The Importance and Impact of Social Support on Outcomes in Patients With Heart Failure

Factors associated with delayed admission to the burn unit: A major burn center's experience

BACKGROUND

Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center.

METHODS

Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch's t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality.

RESULTS

A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5±18.7 % vs. 8.2±12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232).

CONCLUSION

Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.

The Impact of Social Determinants of Health on Outcomes Among Individuals With HIV and Heart Failure: A Literature Review

This narrative review examines the complex interplay between social determinants of health (SDoH) and the outcomes for individuals living with human immunodeficiency virus (HIV) and heart failure (HF), two conditions that pose significant socioeconomic burdens globally. With millions affected by these conditions, the review delves into how socioeconomic status, education, geography, and immigration status influence health outcomes. It further explores the exacerbating roles of stigma and mental health issues, underscoring the need for comprehensive interventions and the importance of enhancing health literacy and community support. Key findings suggest that lower socioeconomic status, limited education, rural residency, and immigrant status are associated with poorer health outcomes in individuals with HIV and HF. These factors contribute to increased morbidity and mortality and decreased quality of life, highlighting the necessity of addressing SDoH to improve patient care and outcomes. There is a critical need for integrated care models that consider the medical, social, and psychological factors affecting those with HIV and HF. Strategies proposed include improving access to care, addressing socioeconomic disparities, enhancing educational efforts, and fostering community engagement. Moreover, the importance of mental healthcare integration into the management of HIV and HF is strongly advocated to improve patient outcomes. By taking a comprehensive look at the various social challenges, embracing integrated care models, and making sure everyone has fair access to healthcare services, we can make real progress in enhancing the lives of those affected by HIV and HF. This approach cannot only lower death rates but also significantly improve the quality of life for these individuals.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE PERSIAN VERSION OF THE FAMILY FUNCTIONING, HEALTH, AND SOCIAL SUPPORT QUESTIONNAIRE IN A SAMPLE OF HEART FAILURE PATIENTS AND THEIR FAMILY MEMBERS

Background and Purpose: Family functioning, family health, and social support have significant roles in the management of heart failure (HF). This study aimed to translate, adapt, and assess the validity and reliability of the Persian version of the Family Functioning, Family Health, and Social Support (FAFHES) questionnaire. Methods: FAFHES questionnaire was translated into Persian, and an expert panel assessed the cross-cultural adaptation. We examined the construct validity by confirmatory factor analysis and internal consistency by Cronbach's alpha coefficients among 576 participants. Results: The Persian FAFHES confirmed the three-factor structure in the social support and the five-factor structure in the family health scales. However, the family functioning scale yielded the three-factor structure versus the four-factor structure in the original scales. The Cronbach's alpha for the three scales varied from 0.85 to 0.94. Conclusions: The adapted FAFHES seems to be valid and reliable to measure family functioning, family health, and social support in families with HF.

Social network and severe lower respiratory tract infections in older adults: findings from a Swedish longitudinal population-based study

OBJECTIVES

To investigate the association between social network and the risk and prognosis of severe lower respiratory tract infections (LRTIs) in older adults.

METHODS

Data from Swedish hospital records were matched with the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Social network was operationalized as social connections and social support, based on different self-reported variables, and categorized as low, medium, and high. The risk of severe LRTI and related outcomes were assessed using Cox, Poisson, and logistic regression models where appropriate.

RESULTS

A total of 362 individuals experienced LRTI-related hospitalizations between 2001 and 2016 (479 total hospitalizations). High levels of social support decreased the hazard of incident LRTI by 29% (hazard ratio 0.71, 95% confidence interval [CI] 0.52-0.96), the hospital length of stay by 21% (incidence rate ratio 0.79, 95% CI 0.65-0.97), and the risk of 30-day mortality by 92% (odds ratio 0.08, 95% CI 0.01-0.68), but was a risk factor for 30-day readmission (odds ratio 3.16, 95% CI 1.38-7.24). High levels of social connections were associated with a higher risk of incident LRTI in women and those with dementia and/or slow walking speed (P_interaction <0.05).

CONCLUSION

Older individuals' quality of social support seems to be a stronger determinant of LRTI incidence and prognosis than the quantity of their social connections. These findings may inform evidence-based policies aimed at preventing LRTIs in older adults.

Activity Patterns and Loneliness in Later Life: The Mediating Effects of Social Support and Attitudes Toward Aging

Studies have documented the inconsistent influences of activity participation on health. However, the underlying mechanisms connecting activity patterns to loneliness are relatively understudied. Using data on 8,545 respondents aged 60 or older from the 2014 China Longitudinal Aging Social Survey, we used latent class analysis to identify the patterns of participating in eight activities and path analysis to examine the mediating effects of formal support, informal support, and aging attitudes in the relationship of activity patterns and loneliness. Three meaningful patterns of activity (high activity, low activity, and working caregivers) were identified. Working caregivers and low activity groups, compared to high activity, showed higher levels of loneliness in later life. Informal support, rather than formal support, and attitudes toward aging mediated the relationship between activity patterns and loneliness in later life. This study highlights the importance of fuller engagement in diverse political, economic, and community activities to prevent loneliness. Additionally, intervention programs that facilitate joint support from family, community, and government and shape scientific understanding of aging are critical for alleviating loneliness in later life.

Effectiveness of a Health Coaching Intervention for Patient-Family Dyads to Improve Outcomes Among Adults With Diabetes: A Randomized Clinical Trial

IMPORTANCE

More than 75% of US adults with diabetes do not meet treatment goals. More effective support from family and friends ("supporters") may improve diabetes management and outcomes.

OBJECTIVE

To determine if the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention improves patient activation, diabetes management, and outcomes compared with standard care.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted from November 2016 to August 2019 among participants recruited from 2 Veterans Health Administration primary care sites. All patient participants were adults aged 30 to 70 years with diabetes who had hemoglobin A1c (HbA1c) levels greater than 8% of total hemoglobin (to convert to proportion of total hemoglobin, multiply by 0.01) or systolic blood pressure (SBP) higher than 150 mm Hg; each participating patient had an adult supporter. Of 1119 recruited, 239 patient-supporter dyads were enrolled between November 2016 and May 2018, randomized 1:1 to receive the CO-IMPACT intervention or standard care, and followed up for 12 to 15 months. Investigators and analysts were blinded to group assignment.

