant characteristics were physical quality of life (OR 6.21, 95% CI: 2.32–18.54), gait speed <1 m/s (OR 2.57, 95% CI: 1.18–5.71), age ≥65 years (OR 2.21, 95% CI: 1.05–4.77), waist circumference ≥102 cm (OR 2.48, 95% CI: 1.05–6.06), and body mass index ≥30 kg/m2 (OR 2.69, 95% CI: 1.20–6.26). Conclusion New models to increase walking may be required for higher-risk patients.
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Affiliation(s)
- Mark H Joven
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Ivana T Croghan
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Stephanie M Quigg
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
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Snipelisky D, Kelly J, Levine JA, Koepp GA, Anstrom KJ, McNulty SE, Zakeri R, Felker GM, Hernandez AF, Braunwald E, Redfield MM. Accelerometer-Measured Daily Activity in Heart Failure With Preserved Ejection Fraction: Clinical Correlates and Association With Standard Heart Failure Severity Indices. Circ Heart Fail 2017; 10:e003878. [PMID: 28588021 DOI: 10.1161/circheartfailure.117.003878] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/26/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Daily physical activity assessed by accelerometers represents a novel method to assess the impact of interventions on heart failure (HF) patients' functional status. We hypothesized that daily activity varies by patient characteristics and correlates with established measures of HF severity in HF with preserved ejection fraction. METHODS AND RESULTS In this ancillary study of the NEAT-HFpEF trial (Nitrate's Effects on Activity Tolerance in HF With Preserved Ejection Fraction), average daily accelerometer units (ADAU) and hours active per day were assessed during a 14-day period before starting isosorbide mononitrate or placebo (n=110). Baseline ADAU was negatively associated with age, female sex, height, and body mass index, and these variables accounted for 28% of the variability in ADAU (P<0.007 for all). Adjusting for these factors, patients with lower ADAU were more likely to have had an HF hospitalization, orthopnea, diabetes mellitus and anemia, be treated with β-blockers, have higher ejection fraction, relative wall thickness and left atrial volume, and worse New York Heart Association class, HF-specific quality of life scores, 6-minute walk distance, and NT-proBNP (N-terminal pro-B-type natriuretic peptide; P<0.05 for all). Associations between hours active per day and clinical characteristics were similar. Relative to baseline, there were no significant associations between changes in ADAU or hours active per day and changes in standard functional assessments (New York Heart Association, quality of life, 6-minute walk distance, and NT-proBNP) with isosorbide mononitrate. CONCLUSIONS Daily activity is a measure of HF-related and global functional status in HF with preserved ejection fraction. As compared with intermittently assessed standard HF assessments, change in daily activity may provide unique information about the impact of HF interventions on functional status. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02053493.
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Affiliation(s)
- David Snipelisky
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Jacob Kelly
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - James A Levine
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Gabriel A Koepp
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Kevin J Anstrom
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Steven E McNulty
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Rosita Zakeri
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - G Michael Felker
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Adrian F Hernandez
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Eugene Braunwald
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.)
| | - Margaret M Redfield
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (D.S., R.Z., M.M.R.); Duke Clinical Research Institution, Duke University, Durham, NC (J.K., K.J.A., S.E.M., G.M.F., A.F.H.); Endocrine Research Unit, Mayo Clinic, Phoenix, AZ (J.A.L., G.A.K.); and Brigham and Women's Hospital, Boston, MA (E.B.).
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Häusser JA, Mojzisch A. The physical activity-mediated Demand–Control (pamDC) model: Linking work characteristics, leisure time physical activity, and well-being. WORK AND STRESS 2017. [DOI: 10.1080/02678373.2017.1303759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Andreas Mojzisch
- Institute of Psychology, University of Hildesheim, Hildesheim, Germany
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Chung ML, Park L, Frazier SK, Lennie TA. Long-Term Adherence to Low-Sodium Diet in Patients With Heart Failure. West J Nurs Res 2017; 39:553-567. [PMID: 27903829 DOI: 10.1177/0193945916681003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although following a low-sodium diet (LSD) for heart failure (HF) has been recommended for decades, little is known about factors related to long-term patient adherence. The purposes of this study were to (a) compare sodium intake and factors affecting adherence in a long-term adherent group and in a non-adherent group and (b) examine predictors of membership in the long-term adherent group. Patients with HF ( N = 74) collected 24-hr urine samples and completed the Dietary Sodium Restriction Questionnaire and the Patient Health Questionnaire-9. Long-term adherence was determined using the Stage of Dietary Behavior Change Scale. The long-term adherent group had lower sodium intake (3,086 mg vs. 4,135 mg, p = .01) and perceived more benefits from LSD than the non-adherent group. Only positive attitudes toward LSD predicted membership in the long-term adherence group (odds ratio [OR] = 1.18, p = .005). Interventions focused on enhancing positive perceptions of the benefits of an LSD may improve long-term dietary adherence in patients with HF.
