Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure

Study of the Relationship Between Death Anxiety and Quality of Life in Patients With Heart Failure

This study aimed to investigate the relationship between death anxiety and QoL in a sample of Iranian heart failure (HF) patients. A cross-sectional correlational design was employed to examine this relationship in a sample of 296 HF patients. Participants were recruited using convenience sampling from teaching hospitals in Kermanshah City, western Iran, between October and December 2023. Data were collected using a demographic questionnaire, the Templer Death Anxiety Scale (TDAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Participants reported moderate to high levels of death anxiety (Mean [SD] = 7.54 [2.35]) on the TDAS and moderate to poor QoL (Mean [SD] = 36.24 [12.26]) on the MLHFQ. The statistical methods used in this study included descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson correlation coefficient, multiple linear regression analysis, and the Kolmogorov-Smirnov test. All statistical analyses were performed using SPSS version 26, with a significance level set at 0.05. A significant positive correlation was found between death anxiety and QoL (r = 0.329, p < .001), indicating that higher levels of death anxiety were associated with lower QoL. These results underscore the importance of addressing death anxiety in HF patients to improve their QoL. Interventions targeting the reduction of death anxiety and the enhancement of QoL are essential for optimizing care for this vulnerable population. The study recommends the implementation of psychological interventions, support groups, comprehensive counseling, education, and regular assessments for this purpose.

Network analysis of anxiety and depressive symptoms among patients with heart failure

BACKGROUND

Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF.

METHODS

This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R.

RESULTS

In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family).

CONCLUSIONS

This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression.

Relationships between heart failure, depression, and anxiety: A Mendelian randomization study

Growing evidence suggests that heart failure (HF) is associated with an increased risk of depressive disorders and anxiety. However, the existing studies were observational and may have confounded and not reflected true causal relationships. This study collected genetic instruments about HF, depression, and anxiety from publicly available genetic summary data. Two-sample Mendelian randomization (MR) analysis was performed, with inverse-variance weighted designated as the primary approach for determining causal effects. Secondary analyses included MR-Egger regression and the weighted media method. Additionally, we conducted MR pleiotropy residual sum and outlier to address horizontal pleiotropy. Cochran Q test, MR-Egger intercept test, and leave-one-out analysis were used to assess the robustness of the findings. The significance is determined by a P-value below .05. Gene prediction result revealed that HF did not exhibit a significant association with elevated incidence of depression by inverse-variance weighted method no matter HF from the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.93-1.18, P = .424 for major depressive disorder, MDD; OR = 1.01, 95% CI = 0.94-1.09, P = .782 for major depression) or the FinnGen Consortium (OR = 1.03, 95% CI = 0.92-1.15, P = .644 for MDD; OR = 1.00, 95% CI = 0.94-1.07, P = .962 for major depression). In contrast, the results of HF on anxiety exhibited inconsistency (OR = 1.60, 95% CI = 1.10-2.31, P = .013 for Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium; OR = 1.42, 95% CI = 0.91-2.21, P = .123 for FinnGen Consortium); however, a combined effect analysis indicated support causal relationship between HF and the risk of anxiety (OR = 1.52, 95% CI = 1.07-2.00, P < .001). Our findings did not reveal evidence to confirm a causal association between HF and depression. However, our results provide support for a causal effect of HF on the risk of anxiety.

Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial

Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.

Strategies in activating lymphatic system on symptom distress and health-related quality of life in patients with heart failure: secondary analysis of a pilot randomized controlled trial

Background

Abnormal interstitial fluid accumulation remains the major cause for patients with heart failure (HF) to endure a myriad of distressing symptoms and a decline in their health-related quality of life (HRQoL). The lymphatic system is essential in regulating fluid balance within the interstitial compartment and has recently been recognized as an important target for the prevention and mitigation of congestion. This study aimed to investigate the effects of exercises in activating lymphatic system on symptom distress and HRQoL among patients with HF.

Methods and results

This was a pre-determined, secondary analysis of the TOLF-HF [The-Optimal-Lymph-Flow for Heart Failure (TOLF-HF)] study, a two-arm pilot randomized controlled trial evaluating the preliminary effects of the lymphatic exercise intervention in enhancing interstitial decongestion among patients with HF. Participants were randomized to receive either a four-week TOLF-HF program in addition to standard care or standard care alone. The Chinese version of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was employed to measure symptom distress and HRQoL before and after the intervention. Data analyses included descriptive statistics, the independent sample t-test, Pearson's chi-square test, the Mann-Whitney U test, and covariance analysis. Of the 66 patients enrolled, 60 completed the study. The study results exhibited that the TOLF-HF intervention were effective in alleviating both physical and psychological symptom distress. The intervention group yielded significantly lower MLHFQ total scores in comparison to the control group. The odd ratio of achieving meaningful improvement in HRQoL in TOLF-HF group was 2.157 times higher than those in the control group.

Conclusions

The TOLF-HF program focusing on activating lymphatic system was effective in alleviating physical and psychological symptom distress as well as improving HRQoL for patients with HF. The tolerability, feasibility, and effectiveness of the TOLF-HF intervention make it a promising intervention for patients to manage HF.

Clinical Trial Registration

http://www.chictr.org.cn/index.aspx, identifier (ChiCTR2000039121).