INTERVENTIONS

Patient-supporter dyads received a health coaching session focused on dyadic information sharing and positive support techniques, then 12 months of biweekly automated monitoring telephone calls to prompt dyadic actions to meet diabetes goals, coaching calls to help dyads prepare for primary care visits, and after-visit summaries. Standard-care dyads received general diabetes education materials only.

MAIN OUTCOMES AND MEASURES

Intent-to-treat analyses were conducted according to baseline dyad assignment. Primary prespecified outcomes were 12-month changes in Patient Activation Measure-13 (PAM-13) and UK Prospective Diabetes Study (UKPDS) 5-year diabetes-specific cardiac event risk scores. Secondary outcomes included 12-month changes in HbA1c levels, SBP, diabetes self-management behaviors, diabetes distress, diabetes management self-efficacy, and satisfaction with health system support for the involvement of family supporters. Changes in outcome measures between baseline and 12 months were analyzed using linear regression models.

RESULTS

A total of 239 dyads enrolled; among patient participants, the mean (SD) age was 60 (8.9) years, and 231 (96.7%) were male. The mean (SD) baseline HbA1c level was 8.5% (1.6%) and SBP was 140.2 mm Hg (18.4 mm Hg). A total of 168 patients (70.3%) lived with their enrolled supporter; 229 patients (95.8%) had complete 12-month outcome data. In intention-to-treat analyses vs standard care, CO-IMPACT patients had greater 12-month improvements in PAM-13 scores (intervention effect, 2.60 points; 95% CI, 0.02-5.18 points; P = .048) but nonsignificant differences in UKPDS 5-year cardiac risk (intervention effect, 1.01 points; 95% CI, -0.74 to 2.77 points; P = .26). Patients in the CO-IMPACT arm also had greater 12-month improvements in healthy eating (intervention effect, 0.71 d/wk; 95% CI, 0.20-1.22 d/wk; P = .007), diabetes self-efficacy (intervention effect, 0.40 points; 95% CI, 0.09-0.71 points; P = .01), and satisfaction with health system support for the family supporter participants' involvement (intervention effect, 0.28 points; 95% CI, 0.07-0.49 points; P = .009); however, the 2 arms had similar improvements in HbA1c levels and in other measures.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, the CO-IMPACT intervention successfully engaged patient-supporter dyads and led to improved patient activation and self-efficacy. Physiological outcomes improved similarly in both arms. More intensive direct coaching of supporters, or targeting patients with less preexisting support or fewer diabetes management resources, may have greater impact.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02328326.

Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial

BACKGROUND

Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management.

METHODS

This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes.

DISCUSSION

This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

Considering health literacy in cardiovascular disease management: a qualitative study on healthcare professionals' and patients' perspectives

Background

Implementing practices adapted to patient health literacy (HL) is a promising avenue for improving their outcomes in the context of cardiovascular diseases (CVD). The health communication skills of healthcare professionals (HCPs) and the quality of information provided are essential for low-HL patients. We aimed to explore HCP knowledge about HL, patients’ and HCPs’ views on current practices regarding low-HL patients, and facilitators and barriers to adapting communication to patients’ HL level, in order to prepare the implementation of a complex intervention dedicated to improve CVD management for low-HL patients.

Methods

We conducted face-to-face semi-structured interviews with HCPs practicing in cardiology units and patients hospitalized for CVD. The study design and analysis were based on the Theory of Planned Behavior for HCPs and on the framework of Health Literacy and Health Action for patients. Deductive and inductive thematic analysis were used. Barriers and facilitators were structured into an Ishikawa fishbone diagram and implementation strategies were selected to address resulting themes from the Expert Recommendations for Implementing Change (ERIC).

Results

Fifteen patients and 14 HCPs were interviewed. HCPs had partial knowledge of HL dimensions. Perceptions of HCPs and patients were not congruent regarding HCP-patient interactions and information provided by hospital and community HCPs. HCPs perceived they lacked validated tools and skills, and declared they adapted spontaneously their communication when interacting with low-HL patients. Patients expressed unmet needs regarding communication during hospital discharge and at return to home.

Conclusion

To implement HL-tailored practices in this setting, our results suggest that several implementation strategies will be valuable at individual (engaging patients and their family), interactional (educating and training of HCPs about HL), and organizational levels (creating a multidisciplinary HCP interest group dedicated to HL).

Trial registration

ClinicalTrials.gov, (NCT number) NCT03949309, May 10, 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08455-8.

The relationship of family functioning and family health with hospital readmission in patients with heart failure: insights from an international cross-sectional study

BACKGROUND

The growing hospital readmission rate among patients with heart failure (HF) has imposed a substantial economic burden on healthcare systems. Therefore, it is essential to identify readmission associating factors to reduce hospital readmission.

AIMS

This study aimed to investigate the relationship of family functioning and family health with hospital readmission rates over six months in patients with HF and identify the sociodemographic and/or clinical variables associated with hospital readmission.

METHODS

This international multicentre cross-sectional study involved a sample of 692 patients with HF from three countries (Denmark 312, Iran 288, and Iceland 92) recruited from January 2015 to May 2020. The Family Functioning, Health, and Social Support questionnaire was used to collect the data. The number of patients' hospital readmissions during the six-month period was retrieved from patients' hospital records.

RESULTS

Of the total sample, 184 (26.6%) patients were readmitted during the six-month period. Of these, 111 (16%) had one readmission, 68 (9.9%) had two readmissions, and 5 (0.7%) had three readmissions. Family functioning, family health, being unemployed, and country of residence were significant factors associated with hospital readmission for the patients.

CONCLUSION

This study highlights the critical roles of family functioning and family health in six-month hospital readmission among patients with HF. Moreover, the strategy of healthcare systems in the management of HF is a key determinant that influences hospital readmission. Our findings may assist the investigation of potential strategies to reduce hospital readmission in patients with HF.

The impact of sources of perceived social support on readmissions in patients with heart failure

BACKGROUND

Lower levels of perceived social support have been known as an independent predictor of hospital readmissions in patients with heart failure (HF). However, the impact of sources of perceived social support on readmissions remain unexplored.

PURPOSE

The main purpose of this study was to investigate and compare the relative importance of social support from significant other, family, and friends on all-cause readmission and cardiac readmission in patients with HF.