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Affiliation(s)
| | - Linda Park
- 2 University of California, San Francisco, CA, USA
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Grabowski P, Wilson J, Walker A, Enz D, Wang S. Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility. Phys Ther Sport 2017; 23:22-30. [DOI: 10.1016/j.ptsp.2016.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 02/01/2023]
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Lundgren JG, Dahlström Ö, Andersson G, Jaarsma T, Kärner Köhler A, Johansson P. The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial. J Med Internet Res 2016; 18:e194. [PMID: 27489077 PMCID: PMC5070581 DOI: 10.2196/jmir.5556] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022] Open
Abstract
Background Depressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms. Objective The aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms. Methods Fifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean. Results No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients. Conclusions Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected. ClinicalTrial Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN)
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Affiliation(s)
- Johan Gustav Lundgren
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
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Abstract
OBJECTIVE Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. METHODS Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. RESULTS Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44). CONCLUSIONS Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
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Abstract
Cognitive impairment in heart failure (HF) is believed to in part stem from structural brain alterations, including shrinkage of subcortical regions. Fortunately, neurocognitive dysfunction in HF can be mitigated by physical activity (PA), though mechanisms for this phenomenon are unclear. PA is protective against age-related cognitive decline that may involve improved structural integrity to brain regions sensitive to aging (e.g., subcortical structures). Yet, no study has examined the benefits of PA on the brain in HF and we sought to do so and clarify related cognitive implications. Fifty older adults with HF completed a neuropsychological battery and wore an accelerometer for 7 days. All participants underwent brain MRI. This study targeted subcortical brain volume given subcortical alterations are often observed in HF and the sensitivity of PA to subcortical structures in other patient populations. Participants averaged 4348.49 (SD=2092.08) steps per day and greater daily steps predicted better attention/executive function, episodic memory, and language abilities, p's<.05. Medical and demographically adjusted regression analyses revealed higher daily steps per day predicted greater subcortical volume, with specific effects for the thalamus and ventral diencephalon, p's<.05. Greater subcortical volume was associated with better attention/executive function, p<.05. Higher daily PA was associated with increased subcortical brain volume and better cognition in older adults with HF. Longitudinal work is needed to clarify whether daily PA can attenuate brain atrophy in HF to reduce accelerated cognitive decline in this population.
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Determinants of Physical Activity Guideline Attainment in Australian Cardiac Patients: A 12-Month Study. J Cardiopulm Rehabil Prev 2015; 35:399-408. [PMID: 26378492 DOI: 10.1097/hcr.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Little is known about the type and intensity of physical activity (PA) reported by cardiac patients during the first year after hospitalization and whether patients are meeting recommended PA guidelines. In addition, the achievement of PA guideline over the course of recovery is largely unknown. METHODS A total of 136 patients consecutively admitted to 2 Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%), were interviewed at 6 weeks and at 4 and 12 months after admission. Physical activity at each time point was assessed by the Active Australia PA Survey. Medical and sociodemographic data, self-reported anxiety and depression, and cardiac rehabilitation attendance status were also recorded. Logistic regression was used to identify predictors of PA guideline attainment at each of the 3 time points. RESULTS At all 3 time points, walking was regularly performed by more than 95% of patients, while moderate- and vigorous-intensity PA reached only 40% and 59% participation by 12 months, respectively. Significant predictors of PA guideline attainment at 6 weeks posthospitalization were physical functioning, depression, and mode of PA. As hypothesized, different predictors were found at 4 months (living arrangements, PA mode, and attainment of 6-week PA guidelines) and 12 months (living arrangements, socioeconomic resources, PA mode, and attainment of 6-week PA guidelines). CONCLUSIONS The study highlighted the potential importance of modifying walking behavior in cardiac patients to achieve PA guidelines and the dynamic nature of variables influencing PA at various stages of recovery.
