Improving Quality of Life in Patients With Heart Failure

The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV

OBJECTIVES

Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL.

METHODS

Secondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses.

RESULTS

In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020).

CONCLUSIONS

QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.

Patient activation with respect to advanced heart failure therapy in patients over age 65 years

BACKGROUND

Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including "activation" (engagement and ability to self-manage).

OBJECTIVE

To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy.

METHODS

Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy.

RESULTS

Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression.

CONCLUSIONS

Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy.

Mechanisms of Cardiotoxicity and the Development of Heart Failure

Cardiotoxicity is a broad term that refers to the negative effects of toxic substances on the heart. Cancer drugs can cause cardiotoxicity by effects on heart cells, thromboembolic events, and/or hypertension that can lead to heart failure. Rheumatoid arthritis biologics may interfere with ischemic preconditioning and cause/worsen heart failure. Long-term and heavy alcohol use can result in oxidative stress, apoptosis, and decreased contractile protein function. Cocaine use results in sympathetic nervous system stimulation of heart and smooth muscle cells and leads to cardiotoxicity and evolution of heart failure. The definition of cardiotoxicity is likely to evolve along with knowledge about detecting subclinical myocardial injury.

Living with heart failure without realising: a qualitative patient study

Heart failure is an important problem in Swedish primary healthcare as in the U.K. In spite of that little is known about how people with heart failure experience support from primary healthcare. This paper investigates how people with heartfailure experience support in primary healthcare. Semi structured interviews were conducted with five men and five women, born 1922-1951. The interviews were analyzed with qualitative content analysis in accordance with Graneheim and Lundman (2004). The participants experienced they had not received information about their diagnosis or about the cause of their condition. They had not been informed they had heart failure. Instead the participants believed their symptoms were caused by age, thus being part of normal ageing. They did not experience they needed care or support to cope with illness or disease. Instead their main needs for support in daily life concerned help with practical matters.There is a risk primary healthcare abandons people with heart failure meaning the patients are forced to develop strategies on their own in order to manage symptoms. When inadequately informed there is also a risk they make up their own explanations signifying possible difficulties to handle their health situation.

A critical link between heart failure self-care and intrathoracic impedance

BACKGROUND

Effective self-care is regarded as essential to the management of heart failure (HF). The influence of self-care on HF decompensation, however, is not well understood. Accordingly, we examined the relationship between self-care and fluid accumulation accompanying worsening HF as indexed by decreasing intrathoracic impedance (Z).

METHODS

Z data were collected from 58 HF patients with OptiVol enabled devices (Medtronic Inc, Minneapolis, Minnesota). Heart failure self-care was measured with the European Heart Failure Self-care Behaviour Scale. Regression modeling was used to describe the influence of HF self-care on the likelihood of a fluid index (FI) threshold crossing, the number of threshold crossings, and number of days spent above threshold.

RESULTS

Patients were elderly (74.98 [SD, 8.12] years), with a mean left ventricular ejection fraction of 26.21% (SD, 9.77%), and 63.7% had class New York Heart Association III HF. Patients were followed up for 317 (SD, 96) days; 65.5% had FI threshold crossings (mean 1.45 [SD, 1.56] crossings), spending an average of 33.8 (SD, 42.4) days above FI threshold. Controlling for age, sex, left ventricular ejection fraction, functional class, and duration of follow-up, each additional point on the European Heart Failure Self-care Behaviour Scale was associated with an increase in the odds of having had an FI threshold crossing (adjusted odds ratio, 1.201; 95% confidence interval, 1.013-1.424; P<.05) and more days spent above FI threshold (incidence rate ratio, 1.051; 95% confidence interval, 1.002-1.102; P<.05).

CONCLUSION

Intrathoracic impedance measurements obtained from implantable devices provide important information regarding the influence of self-care on fluid accumulation in patients with HF.