METHODS

The prospective cohort study was used to recruit a total of 299 patients with HF in Taiwan between May 2012 and December 2014. Demographic and clinical characteristics, Multidimensional Perceived Social Support Scale (MPSSS), and 18-month follow-up readmissions were recorded during the hospital stay. Univariate and multivariate logistic regressions were constructed to determine the impact of levels and sources of perceived social support with all-cause readmission and cardiac readmission.

RESULTS

A total of 158 patients (52.8%) and 118 patients (39.5%), respectively, had all-cause readmission and cardiac readmissions within 18 months. Multivariate logistic regression yielded inverse associations between levels of perceived social support and readmissions by 18-months. Importantly, social support from significant other was significantly associated with a lower risk of readmissions, both of all-cause readmission and cardiac readmission, in patients with HF, even after controlling for possible covariates, social support from family and friends.

CONCLUSIONS

Social support from significant other, rather than from family and friends, was relatively and inversely associated with 18-month all-cause readmission and cardiac readmission in patients with HF, which is consistent with the hierarchical compensatory model.

The effect on the anxiety level of the social support given to multiple sclerosis patients

PURPOSE

This is a descriptive study aiming at determining the effect on the anxiety level of the social support given to multiple sclerosis (MS) patients.

DESIGN AND METHODS

This study was conducted with 123 MS patients. The data were collected the Multidimensional Scale of Perceived Social Support (MSPSS), the Hamilton Anxiety Rating Scale (HAM-A).

RESULTS

The Multidimensional Scale of Perceived Social Support total score average was 57.18 ± 18.5, and the HAM-A total score average was 20.33 ± 10.42. A negative weak significant relationship was found between the MSPSS total score average and the HAM-A total score and its sub-dimensions.

PRACTICE IMPLICATIONS

MS nurses should plan their anxiety management accordingly by giving holistic care and evaluating social support mechanisms.

Examining Information Needs of Heart Failure Patients and Family Companions Using a Previsit Question Prompt List and Audiotaped Data: Findings From a Pilot Study

BACKGROUND

Question prompt lists (QPLs) are an effective tool for improving communication during medical visits. However, no studies have attempted to correlate intentions related to question asking and actual questions asked during visits. Moreover, few studies have used QPLs with patients with heart failure (HF) or family companions who accompany them to visits. We examined the use of a previsit QPL for patients with HF and their family companions intended to enhance engagement in HF care. The aim of this research was to assess which questions from the QPL patients and companions selected most frequently to ask and compare this item with which questions were actually asked during the medical visit.

METHODS AND RESULTS

This secondary analysis of QOLs and audiotaped visit data from a pilot study enrolled and consented patients with HF, family companions, and HF clinicians. A single group of 30 patients with HF and 23 family companions received the QPL to complete in the waiting room immediately before their cardiology visit. To meet our aims, we calculated the frequencies for each question selected and asked from the QPL, using data derived from completed prompt lists and audiotaped medical visits. A follow-up survey was administered 2 days after the appointment to assess differences in how participants filled out and used the prompt list. Patients and companions primarily selected and asked questions from the QPL regarding the management and treatment of the disease, general questions about HF, and questions about prognosis. Participants rarely asked questions about support for family and friends or health care team roles and responsibilities. Patients and companions did not ask many of the questions they reported wanting to ask.

CONCLUSIONS

Prompt lists may empower patients and companions to communicate with their clinician by identifying important questions to help overcome patients' and companions' knowledge gaps. More research is needed to understand the true impact of prompt lists on patient-family-clinician communication and subsequent HF outcomes, and how best to implement them in clinical workflows to increase their potential usefulness.

Informal carers in Sweden - striving for partnership

Purpose

Informal carers have an important role in society through their care and support of their long-term ill relatives. Providing informal care is challenging and can lead to caregiver burden; moreover, many support needs of the carers are not met, leading to confusion, disappointment and frustration. We conducted an interview study to clarify the meaning of support given and received by informal carers to relatives with chronic obstructive pulmonary disease or chronic heart failure.

Methods

We purposively selected and recruited informants via participants in another study, thereby conducting interviews over the phone from June 2016 to May 2017. In total, we conducted 14 interviews with 12 informants. All interviews were transcribed verbatim and the content was analysed using a phenomenological hermeneutical approach.

Result and conclusion

Our comprehensive understanding of the meaning of support for these carers is twofold: it is a self-evident struggle for the good life of their relatives and that they want to be carers in partnership. The healthcare system must recognize the efforts of carers and include them in the strategic planning and operational stages of care and treatment for people with long-term illness.

Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease

AIMS

To examine self-management behaviors level and discuss the associated factors among chronic obstructive pulmonary disease (COPD) patients.

METHODS

A descriptive study design was used. A convenience sample of 124 COPD patients was recruited from three hospitals in Fuzhou. Self-management Behaviors, Social Support Rating Scale and The Family APGAR Score were used to collect data. Descriptive statistics, one-way analysis of variance (ANOVA), Pearson correlation and multiple linear regression were used for data analysis.

RESULTS

The overall score of self-management behaviors ranged 4-41, with a mean score of 21.26 ± 7.72. Pearson correlation analyses and ANOVA revealed that age, course of disease, education, marital status, family function, subjective support, objective support, and availability of support were positively correlated with overall self-management behaviors (p < .05). Multiple linear regression analyses revealed that subjective support and availability of support significantly predicted self-management behaviors.

CONCLUSIONS

The level of self-management behaviors of COPD patients was suboptimal. We suggest that people in the patients' social network should provide support for them, and help them use available resources to improve the level of self-management behaviors.

Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study

Background

Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cause mortality among patients with chronic HF, and investigates geographic and hospital variation in mortality.

Methods and findings

We included 9,277 patients with chronic HF enrolled between May 2011 and November 2017 in the prospective cohort study European Society of Cardiology Heart Failure Long Term registry across 142 hospitals, located in 22 countries. Mean age of the selected outpatients was 65 years (sd 13.2) and 28% were female. The all-cause 1-year mortality rate per 100 person-years was 7.1 (95% confidence interval (CI) 6.6–7.7), and varied between countries (median 6.8, IQR 5.6–11.2) and hospitals (median 7.8, IQR 5.2–12.4). Mortality was associated with age (incidence rate ratio 1.03, 95% CI 1.02–1.04), diabetes mellitus (1.37, 1.15–1.63), peripheral artery disease (1.56, 1.27–1.92), New York Heart Association class III/IV (1.91, 1.60–2.30), treatment with angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists (0.71, 0.57–0.87) and HF clinic (0.64, 0.46–0.89). No other hospital-level characteristics, and no country-level healthcare characteristics were associated with 1-year mortality, with case-mix standardised variance between countries being very low (1.83e-06) and higher for hospitals (0.372).