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Rosenberg DE, Lee IM, Young DR, Prohaska TR, Owen N, Buchner DM. Novel strategies for sedentary behavior research. Med Sci Sports Exerc 2015; 47:1311-5. [PMID: 25222817 PMCID: PMC4362872 DOI: 10.1249/mss.0000000000000520] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This article reports on the "Novel Strategies for Sedentary Behavior Research" session of the Sedentary Behavior: Identifying Research Priorities workshop. METHODS The purpose of this session of the workshop were to propose strategies for accomplishing a research agenda in dealing with sedentary behavior and to consider research priorities for people at high risk for excess sedentary behavior. RESULTS AND CONCLUSIONS The four major recommendations from this workshop were as follows: 1) To add repeated objective measures of physical activity and sedentary behavior to existing cohort studies and standardize approaches to measurement and analysis. Epidemiologic studies will be the most efficient design for addressing some research questions. 2) To increase research efficiency, consider the advantages of a network of connected research studies and health systems. Advantages include access to existing data in electronic health records. 3) To carefully select a variety of high-risk study populations and preplan collaboration among studies in intervention research. This strategy can efficiently address the breadth of issues in sedentary behavior research. 4) To include comparative effectiveness designs and pure environmental interventions in intervention research. This strategy facilitates and enhances translation of interventions into practice.
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Affiliation(s)
- Dori E Rosenberg
- 1Group Health Research Institute, Seattle, WA; 2Harvard Medical School, Boston, MA; 3Kaiser Permanente Southern California, Pasadena, CA; 4George Mason University, College of Health and Human Services, Fairfax, VA; 5Baker IDI Heart and Diabetes Institute, Melbourne, AUSTRALIA; and 6University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Champaign, IL
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Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev 2015; 19:403-11. [PMID: 23743688 DOI: 10.1007/s10741-013-9399-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, 340 Kent Hall, Kent, OH, 44224, USA,
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Hayes SM, Josephson R, Hughes J, Gunstad J. Decreases in daily physical activity predict acute decline in attention and executive function in heart failure. J Card Fail 2015; 21:339-46. [PMID: 25573830 DOI: 10.1016/j.cardfail.2014.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/10/2014] [Accepted: 12/19/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reduced physical activity (PA) may be one factor that contributes to cognitive decline and dementia in heart failure (HF). Yet, the longitudinal relationship between PA and cognition in HF is poorly understood owing to limitations of past work, including single-time assessments of PA. This is the first study to examine changes in objectively measured PA and cognition over time in HF. METHODS AND RESULTS At baseline and 12 weeks, 57 HF patients completed psychosocial self-report measures and a neuropsychological battery and wore an accelerometer for 7 days. At baseline, HF patients spent an average of 597.83 (SD 75.91) minutes per day sedentary. Steps per day declined from baseline to the 12-week follow-up; there was also a trend for declines in moderate-vigorous PA. Regression analyses controlling for sex, HF severity, and depressive symptoms showed that decreases in light (P = .08) and moderate-vigorous (P = .04) daily PA emerged as strong predictors of declines in attention/executive function over the 12-week period, but not of memory or language. CONCLUSIONS Reductions in daily PA predicted acute decline in attention/executive function in HF, but not of memory or language. Modifications to daily PA may attenuate cognitive decline, and prospective studies are needed to test this possibility.