Factors that contribute to trait mindfulness level among hospitalized patients with major depressive disorder

Mindfulness training among patients with major depressive disorder (MDD) reduces symptoms, prevents relapse, improves prognosis, and is more efficient for those with a high level of trait mindfulness. Upon hospital admission, 126 MDD patients completed the Beck Depression Inventory (BDI), World Health Organization Quality of Life Brief, Five-Factor Mindfulness Questionnaire (FFMQ), and the Rumination Response Scale (RRS). The 65 patients that scored less than the median of all subjects on the FFMQ were placed into the low mindfulness level (LML) group. The other 61 patients were placed in the high mindfulness level (HML) group. All facet scores were statistically different between the mental health assessment scores of the HML and LML groups except for RRS brooding and FFMQ nonjudgement. Trait mindfulness level exhibited a negative and bidirectional association with MDD severity primarily through the facets of description and aware actions. Trait mindfulness was also related positively with age primarily through the facets of nonreactivity and nonjudgement. Being married is positively associated with trait mindfulness levels primarily through the facet of observation and by an associated increase in perceived quality of life. Mindfulness training prior to MDD diagnosis also associates positively with trait mindfulness level. Hospitalized MDD patients should have their trait mindfulness levels characterized to predict treatment efficiency, help establish a prognosis, and identify mindfulness-related therapeutic targets.

Sex Differences in Depression, Anxiety, Stress, and Mindfulness Among Patients With Percutaneous Coronary Intervention

An in-depth understanding of psychological symptoms and mindfulness of men and women with percutaneous coronary intervention (PCI) may help develop sex-specific treatments and outcomes. This study aimed to examine differences in depression, anxiety, stress, and mindfulness between men and women undergoing PCI using a convenience sample of 114 participants (81 men and 33 women) with PCI at a university hospital in 2013. The Depression Anxiety Stress Scales and the Korean version of the Mindfulness Attention Awareness Scale were administered. The depression, anxiety, and stress scores of women were higher than those of men, with no significant differences in mindfulness between the two sexes. The comparison of cutoff scores for severity (normal scores vs. ≥ mild) of depression, anxiety, and stress for men versus women revealed a higher proportion of women in the ≥ mild categories for the three components. Women who received PCI showed greater psychological distress than men. Therefore, awareness of these differences may alert cardiovascular nurses to employ systematic vigilance in assessing and mitigating this distress among cardiac patients, particularly women.

Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat

Heart failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events. Over time, unless optimization of HF treatment, worsening HF events become more frequent and patients enter into a cycle of recurrent events with high morbidity and mortality. In patients with HF there is an activation of deleterious neurohormonal pathways, such as the renin angiotensin aldosterone system and the sympathetic system, and an inhibition of protective pathways, including natriuretic peptides and guanylate cyclase. Therefore, HF burden can be reduced only through a holistic approach that targets all neurohormonal systems. In this context, vericiguat may play a key role, as it is the only HF drug that activates the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate system. On the other hand, it has been described relevant disparities in the management of HF population. Consequently, it is necessary to homogenize the management of these patients, through an integrated patient-care pathway that should be adapted at the local level. In this context, the development of new technologies (ie, video call, specific platforms, remote control devices, etc.) may be very helpful. In this manuscript, a multidisciplinary group of experts analyzed the current evidence and shared their own experience to provide some recommendations about the therapeutic optimization of patients with recent worsening HF, with a particular focus on vericiguat, and also about how the integrated patient-care pathway should be performed.

The predictive value of self-compassion for psychological adjustment in left ventricular assist device patients: an observational study

Aims

Implantation of a left ventricular assist device (LVAD) is an established treatment option for patients with advanced heart failure. However, apart from its challenging medical management, it comes with serious psychological implications. Empirical evidence suggests that self‐compassion, a self‐regulation strategy for countering negative self‐directed emotions, might be a promising approach in facilitating psychological adjustment also in LVAD patients. The aims of the present study were to investigate self‐compassion as a protective factor for anxiety and depressive symptoms, to test whether taking a decentred perspective mediates these effects, and to explore whether self‐compassion predicts the clinically rated functional health status.

Method and results

A sample of N = 45 patients (36 male) with a mean age of 60.5 years (SD = 10.8) from the outpatient department for terminal heart failure at the University Medical Center in Kiel, Germany, participated in the study. Patients completed self‐report measures for psychological adjustment (HADS), self‐compassion (SCS), and decentring (EQ). Functional health status was determined by the NYHA classification. The more patients were self‐compassionate, the less they reported anxiety (r = −0.28) and depressive symptoms (r = −0.34). Decentring mediated both effects. Moreover, self‐compassion predicted the functional health status, even when controlling for anxiety (odds ratio [OR] = 0.09) and depressive symptoms (OR = 0.11).

Conclusions

This study provides the first evidence for a significant interrelation between self‐compassion and common adverse psychological conditions in LVAD patients. Longitudinal data and the evaluation of interventions to strengthen self‐compassion are needed to further validate the beneficial effects of self‐compassion in LVAD patients in the future.

Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial

Purpose

Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention.

Methods

This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year.

Results

We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2.

Conclusion

Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02788-3).