Conclusions

All-cause mortality at 1 year among outpatients with chronic HF varies between countries and hospitals, and is associated with patient characteristics and the availability of hospital HF clinics. After full adjustment for clinical, hospital and country variables, between-country variance was negligible while between-hospital variance was evident.

Effect of Behaviorally Designed Gamification With a Social Support Partner to Increase Mobility After Hospital Discharge: A Randomized Clinical Trial

IMPORTANCE

Hospitalization is associated with decreased mobility and functional decline. Behaviorally designed gamification can increase mobility in community settings but has not been tested among patients at risk for functional decline during a high-risk transition period after hospitalization.

OBJECTIVE

To test a behaviorally designed gamification intervention with a social support partner to increase patient mobility after hospital discharge.

DESIGN, SETTING, AND PARTICIPANTS

This study is a randomized clinical trial of a 12-week intervention without follow-up. Enrollment occurred from January 2018 to June 2019 at a referral hospital with a remote at-home monitoring intervention among patients living predominantly in 3 states (Pennsylvania, New Jersey, and Delaware). Participants included adult patients discharged from general medicine and oncology units to home. Data analysis was performed from October 2019 to March 2020.

INTERVENTIONS

All participants received a wearable device to track daily steps. The control group received feedback from the device but no other interventions. The intervention group entered into a 12-week game informed by behavioral economics to assign points and levels for achieving step goals and reinforced by a support partner who received updates on participant progress.

MAIN OUTCOMES AND MEASURES

The primary outcome was change in mean daily steps from baseline through the 12-week intervention. Secondary measures were change in functional status and urgent care utilization (ie, emergency department visits and hospital readmissions) within this period.

RESULTS

A total of 232 participants were enrolled in the study (118 randomized to control and 114 randomized to the intervention). Participants had a mean (SD) age of 40 (14) years, 141 (61%) were female, 101 (43%) were White, and 103 (44%) had an annual household income less than $50 000. Daily step counts increased from 3795 to 4652 steps (difference, 857 steps; 95% CI, 488 to 1224 steps) among intervention participants and increased from 3951 to 4499 steps (difference, 548 steps; 95% CI, 193 to 903 steps) among control participants. The change in mean daily step count from baseline was not significantly different for participants in the intervention group vs the control group (adjusted difference, 270 steps; 95% CI, -214 to 754 steps; P = .27). Among the subgroup of 76 participants with higher levels of social engagement, post hoc exploratory analyses showed a significant increase in mobility for intervention vs control (adjusted difference, 1125 steps; 95% CI, 409 to 1841 steps; P = .002). Fewer participants in this subgroup experienced functional decline (1 of 36 participants [4%] in the intervention group vs 5 of 40 participants [12%] in the control group) and hospital readmission at 30 days (3 of 36 participants [8%] in the intervention group vs 6 of 40 participants [15%] in the control group), but the differences were not statistically significant. There were no significant differences in these secondary outcomes for the overall sample.

CONCLUSIONS AND RELEVANCE

Gamification with social incentives did not affect mobility or functional decline in all participants, but post hoc analysis suggests positive findings for both outcomes for patients with higher social engagement.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03321279.

Factors associated with family functioning in patients with heart failure and their family members: An international cross-sectional study

AIMS

To describe and compare family functioning, family health, and perceived social support from nurses and to identify the variables that are associated with family functioning in patients with heart failure (HF) and their family members in Denmark, Iran, and Iceland.

DESIGN

An international multi-centre cross-sectional study.

METHODS

A sample of 1382 participants (692 patients and 690 family members) from Denmark, Iceland, and Iran were included from January 2015 to May 2020. Data were collected using the Family Functioning, Health, and Social Support questionnaire.

RESULTS

The significant factors associated with family functioning in patients were country, New York Heart Association classification (NYHA), education level, age, family health, social support, and there was a significant interaction effect between NYHA class and gender. The significant factors associated with family functioning in family members were country, education level, work status, family health, and there was a significant interaction effect between education and work status.

CONCLUSION

This study indicated that the strongest factor associated with higher family functioning was family health for both patients and family members. Women in NYHA class I and younger patients and those with an academic education had a lower level of family functioning. Moreover, unemployed family members with an elementary education and family members with elementary and high school educations who were self-employed or employees had a lower level of family functioning.

IMPACT

This is the first international study to investigate family functioning, family health, and social support and adds to the literature on the factors associated with family functioning in patients with HF and their family members. Our findings may help nurses to identify the most vulnerable families living with HF, thereby being able to provide special support to enhance their family functioning to promote self-management strategies.

Care needs, social support and meaning in life in patients after acute heart failure hospitalisation: a longitudinal study

BACKGROUND

Meaning in life serves as a protective mechanism for coping with persistent, often distressful symptoms in patients with heart failure. However, meaning in life and its associated factors are not adequately explored in patients after acute hospitalisation for heart failure.

AIMS

To explore the associated factors of meaning in life in patients with heart failure from acute hospitalisation to 3 months post-discharge.

METHODS

A total of 103 hospitalised patients with heart failure in Northern Taiwan were recruited using a longitudinal study design and interviewed with structured questionnaires including meaning in life, symptom distress, care needs, and social support at hospitalisation, 1 month and 3 months post-discharge.

RESULTS

A total of 83 patients completed the 3 months follow-up. The presence of meaning in life significantly increased from hospitalisation to 3 months post-discharge. Decreases in care needs (B=-0.10, P=0.020) and social support (B=-0.18, P=0.016) from hospitalisation to 3 months post-discharge were significantly associated with an increase in the presence of meaning in life, while a decrease in social support was associated with an increase in the search for meaning in life (B=-0.17, P=0.034).

CONCLUSION

Care needs and social support were pivotal factors for developing meaning in life for patients with heart failure. Assessments of care needs and social support might help strengthen their meaning in life.