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Affiliation(s)
- Michael L Alosco
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | | - Ronald Cohen
- Departments of Neurology Psychiatry and Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, Athens, Georgia
| | - Scott M Hayes
- Memory Disorders Research Center, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts; Neuroimaging Research for Veterans Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Richard Josephson
- Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio; Harrington Heart and Vascular Institute, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joel Hughes
- Department of Psychological Sciences, Kent State University, Kent, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
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Choi NG, Kim J, Marti CN, Chen GJ. Late-life depression and cardiovascular disease burden: examination of reciprocal relationship. Am J Geriatr Psychiatry 2014; 22:1522-9. [PMID: 24856874 PMCID: PMC4351713 DOI: 10.1016/j.jagp.2014.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Empirical studies of the relationship between depression and cardiovascular disease (CVD) tend to be limited to examination of one-way relationships. This study assessed both cross-sectional association and longitudinal reciprocal relationships between late-life depressive symptoms and CVD. METHODS The National Health and Aging Trends Study waves 1 (T1) and 2 (T2, one year later) provided the data. The study sample (N = 5,414) represented Medicare beneficiaries aged 65 years or older. We fit structural equation models to examine: 1) cross-sectional association between depression and CVD at each wave; and 2) longitudinal reciprocal relationship between T1 depression and T2 CVD and between T1 CVD and T2 depression. RESULTS At T1, 28.6% reported a CVD diagnosis, and at T2, 4.9% reported having had a new diagnosis or new episode of heart attack or heart disease and 2.2% reported having had a stroke since T1. In addition to significant cross-sectional relationships between depression and CVD, T1 CVD had significant impact on T2 depressive symptoms, and T1 depressive symptoms had significant impact on T2 CVD, with a 1-point increase in depressive symptom score increasing the odds of having a new CVD diagnosis or episode by 21%. CONCLUSIONS The care of older adults with CVD and/or depression needs to include interventions focusing on lifestyle and psychological factors that can reduce risks for both CVD and depression. Depression prevention and treatment also needs to be an integral part of CVD prevention and management.
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Affiliation(s)
- Namkee G Choi
- School of Social Work, University of Texas at Austin, Austin, TX.
| | - Jinseok Kim
- Department of Social Welfare, Seoul Women's University, Seoul, Korea
| | - C Nathan Marti
- Division of Statistics and Scientific Computation, College of Natural Sciences, University of Texas at Austin, Austin, TX
| | - G John Chen
- Division of Health Services Research, Department of Internal Medicine, the University of Kansas Medical Center, Kansas City, KS
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Cardiac rehabilitation is associated with lasting improvements in cognitive function in older adults with heart failure. Acta Cardiol 2014; 69:407-14. [PMID: 25181916 DOI: 10.2143/ac.69.4.3036657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Heart failure (HF) is a known risk factor for cognitive impairment. Cardiac rehabilitation (CR) may attenuate poor neurocognitive outcomes in HF via improved physical fitness--a significant promoter of cognitive function. However, no study has examined the possible acute and lasting benefits of CR on cognitive function in persons with HF. METHODS AND RESULTS Fifty-two patients with HF completed a 12-week Phase II CR program. All participants were administered neuropsychological testing and completed a brief physical fitness assessment at baseline, completion of CR (i.e. 12 weeks), and 12-month follow-up. Repeated measures analyses showed a significant time effect for both attention/executive function and memory (P < 0.05). Attention/executive function performance increased from baseline to 12 weeks and these gains remained up to 12 months; memory was unchanged from baseline to 12 weeks, but then improved between the 12-week and 12-month time points. Physical fitness improved from baseline to 12 weeks and these benefits were maintained 12 months later. Changes in physical fitness and cognitive function over time did not reach a statistically significant association, though poorer physical fitness was associated with decreased cognitive performance at the baseline and 12-month time points. CONCLUSIONS CR is associated with both acute and lasting cognitive benefits in patients with HF. Prospective studies with extended follow-ups are needed to clarify the mechanisms that underpin cognitive improvements following CR (e.g., improved cerebral perfusion) and whether CR can ultimately reduce risk for cognitive decline and conditions like Alzheimer's disease in HF.
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Better adherence to treatment recommendations in heart failure predicts improved cognitive function at a one-year follow-up. J Clin Exp Neuropsychol 2014; 36:956-66. [PMID: 25352233 DOI: 10.1080/13803395.2014.957167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Treatment nonadherence is common in heart failure (HF) and is associated with poor health outcomes in this population. Recent cross-sectional work in heart failure and past work in other medical populations suggest that cognitive function is a key determinant of a patient's ability to adhere to treatment recommendations. However, it is also possible that treatment adherence is an important modifier and predictor of cognitive function, though no study has examined this possibility, and we sought to do so in a sample of heart failure patients. METHOD A total of 115 patients with heart failure self-reported adherence to treatment recommendations. The Modified Mini Mental State Examination (3MS), Trail Making Test Parts A and B, and the California Verbal Learning Test-II (CVLT-II) assessed cognitive function. These procedures were performed at baseline and a 12-month follow-up. RESULTS Global cognition and memory abilities improved over the 12-month period. Regression analyses controlling for baseline and medical and demographic factors showed that better baseline treatment adherence predicted improved 12-month performances on the 3MS and CVLT-II. Adherence to medication and diet regimens and smoking abstinence emerged as the most important contributors. CONCLUSIONS Better treatment adherence predicted improved cognition one year later in HF. Prospective studies that utilize objective assessments of treatment adherence are needed to confirm our findings and examine whether improved treatment adherence preserves cognitive function in heart failure.