Meeting the communication and information needs of chronic heart failure patients

There is a lack of evidence on how best to meet policy guidance in fulfilling the information needs of patients with chronic heart failure (CHF) and their families. We aimed to generate guidance for appropriate information provision to CHF patients and their families through a cross-sectional qualitative methodology with constant comparison of emergent themes. Participants were 20 CHF patients (New York Heart Association Functional Classification III, III-IV, and IV); 11 family carers; six palliative care staff; and six cardiology staff. Patients and carers severely lacked understanding of CHF and its symptoms. None had discussed disease progression or advanced care planning with staff. Although patients expected honest discussion of disease implications, data from clinicians described an unwillingness to disclose poor prognosis. We identified four types of barriers to the discussion of disease progression: disease-specific; patient-specific; specialism-specific; and staff time and resources. This is the first study to integrate cardiology, palliative care, and patient and family views to develop feasible recommendations on meeting information needs. Three recommendations for hospital-based clinical practice were generated from the data: (1) improved methods of providing information; (2) introduction of mutual education and joint working; and (3) development of care pathways and referral criteria.

Considerations to implement holistic groups with the elderly

The group modality is a viable holistic treatment consideration for the elderly, given the steady increase in the elderly population, the presence of various psychiatric and/or medical conditions in this cohort, and cost concerns. The holistic nurse and group leader share similar role definitions of being a facilitator in the healing process. They embrace the concept that the person and group are greater than the sum of the parts. Using a group modality can increase the number of people served by one nurse, thereby making it cost-effective. Incorporating the holistic mind-body-spirit approach addresses the Healthy People 2010 goal of increasing the quality of life. Tips on conducting groups with the elderly are reviewed, including types of groups, setting, goals, composition, duration, and frequency. Theme-centered groups are discussed from a holistic perspective. Yalom's 11 therapeutic factors that account for group functions are explained, along with other group concepts that reflect holistic nursing concepts.

Assessing treatment fidelity in pilot studies assist in designing clinical trials: an illustration from a nurse practitioner community-based intervention for pain

Treatment fidelity refers to the degree to which treatment is administered as intended, and it is key to interpreting and translating research into practice. As an illustration, we report the benefits of examining treatment fidelity in a pilot study of nurse practitioner-delivered Coping Skills Training for chronic pain. Analysis revealed both strengths and weaknesses of protocol design and treatment delivery. This pilot work formed the basis for subsequently modifying the design of a large-scale clinical trial. Monitoring treatment fidelity throughout the pilot and trial phases of research can dramatically improve the research enterprise and facilitate successful dissemination.

B-type natriuretic peptide rapid assay: a diagnostic test for heart failure

Hospitals are constantly besieged with congestive heart failure admissions. Current studies show that the advent of the B-type natriuretic peptide (BNP) rapid assay as a quick and easy blood test is beneficial to nurses in confirming the diagnosis of heart failure. B-type natriuretic peptide is a neurohormone produced by the failing heart in response to increased volume and cardiac overload. The BNP rapid assay measures the presence of BNP levels present in the circulating bloodstream to confirm the diagnosis of congestive heart failure. It is a simple blood test that can be done at the bedside or at the clinic so it is a valid point-of-care modality. Elevated levels suggest severity of heart failure and possibility of sudden death. This article focuses on the description of the diagnostic performance of the BNP rapid assay, its clinical dimensions, and its implications to nursing practice and collaborative practice models.

Effect of behavioral management on quality of life in mild heart failure: a randomized controlled trial

There has been a lack of research regarding nonpharmacologic interventions in heart failure. The objective was to determine the effect of behavioral management on health related quality of life (HRQL) in patients with heart failure. Participants (N = 116) were randomly assigned to one of two groups: usual care for heart failure (n = 58) and the 15-week behavioral management program (n = 58). Outcomes included exercise performance (6-min walk), physical and mental functioning (SF-36), general health perceptions (SF-36), and disease specific HRQL (Minnesota Living with Heart Failure Questionnaire-MLHF). Outcomes were assessed at baseline, 4, 10 and 16 months. Participants were mostly male (95%) and Caucasian (75%), with a mean age of 67 years (S.D. = 10). Intervention patients showed significantly improved self-reported disease specific HRQL (MLHF physical dimension scores) over time compared to control patients. There were no group differences in exercise performance, physical functioning, mental functioning or general health perceptions.