The emotional and social burden of heart failure: integrating physicians', patients', and caregivers' perspectives through narrative medicine

Background

The The Roadmap Using Story Telling project used a narrative medicine (NM) framework to assess the perspectives of people with heart failure (HF), their informal caregivers and HF specialists of the impact of HF on the daily life of patients and their carers.

Methods

Italian HF specialists participated on a voluntary basis, completing their own narratives, and inviting patients and their caregivers to write anonymously about their experiences, all on a dedicated online platform. The narratives were analyzed according to standard NM methodology.

Results

82 narratives were collected from patients, 61 from caregivers, and 104 from HF specialists. Analysis of the three points of view revealed the extent of the burden of illness on the entire family, particularly that of the caregiver. The impact was mainly experienced as emotional and social limitations in patients’ and their caregivers’ daily lives. The analysis of all three points of view highlighted a strong difference between how HF is perceived by patients, caregivers, and HF specialists.

Conclusions

This NM project illustrates the complex issues of living with HF and gave insights to integrate three different perspectives into the HF pathway of care.

Coping resources of heart failure patients - a comparison with cancer patients and individuals having no chronic condition results from the esther study

BACKGROUND

Heart failure (HF) and cancer patients share similarities in symptom burden and depression prevalence. Coping resources, such as optimism have been associated with improved health-related quality of life (HRQoL) and mental health.

OBJECTIVES

To investigate a wide range of resources in a large population-based sample of HF patients; to compare resources between three groups: HF patients, cancer patients, and individuals having no chronic condition.

METHODS

This cross-sectional analysis was performed among n = 2761 subjects who participated in home visits during the 11-year follow-up of the epidemiological ESTHER study. Resources were assessed by trained medical doctors through a questionnaire that lists 26 items. One-way analyses of covariance (ANCOVAs) controlled for sociodemographic variables and depression were performed to compare resources between groups.

RESULTS

Family and self-efficacy were the most frequently reported resources in all groups. HF patients reported optimism significantly less frequently as a resource in comparison to cancer patients (p=.031). HF patients showed significantly lower levels of resource factor 3 (positive attitude), compared to cancer patients (p=.006), and not chronically ill participants (p=.037).

CONCLUSIONS

Family and self-efficacy seem to be the most important resources, regardless of diagnosis. HF patients appear to have significantly lower levels of resources concerning positive attitude, compared to cancer patients, and not chronically ill individuals. We suggest the development of psychosocial interventions to enhance optimism in HF.

Nurses as educators in the comprehensive heart failure care programme-Are we ready for it?

Aim

To assess education frequency and nurses' comfort when educating patients hospitalized in different hospital units to prepare them for self-care.

Design

A cross-sectional survey. The study included nurses working in units where HF patients were hospitalized.

Results

The average score for comfort of education was 5.43 (between "slightly comfortable" and "very comfortable"). The most comfortable topics were "Daily weight monitoring" (5.81 ± 1.25), "Signs/symptoms of worsening condition" (5.77 ± 1.19) and "Fluid restriction" (5.76 ± 1.23). The respondents felt least comfortable when teaching about "Medications" (5.06 ± 1.35) and "Low-sodium diet" (5.31 ± 1.42). The mean score obtained for education frequency was 5.21 (SD 2.51). The nurses most frequently educated their patients on such topics as "Daily weight monitoring" (5.82), "Signs/symptoms of worsening condition" (5.9) and "Fluid restriction" (5.92).

Conclusions

Polish nurses are not ready to perform comprehensive HF care tasks without preparation.

Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association

Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study ( Data Supplement ) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.

Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure

AIM

The aim of this study was to evaluate the suitability and comprehensibility of the integrated palliative care outcome scale for the evaluation of palliative care needs in patients with heart failure.

METHODS AND RESULTS

This cross-sectional study investigated 100 heart failure patients (40 women, 60 men; median age 79 years) within the first few days of their hospitalisation by applying the integrated palliative care outcome scale (3-day recall period) and two additional self-developed questions about the suitability and comprehensibility of the integrated palliative care outcome scale. Clinically relevant somatic and psycho-emotional symptoms were reported very frequently (approximately 75% each), followed by communicational needs or practical issues. Ninety-five per cent of patients thought the integrated palliative care outcome scale very easy to understand, and 91% judged the integrated palliative care outcome scale suitable to assess palliative care needs.

CONCLUSION

The integrated palliative care outcome scale was well accepted by hospitalised patients with heart failure and identified a high burden of both physical and psycho-emotional symptoms. Screening for palliative care has to consider patients and their relatives alike, and should be part of a comprehensive care concept jointly integrated into clinical routine by primary and specialised palliative care teams.

The association of prediagnosis social support with survival after heart failure in the Cardiovascular Health Study

PURPOSE

Although social support has been shown to be associated with survival among persons with cardiovascular disease, little research has focused on whether social support, measured before the onset of heart failure, can enhance survival after diagnosis. The objective of this study was to assess the association between prediagnosis social support and postdiagnosis survival among older adults with heart failure.

METHODS

We obtained the data from the Cardiovascular Health Study, which included noninstitutionalized adults aged 65 years or older from four sites in the United States with primary enrollment in 1989-1990. We used two measures of social support, the Lubben Social Network Scale and the Interpersonal Support Evaluation List. The analytic data set included 529 participants with a social support measure within two years before diagnosis of heart failure.

RESULTS

After adjustment for demographic covariates, cardiovascular risk factors, and general health status, mortality rates were lower among participants in the highest tertile of social network scores (HR 0.74, 95% CI: 0.59, 0.93) and the middle tertile (HR 0.73 [0.58, 0.90]), compared with the lowest tertile. Results with interpersonal support were null.

CONCLUSIONS

These findings suggest that prediagnosis structural social support may modestly buffer heart failure patients from mortality.

Functional support and burden among out-of-home supporters of heart failure patients with and without depression

OBJECTIVE

Over 20% of patients with heart failure (HF) experience clinical depression, which is associated with higher rates of mortality, morbidity, and hospitalization. Support from family members or friends (whom we refer to as care partners [CPs]) can lower the risk of these outcomes. We examined whether HF patients with depression received assistance from CPs living outside of their homes. Further, we examined whether patient depression was associated with support-related strain among out-of-home CPs.