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Affiliation(s)
- Michael L Alosco
- a Department of Psychological Sciences , Kent State University , Kent , OH , USA
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COPD is associated with cognitive dysfunction and poor physical fitness in heart failure. Heart Lung 2014; 44:21-6. [PMID: 25308768 DOI: 10.1016/j.hrtlng.2014.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the associations among chronic obstructive pulmonary disease (COPD), cognitive function, and physical fitness in heart failure (HF). BACKGROUND Cognitive impairment in HF in part stems from medical comorbidities and poor physical fitness. COPD, a frequent co-existing condition in HF, is a risk factor for cognitive impairment and a known cause of poor physical fitness. Yet, the interplay among COPD, cognition, and physical fitness has never been examined in HF. METHODS 191 HF patients completed a cognitive test battery and brief physical fitness assessment. Diagnostic history of COPD was ascertained via medical chart review. RESULTS Regression analyses showed HF patients with COPD exhibited worse attention/executive function and poorer fitness relative to their non-COPD counterparts. Worse fitness correlated with cognitive dysfunction. CONCLUSIONS COPD is associated with reduced cognition and worse fitness in HF. Longitudinal work that employs objective assessments of COPD is needed to determine directionality and clarify mechanisms.
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Hayes SM, Alosco ML, Forman DE. The Effects of Aerobic Exercise on Cognitive and Neural Decline in Aging and Cardiovascular Disease. CURRENT GERIATRICS REPORTS 2014; 3:282-290. [PMID: 25750853 DOI: 10.1007/s13670-014-0101-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aging is characterized by a decline in cognitive functions, particularly in the domains of executive function, processing speed and episodic memory. These age-related declines are exacerbated by cardiovascular disease (CVD) and cardiovascular risk factors (hypertension, diabetes, obesity, elevated total cholesterol). Structural and functional alterations in brain regions, including the fronto-parietal and medial temporal lobes, have been linked to age- and CVD-related cognitive decline. Multiple recent studies indicate that aerobic exercise programs may slow the progression of age-related neural changes and reduce the risk for mild cognitive impairment as well as dementia. We review age- and CVD-related decline in cognition and the underlying changes in brain morphology and function, and then clarify the impact of aerobic exercise on moderating these patterns.
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Affiliation(s)
- Scott M Hayes
- Memory Disorders Research Center (151A), VA Boston Healthcare System and Boston University School of Medicine, 150 South Huntington Ave, Boston, MA 02130, USA; Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
| | - Michael L Alosco
- Memory Disorders Research Center (151A), VA Boston Healthcare System and Boston University School of Medicine, 150 South Huntington Ave, Boston, MA 02130, USA; Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Daniel E Forman
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Geriatric Cardiology Section, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Parissis J, Karavidas A, Farmakis D, Papoutsidakis N, Matzaraki V, Arapi S, Potamitis N, Nikolaou M, Paraskevaidis I, Ikonomidis I, Pyrgakis V, Kremastinos D, Lekakis J, Filippatos G. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. Eur J Prev Cardiol 2014; 22:831-6. [DOI: 10.1177/2047487314540546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/02/2014] [Indexed: 11/15/2022]
Affiliation(s)
- John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | | | - Sofia Arapi
- Department of Cardiology, G Gennimatas Hospital, Athens, Greece
| | | | - Maria Nikolaou
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Ioannis Paraskevaidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Dimitrios Kremastinos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
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Chung ML, Lennie TA, Mudd-Martin G, Dunbar SB, Pressler SJ, Moser DK. Depressive symptoms in patients with heart failure negatively affect family caregiver outcomes and quality of life. Eur J Cardiovasc Nurs 2014; 15:30-8. [PMID: 24829295 DOI: 10.1177/1474515114535329] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depressive symptoms in people with heart failure (HF) are highly prevalent. Caring for patients with both HF and depression may be more burdensome than caring for patients with HF alone. AIMS The purpose of this study was to examine differences in caregivers' outcomes (i.e. caregiving burden, difficulty and time spent on caregiving, perceptions of life change as a result of caregiving, and quality of life) between caregivers who take care of HF patients with depressive symptoms and without depressive symptoms. METHOD Patient-caregiver dyads at an outpatient clinic completed survey questionnaires. Patients' depression was assessed using the Beck Depression Inventory-II (BDI-II); primary caregivers completed caregiving outcome questionnaires. Differences