METHOD

We analyzed baseline survey data from 348 HF patients with reduced ejection fraction and their CPs. Patients with scores on the Center for Epidemiological Studies Depression Scale-10 (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993) of ≥10 were classified as having clinically significant depressive symptoms (i.e., depression). Outcomes included CP-reported hr per week helping with health care and talking with patients via telephone and scores on the Modified Caregiver Strain Index. Negative binomial regression models examined differences in the amount of in-person and telephone support for patients with and without depression, controlling for patients' comorbidities, living alone, CP geographic distance, and CP emotional closeness to the patient.

RESULTS

CPs provided more in-person support to HF patients with depression (M = 3.64 hr) compared with those without depression (M = 2.60 hr per week, incident rate ratio [IRR] = 1.40, p = .019). CPs provided more telephone support to patients with depression (M = 3.02 hr) compared with those without depression (M = 2.09 hr per week, IRR = 1.42, p < .001). Patient depression had no effect on caregiver burden (IRR = 1.00, p = .843).

CONCLUSION

Patients with clinically significant depressive symptoms receive more in-person assistance and telephonic support from CPs. Despite that additional contact, caregiver burden was not greater among the supporters of depressed patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Measuring social support in psychiatric patients and controls: Validation and reliability of the shortened Close Persons Questionnaire

Although previous studies have underlined the protective role of social support for physical and psychological health, no self-report questionnaires are validated for measuring social support in large-scale psychiatric epidemiological studies. In the current study, we aim to validate the shortened version of the Close Persons Questionnaire (CPQ), a self-report questionnaire that is administered twice to measure social support received from the partner (CPQ-p) as well as from a close friend/family member (CPQ-f). Data of psychiatric patients (n = 1891) and controls (n = 1872) from three Dutch epidemiological studies that assessed determinants of psychopathology were used to validate the shortened CPQ. This included determining factor structure and reliability for the different scales. Using multigroup confirmatory factor analyses, a four-factor model proved to be the best fitting model for both the CPQ-p and CPQ-f. The resulting subscales -emotional support, practical support, negative support experiences, inadequacy of support-showed moderate to good reliability for both the CPQ-p and the CPQ-f, and were all correlated with other social measures in the expected directions. The shortened version of the CPQ proves to be a valid and reliable measure of social support for both psychiatric patients and controls. Further research is needed to assess usability of the shortened version of the CPQ for clinical practice.

Self-care confidence mediates self-care maintenance and management in patients with heart failure

BACKGROUND

Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care.

OBJECTIVES

To examine whether confidence explained the associations of social support and HF-knowledge with self-care.

METHODS

In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care.

RESULTS

Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144).

CONCLUSION

Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.

High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population

BACKGROUND

Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital.

METHODS

This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term.

RESULTS

Participants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26-0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16-0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07-12.9).

CONCLUSION

In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients' social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study.

TRIAL REGISTRATION

NIH trials registry number ClinicalTrials.gov: NCT01221532 .

Influence of preparedness on anxiety, depression, and quality of life in caregivers of heart failure patients: Testing a model of path analysis

OBJECTIVES

Testing the influence of heart failure (HF) caregiver preparedness on anxiety and depression, and the influence of HF caregiver anxiety and depression on caregiver physical and mental QOL.

METHODS

In this cross-sectional study, we used the Caregiver Preparedness Scale (CPS), the Hospital Anxiety and Depression Scale (HADS) with the anxiety (HADS-A) and depression (HADS-D) subscales, and the Short-Form 12 (SF-12) measuring the physical component summary (PCS) and the mental component summary (MCS) of QOL. Socio-demographic data and patients' clinic data were also collected. Data analysis was conducted with descriptive statistics, correlations, and path analysis.

RESULTS

A total of 366 HF caregiver and patient dyads were enrolled. Caregivers were mostly females (73.3%) with a mean age of 58.61 (SD = 15.66) years. The tested model showed excellent fit indices with the following significant paths: CPS scores predicted HADS-D scores; HADS-A scores predicted MCS scores; and HADS-D scores predicted both PCS and MCS scores. Also, HADS-D mediated the relationship between CPS and MCS scores.

CONCLUSION

Preparedness influences HF caregiver depression and depression influences caregiver physical and mental QOL. Depression mediates between preparedness and HF caregiver mental QOL.

PRACTICE IMPLICATIONS

Interventions focused on improving HF caregiver preparedness may improve caregivers' depression and QOL.

Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients

PURPOSE

The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields.

METHOD

Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure.

RESULTS

Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS.

CONCLUSION

Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes.

TRIAL REGISTRATION

NCT01357694.

Self-Management: A Comprehensive Approach to Management of Chronic Conditions

For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions—moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.

New Insights in Peripartum Cardiomyopathy

Significant progress in understanding the pathophysiology of peripartum cardiomyopathy, especially hormonal and genetic mechanisms, has been made. Specific criteria should be used for diagnosis, but the disease remains a diagnosis of exclusion. Both long-term and recurrent pregnancy prognoses depend on recovery of cardiac function. Data from large registries and randomized controlled trials of evidence-based therapeutics hold promise for future improved clinical outcomes.

Engaging family supporters of adult patients with diabetes to improve clinical and patient-centered outcomes: study protocol for a randomized controlled trial

Background

Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”). These family supporters are an important resource who could be leveraged to improve patients’ engagement in their care and patient health outcomes. However, healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient self-management support. This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications.

Methods/design

We will conduct a randomized trial evaluating the CO-IMPACT (Caring Others Increasing EnageMent in Patient Aligned Care Teams) intervention. Two hunded forty adults with diabetes who are at high risk for diabetes complications due to poor glycemic control or high blood pressure will be randomized, along with a family supporter (living either with the patient or remotely), to CO-IMPACT or enhanced usual primary care for 12 months. CO-IMPACT provides patient-supporter dyads: it provides one coaching session addressing supporter techniques for helping patients with behavior change motivation, action planning, and proactive communication with healthcare providers; biweekly automated phone calls to prompt dyad action on new patient health concerns; phone calls to prompt preparation for patients’ primary care visits; and primary care visit summaries sent to both patient and supporter. Primary outcomes are changes in patient activation, as measured by the Patient Activation Measure-13, and change in 5-year cardiac event risk, as measured by the United Kingdom Prospective Diabetes Study cardiac risk score for people with diabetes. Secondary outcomes include patients’ diabetes self-management behaviors, diabetes distress, and glycemic and blood pressure control. Measures among supporters will include use of effective support techniques, burden, and distress about patient’s diabetes care.