in caregiving outcomes between patients with and without depressive symptoms (BDI-II≥14) were examined using t-tests, Chi-square, and Mann-Whitney U-test. RESULTS Of 102 patients (64% male, mean age 61, 41% NYHA Class III-IV, mean ejection fraction 35.8±13.9), 26.5% had clinically significant depressive symptoms. Of the primary caregivers (78% female; mean age 56.7), 42% reported severe burden (the Zarit Burden Interview (ZBI)≥17). Caregivers of patients with depressive symptoms had a higher level of burden (25±13 vs 13.5±12 on the ZBI; p<0.001), spent more time caregiving (37±12 vs 30±11 on the Oberst Caregiving Burden Scale; p=0.004), and reported worse mental quality of life (46±10 vs 51±10 on the SF-12v2; p=0.026) than those of patients without depressive symptoms. CONCLUSION Family members caring for HF patients with depressive symptoms had significantly higher levels of caregiving burden and worse quality of life compared to those caring for patients without depressive symptoms.
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Obesity and cognitive dysfunction in heart failure: the role of hypertension, type 2 diabetes, and physical fitness. Eur J Cardiovasc Nurs 2014; 14:334-41. [PMID: 24829294 DOI: 10.1177/1474515114535331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/22/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cognitive impairment is common in heart failure. Obesity is a known risk factor for cognitive dysfunction in heart failure, though the mechanisms remain unclear. Obesity increases risk for conditions like hypertension and type 2 diabetes mellitus (T2DM) as well as poor fitness levels, and this may serve as one possible pathway accounting for association between obesity and cognitive dysfunction. AIMS We used structural equation modeling to test whether the combination of hypertension, T2DM, and reduced fitness mediate the association between obesity and cognitive dysfunction. METHODS Two hundred heart failure patients completed neuropsychological testing and a physical fitness assessment. Hypertension and T2DM were ascertained via self-report and medical records. Body mass index (BMI) was calculated. RESULTS Forty-three percent of the sample was obese. Hypertension (70%) and T2DM (36%) were common, and fitness levels were reduced. The structural equation model with these factors as mediators between BMI and cognitive function demonstrated excellent fit (comparative fit index = 0.98; root mean-square error of approximations = 0.03). Higher BMI correlated with hypertension, T2DM, and poorer fitness. Each of these factors predicted worse cognition. Models that isolated medical comorbidities and physical fitness as the mediator were weaker than the full model. CONCLUSIONS Increased risk for medical comorbidities and reduced fitness levels helped to explain the negative effects of obesity on cognitive dysfunction in heart failure. Prospective studies should confirm this pattern and examine how weight loss benefits cognitive function in heart failure.
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Affiliation(s)
| | - Mary Beth Spitznagel
- Department of Psychology, Kent State University, USA Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - Ronald Cohen
- Departments of Neurology Psychiatry and the Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville, USA
| | | | - Richard Josephson
- University Hospitals Case Medical Center and Department of Medicine, Cleveland, USA Harrington Heart and Vascular Institute, Cleveland, USA Case Western Reserve University School of Medicine, Cleveland, USA
| | - Joel Hughes
- Department of Psychology, Kent State University, USA Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - Jim Rosneck
- Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - John Gunstad
- Department of Psychology, Kent State University, USA
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Lee J, Choi M, Jung D, Sohn YH, Hong J. A Structural Model of Health-Related Quality of Life in Parkinson's Disease Patients. West J Nurs Res 2014; 37:1062-80. [PMID: 24718037 DOI: 10.1177/0193945914528588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disability-adjusted life expectancy is focused on more than just extending life span; thus, health-related quality of life (HRQOL) has emerged as an important issue for elderly patients with chronic disease. The number of patients with Parkinson's disease (PD) is predicted to grow along with the aging population, so it is essential to identify the predictors of HRQOL. This study utilized structural equation modeling (SEM) to predict the HRQOL of patients with PD. Participants (N = 217) were patients diagnosed with PD (M age = 66.01). Demographic and disease-related characteristics, sleep quality, pain, depression, and HRQOL were investigated via a structured questionnaire. Participants' functional factors were measured using physical function evaluations. The hypothetical model verified disease-related factors, depression, and pain as direct factors that significantly predicted HRQOL of patients with PD (Goodness of Fit Index = 0.93 and Comparative Fit Index = 0.96). These findings are useful for developing comprehensive interventions to improve the HRQOL of patients with PD.