Discussion

If effective in improving patient activation and diabetes management, CO-IMPACT will provide healthcare teams with evidence-based tools and techniques to engage patients’ available family or friends in supporting patient self-management, even if they live remotely. The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities.

Trial registration

ClinicalTrials.gov, NCT02328326. Registered on 31 December 2014.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2785-2) contains supplementary material, which is available to authorized users.

The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review

OBJECTIVE

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community.

METHOD

A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed.

RESULT

The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified.

CONCLUSION

These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions.

PRACTICE IMPLICATIONS

Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation.

Factors associated with adoption of coping strategies among Chinese patients with heart failure in ethnic minority regions

AIMS AND OBJECTIVES

To examine the coping strategies in patients with heart failure (HF) in the ethnic minority regions of China and to explore the factors affecting the adoption of coping strategies.

BACKGROUND

Effective coping with illness is an important element that influences the adaptation and increases the patient quality of life. Although different factors have been proposed to be determinants of coping strategy, findings are inconclusive, especially when it comes to the cultural background.

DESIGN

A cross-sectional study was performed.

METHODS

A total of 360 HF patients in four districts of Xinjiang were enrolled. All participants completed the Medical Coping Modes Questionnaire, the Minnesota Living with HF Questionnaire and self-management Questionnaire.

RESULTS

Heart failure patients had lower scores in confrontation and higher scores in avoidance and acceptance resignation than patients in the Chinese norm. The multiple regression analysis revealed several factors that indicate confrontation coping including symptom management, employment status and psychological and social management, whereas religion (R2), disease duration, employment status and payment system (P2) were identified as indicators of avoidance coping. In addition, ethnicity (E1), disease duration and employment status were indicators of acceptance resignation coping.

CONCLUSIONS

Our findings from this study suggest that HF patients in the ethnic minority regions may use less confrontation coping and more avoidance and acceptance resignation coping than patients in the Chinese norm. Moreover, the cultural background, duration of disease, quality of life and self-management play important roles in the selection of HF coping strategy.

RELEVANCE TO CLINICAL PRACTICE

The disparities of racial/ethnic exist in coping strategy. Healthcare providers are required to better understand the role of religion in the coping process and how it contributes to the selection of coping strategies.

The association of a heart attack or stroke with depressive symptoms stratified by the presence of a close social contact: findings from the National Health and Aging Trends Study Cohort

OBJECTIVE

The objective of the study is to examine whether the risk of having clinically significant depressive symptoms following a heart attack or stroke varies by the presence of a close social contact.

METHODS

The National Health and Aging Trends Study is a nationally representative longitudinal survey of US Medicare beneficiaries aged 65 and older initiated in 2011. A total of 5643 older adults had information on social contacts at baseline and depressive symptoms at the 1-year follow-up interview. The two-item Patient Health Questionnaire identified clinically significant depressive symptoms. Interview questions examined social contacts and the presence of self-reported heart attack or stroke during the year of follow-up.

RESULTS

A total of 297 older adults reported experiencing a heart attack and/or stroke between their baseline and follow-up interviews. In regression analyses accounting for sociodemographics, baseline depressive symptoms, medical comorbidity, and activities of daily living impairment, older adults with no close social contacts had increased odds of depressive symptoms at follow-up after experiencing a heart attack or stroke, while those with close social contacts had increased odds of depressive symptoms at follow-up after experiencing a stroke, but not a heart attack.

CONCLUSIONS

Older adults have increased odds of having depressive symptoms following a self-reported stroke, but only those with no close social contacts had increased odds of depressive symptoms following a heart attack. Social networks may play a role in the mechanisms underlying depression among older adults experiencing certain acute health events. Future work exploring the potential causal relationships suggested here, if confirmed, could inform interventions to alleviate or prevent depression among at risk older adults. Copyright © 2017 John Wiley & Sons, Ltd.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Patients With Heart Failure

BACKGROUND AND PURPOSE

Low social support is associated with worse outcomes in patients with heart failure. Thus, the purpose of this study was to examine the reliability and validity of the Multidimensional Scale of Perceived Social Support (MSPSS).

METHODS

We performed a secondary analysis of registry data from patients (n = 475) with confirmed heart failure.

RESULTS

The MSPSS demonstrated excellent internal consistency reliability. Factor analysis yielded 3 factors that explained 83% of the variance in perceived social support. More than half of the sample had depressive symptoms (56%). Hypothesis testing demonstrated that worse perceived social support was a predictor of depressive symptoms.

CONCLUSION

The MSPSS is a reliable and valid instrument to measure perceived social support in patients with heart failure.

Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.

Behind the smile: qualitative study of caregivers' anguish and management responses while caring for someone living with heart failure

BACKGROUND

Caregivers support self-management in heart failure but often experience stress, anxiety and ill health as a result of providing care.

AIMS

1. To identify the factors that contribute to the experience of anguish.2. To understand how caregivers learn to live with what is frequently a challenging and demanding role.

METHODS

Individual interviews with caregivers who had been caring for someone with heart failure for a minimum of 6 months. We used thematic analysis to inductively analyse transcripts.

RESULTS

Twenty-two caregivers, from three centres in the United Kingdom, took part in individual interviews. The caregivers were aged between 39 and 84 years, and six were men. Twenty were in spousal or partner relationships. We found that caregivers often hide the extent of their emotional stress or anguish. We identified four main themes with explanatory subthemes-emotional impact (fear for the future and sense of hopelessness), role definition (changing sense of who I am, reduced resilience, learning care skills, role conflict and changing role), exclusion (exclusion by the cared-for person and by health professionals and feeling alone) and ignoring one's own health-that were associated with anguish. From these findings, we produced a caregiver needs assessment model in the context of caring for a person with heart failure.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Caregivers have many unmet and hidden needs. Primary care health professionals are well placed to meet the needs of caregivers. The model may be used by health and social care professionals to identify needs and to provide caregivers with targeted practical and emotional support; and for researchers developing interventions to enhance self-management in heart failure.

Aspects of family caregiving as addressed in planned discussions between nurses, patients with chronic diseases and family caregivers: a qualitative content analysis

BACKGROUND

Caregiving by family members of elderly with chronic conditions is currently intensifying in the context of an aging population and health care reform in the Netherlands. It is essential that nurses have attention for supporting roles of family caregivers of older patients and address family caregiving aspects on behalf of the continuity of care. This study aims to explore what aspects of family caregiving were addressed during planned discussions between nurses, patients and family caregivers in the hospital.

METHODS

Qualitative descriptive research was conducted using non-participant observation and audio-recordings of planned discussions between nurses, older patients and their family caregivers as they took place in the hospital. Through purposive sampling eligible patients (≥ 65 years) with one or more chronic conditions were included. These patients were admitted to the hospital for diagnostics or due to consequences of their chronic illness. Retrospective chart review was done to obtain patient characteristics. Data were collected in November/December 2013 and April/May 2014 in four hospitals. Qualitative content analysis was performed using the inductive approach in order to gain insight into addressed aspects of family caregiving.

RESULTS

A total of 62 patients (mean age (SD) 76 years (7.2), 52% male) were included in the study, resulting in 146 planned discussions (62 admission and discharge discussions and 22 family meetings). Three themes were identified regarding addressed aspects of family caregiving. Two themes referred to aspects addressing the patients' social network, and included 'social network structure' and 'social network support'. One theme referred to aspects addressing coordination of care issues involving family caregiving, referred to as 'coordination of care'.

CONCLUSIONS

During discussions nurses mostly addressed practical information on the patients' social network structure. When specific family caregiving support was addressed, information was limited and nurses did not seem to explore the nature of the family support. Patients discharge and after care needs were addressed occasionally as aspects of coordination of care. Current nursing policies could be evaluated on nursing and family oriented theories. Implications for education could include mirroring study findings with nurses in a group discussion to enhance their awareness on family caregiving aspects.

Social support and breast cancer: A comparatory study of breast cancer survivors, women with mental depression, women with hypertension and healthy female controls

OBJECTIVES

Among breast cancer (BC) survivors, inadequate social support (SS) is associated with a significant increase in cancer-related mortality and reduction in quality of life (QoL). The aim of the study was to explore perceived SS during BC trajectory by comparing BC survivors, women with depression, women with arterial hypertension, and healthy female controls to each other, and to compare perceived balance of receiving and providing SS.

MATERIAL AND METHODS

The data of ongoing prospective postal survey was linked with national health registries. Respondents with BC (n = 64), depression (n = 471), arterial hypertension (n = 841) and healthy controls (n = 6274) formed the study population. SS was measured by a Sarason's 6-item shortened version of the Social Support Questionnaire (SSQ). The modified Antonucci's (1986) social support convoy model of the network of individuals was used to measure the dominating direction of SS.

RESULTS

The main provider of SS for all participants combined was the spouse or partner (94.3%), close relative (12.0%) and friends (5.4%). In all groups, particularly in the BC and arterial hypertension group, spouse or partner was seen as the most important supporter. The group suffering from depression reported significantly less SS in each domain of appraisal (p < 0.001). In total, 24.6% of all respondents reported receipt dominance of SS.

CONCLUSION

SS is a well-known determinant of wellbeing. Our study lends support to the spouse's or the partner's central role during the recovery phase of BC. Identification of factors improving the overall QoL of BC survivors is an important public health challenge.

Anger, hostility, and hospitalizations in patients with heart failure

OBJECTIVE

Heart failure patients have a high hospitalization rate, and anger and hostility are associated with coronary heart disease morbidity and mortality. Using structural equation modeling, this prospective study assessed the predictive validity of anger and hostility traits for cardiovascular and all-cause rehospitalizations in patients with heart failure.

METHOD

146 heart failure patients were administered the STAXI and Cook-Medley Hostility Inventory to measure anger, hostility, and their component traits. Hospitalizations were recorded for up to 3 years following baseline. Causes of hospitalizations were categorized as heart failure, total cardiac, noncardiac, and all-cause (sum of cardiac and noncardiac).

RESULTS

Measurement models were separately fit for Anger and Hostility, followed by a Confirmatory Factor Analysis to estimate the relationship between the Anger and Hostility constructs. An Anger model consisted of State Anger, Trait Anger, Anger Expression Out, and Anger Expression In, and a Hostility model included Cynicism, Hostile Affect, Aggressive Responding, and Hostile Attribution. The latent construct of Anger did not predict any of the hospitalization outcomes, but Hostility significantly predicted all-cause hospitalizations. Analyses of individual trait components of each of the 2 models indicated that Anger Expression Out predicted all-cause and noncardiac hospitalizations, and Trait Anger predicted noncardiac hospitalizations. None of the individual components of Hostility were related to rehospitalizations or death.

CONCLUSION

The construct of Hostility and several components of Anger are predictive of hospitalizations that were not specific to cardiac causes. Mechanisms common to a variety of health problems, such as self-care and risky health behaviors, may be involved in these associations. (PsycINFO Database Record

The association between supportive relatives and lower occurrence of anxiety and depression in heart patients: Results from a nationwide survey

BACKGROUND

Approximately 30-40% of heart patients develop anxiety and/or depression, which might influence recovery and long-term survival. Research has suggested that support from relatives may decrease anxiety and depression among heart patients; however, the results are inconsistent and often based on small study populations.

AIM

The paper aimed to investigate the association between having supportive relatives and the occurrence of anxiety and depression in heart patients.

METHODS

A population-based cross-sectional study among Danish patients diagnosed with ischemic heart disease, atrial fibrillation, heart failure, or heart valve disease. Presence of supportive relatives was measured as the degree to which the patients felt that they had relatives they could count on, while symptoms of anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Multiple logistic regression analyses accounting for confounders were used to examine the association between supportive relatives and anxiety/depression.

RESULTS

The questionnaire was answered by 2496 heart patients, corresponding to 50% of the invited population. Patients with low or some degree of supportive relatives had a higher odds ratio (OR) of anxiety than patients with a high degree (OR = 2.20, 95% confidence interval (CI): 1.28-2.37; OR = 1.75, 95% CI: 1.57-3.08, respectively). Likewise, patients with low or some degree of supportive relatives had a higher OR of depression than patients with a high degree (OR = 1.96, 95% CI: 1.40-2.66; OR = 1.93, 95% CI: 1.37-2.60, respectively).

CONCLUSIONS

The presence of supportive relatives was found to be associated with lower occurrence of anxiety and depression. Health professionals should focus on including relatives in the treatment and rehabilitation of heart patients.