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Affiliation(s)
- JuHee Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - MoonKi Choi
- College of Nursing, Yonsei University, Seoul, Korea
| | - Dukyoo Jung
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
| | - JinYong Hong
- Department of Neurology, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Alosco ML, Spitznagel MB, Sweet LH, Josephson R, Hughes J, Gunstad J. Cognitive dysfunction mediates the effects of poor physical fitness on decreased functional independence in heart failure. Geriatr Gerontol Int 2014; 15:174-81. [PMID: 24533907 DOI: 10.1111/ggi.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2013] [Indexed: 11/26/2022]
Abstract
AIM Heart failure (HF) patients require assistance with activities of daily living (ADL). Poor physical fitness has recently been identified as a contributor to the high rates of disability in HF, though the mechanisms for such effects are unclear. Although not previously examined, decreased fitness might adversely impact ADL in HF through its known association with cognitive impairment, a key correlate of self-care abilities in this population. We sought to test this possibility using a model-based approach. METHODS A total of 197 patients with HF completed a physical fitness test and a neuropsychological test battery. A total ADL composite was derived from the Lawton Brody scale. Structural equation modeling tested whether cognitive function mediated the association between physical fitness and total ADL. RESULTS Fitness was reduced, and cognitive dysfunction and impaired ADL were prevalent. The initially significant association between fitness and total ADL was attenuated when cognitive function was introduced as a mediator. This model showed good fit (comparative fit index=0.91: root mean-square error of approximations=0.077) with a significant indirect pathway between physical fitness and total ADL through cognitive function: Decreased physical fitness was associated with cognitive dysfunction (β=0.35), which predicted greater assistance with ADL (β=0.22). CONCLUSIONS Poor physical fitness might lead to decreased functional independence in HF through its negative effects on cognitive function. Prospective studies are required to confirm our findings, identify other mechanisms by which poor fitness impacts ADL, and examine whether exercise interventions can improve cognition and help preserve ADL independence in HF.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, Ohio, USA
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Alosco ML, Spitznagel MB, Cohen R, Raz N, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Decreased physical activity predicts cognitive dysfunction and reduced cerebral blood flow in heart failure. J Neurol Sci 2014; 339:169-75. [PMID: 24581672 DOI: 10.1016/j.jns.2014.02.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/14/2014] [Accepted: 02/12/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Cognitive impairment in heart failure (HF) is believed to result from brain hypoperfusion subsequent to cardiac dysfunction. Physical inactivity is prevalent in HF and correlated with reduced cardiac and cognitive function. Yet, no longitudinal studies have examined the neurocognitive effects of physical inactivity in HF. The current study examined whether reduced physical activity increases risk for cognitive impairment and brain hypoperfusion over time in HF. METHODS At baseline and 12 months later, 65 HF patients underwent neuropsychological testing, transcranial Doppler ultrasonography, and were asked to wear an accelerometer for seven days. RESULTS Lower baseline step count and less time spent in moderate free-living activity best predicted worse attention/executive function and decreased cerebral perfusion at the 12-month follow-up. Decreased baseline cerebral perfusion also emerged as a strong predictor of poorer 12-month attention/executive function. CONCLUSIONS Lower physical activity predicted worse cognition and cerebral perfusion 12 months later in HF. Physical inactivity in HF may contribute to cognitive impairment and exacerbate risk for conditions such as Alzheimer's disease. Larger studies are needed to elucidate the mechanisms by which physical inactivity leads to cognitive dysfunction in HF, including clarification of the role of cerebral hypoperfusion.
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Affiliation(s)
| | | | - Ronald Cohen
- Department of Neurology, University of Florida, USA; Department of Psychiatry, University of Florida, USA; The Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, USA
| | - Naftali Raz
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | | | - Richard Josephson
- University Hospitals Case Medical Center and Department of Medicine, Cleveland, OH, USA; Harrington Heart & Vascular Institute, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joel Hughes
- Department of Psychology, Kent State University, Kent, OH, USA; Cardiac Rehabilitation, Summa Health System, Akron City Hospital, Akron, OH, USA
| | - Jim Rosneck
- Cardiac Rehabilitation, Summa Health System, Akron City Hospital, Akron, OH, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA.
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Harzheim D, Klose H, Pinado FP, Ehlken N, Nagel C, Fischer C, Ghofrani A, Rosenkranz S, Seyfarth HJ, Halank M, Mayer E, Grünig E, Guth S. Anxiety and depression disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Respir Res 2013; 14:104. [PMID: 24107187 PMCID: PMC4021210 DOI: 10.1186/1465-9921-14-104] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/25/2013] [Indexed: 01/23/2023] Open
Abstract
Background The objective of this prospective study was to assess the prevalence of anxiety and depression disorders and their association with quality of life (QoL), clinical parameters and survival in patients with pulmonary hypertension (PH). Methods We prospectively assessed 158 patients invasively diagnosed with pulmonary arterial hypertension (n = 138) and inoperable chronic thromboembolic PH (n = 20) by clinical measures including quality of life (QoL, SF-36 questionnaire), cardiopulmonary exercise testing and six minute walking distance and by questionnaires for depression (PHQ-9) and anxiety (GAD-7). According to the results of the clinical examination and the questionnaires for mental disorders (MD) patients were classified into two groups, 1) with moderate to severe MD (n = 36, 22,8%), and 2) with mild or no MD (n = 122). Patients were followed for a median of 2.7 years. Investigators of QoL, SF-36 were blinded to the clinical data. Results At baseline the 2 groups did not differ in their severity of PH or exercise capacity. Patients with moderate to severe MD (group 1) had a significantly lower QoL shown in all subscales of SF-36 (p < 0.002). QoL impairment significantly correlated with the severity of depression (p < 0.001) and anxiety (p < 0.05). During follow-up period 32 patients died and 3 were lost to follow-up. There was no significant difference between groups regarding survival. Only 8% of the patients with MD received psychopharmacological treatment. Conclusion Anxiety and depression were frequently diagnosed in our patients and significantly correlated with quality of life, but not with long term survival. Further prospective studies are needed to confirm the results.
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Affiliation(s)
- Dominik Harzheim
- Centre for Pulmonary Hypertension, Thoraxclinic University Hospital Heidelberg, Amalienstrasse 5, Heidelberg D-69126, Germany.
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Alosco ML, Spitznagel MB, Raz N, Cohen R, Sweet LH, Garcia S, Josephson R, van Dulmen M, Hughes J, Rosneck J, Gunstad J. The interactive effects of cerebral perfusion and depression on cognitive function in older adults with heart failure. Psychosom Med 2013; 75:632-9. [PMID: 23873714 PMCID: PMC3770733 DOI: 10.1097/psy.0b013e31829f91da] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depression is common among persons with heart failure (HF) and has been linked to cognitive impairment in this population. The mechanisms of this relationship are unclear, and the current study examined whether cerebral perfusion moderates the association between depressive symptoms and cognitive impairment in patients with HF. METHODS Persons with HF (n = 89; mean [standard deviation] age = 67.61 [11.78] years) completed neuropsychological testing and impedance cardiography. Depressive symptoms were assessed using the Beck Depression Inventory II, and transcranial Doppler was used to quantify cerebral perfusion. RESULTS Depression was associated with reduced performance on tasks assessing attention/executive function (r = -0.28), language (r = -0.0.30), and motor function (r = -0.28) in unadjusted models (p values <.05). Global cerebral blood flow was correlated with memory performance (r = 0.22, p = .040) but not with other tasks. A moderation analysis was performed using hierarchical regression models for attention/executive function, memory, language, and motor function. For each model, medical and demographic characteristics were entered into the initial blocks, and the final block consisted of an interaction term between global cerebral blood flow velocity and the Beck Depression Inventory II. The interaction between greater depressive symptoms and decreased global cerebral blood flow velocity was associated with greater deficits in attention/executive function (β = .32, ΔR(2) = 0.08, p = .003). CONCLUSIONS Depressive symptoms and cerebral hypoperfusion interact to adversely affect cognitive performance in older adults with HF. Longitudinal studies are needed to clarify this relationship and elucidate subsequent neuropathology.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
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