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Heif DM, Masa'Deh R, AbuRuz ME, Hamaideh SH, Rayan A, Al-Yateem N. The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure. Holist Nurs Pract 2024; 38:85-92. [PMID: 38363969 DOI: 10.1097/hnp.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.
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Affiliation(s)
- Dunia M Heif
- Applied Science Private University, Amman, Jordan (Ms Heif); Psychiatric Mental Health, School of Nursing, Applied Science Private University, Amman, Jordan (Dr Masa'Deh); Critical Care Nursing, School of Nursing, Applied Science Private University, Amman, Jordan (Dr AbuRuz); Department of Community & Mental Health Nursing, Faculty of Nursing, Hashemite University, Zarqa, Jordan (Dr Hamaideh); Faculty of Nursing, Zarqa University, Jordan (Dr Rayan); and Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates (Dr Al-Yateem)
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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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3
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Fomicheva AV, Volel BA, Troshina DV, Andreev DA, Simonov AN, Zozulya SA, Klyushnik TP. [Clinical features of asthenic disorders in chronic heart failure]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:104-111. [PMID: 36843466 DOI: 10.17116/jnevro2023123021104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The aim of the study is to study the clinical features of asthenic disorders in chronic heart failure (CHF) considering the reaction to the disease. MATERIAL AND METHODS 62 inpatients with CHF II-IV functional class (FC) according to NYHA were examined. Research methods included somatic, psychopathological and pathopsychological examination using psychometric scales. RESULTS According to a pathopsychological study using the Multidimensional Fatigue Inventory (MFI-20), asthenic disorders were discovered in all examined patients, realized mainly by «general fatigue» (75.8%) and «physical fatigue» (72.6%), more rarely «mental fatigue» was observed (32.2%). Correlations of «general fatigue» with the age of patients were revealed (p=0.018). There was a relationship between the severity of asthenic disorders and the severity of CHF, as evidenced by the correlation between «general fatigue» and reduced ejection fraction (EF) of the left ventricle (p=0.005), as well as «physical fatigue» and FC according to NYHA (p=0.022). The negative impact of all components of the dimensions of asthenic disorders on the quality of life was determined (p<0.05). According to the concept of the formation of different perceptions of the manifestations of a somatic disease, two types of reactions to asthenic disorders were identified: 1. Dissociative reactions, manifested by a discrepancy between the severity of CHF and a subjective assessment of the condition with an underestimation of the asthenic symptoms denial of its influence on the usual lifestyle and associated with an unfavorable course of CHF and 2. Adaptive reactions, realized by a harmonious perception of asthenia, awareness of the need to change lifestyle considering the presence of CHF symptoms. CONCLUSION In accordance with the results, the described clinical features of asthenic disorders allow to distinguish asthenia in CHF and other pathology, and the identified types of reactions can contribute to the timely verification of asthenia, prevention of further progression of CHF, and the development of appropriate treatment approaches.
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Affiliation(s)
- A V Fomicheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - B A Volel
- Sechenov First Moscow State Medical University, Moscow, Russia.,Mental Health Research Centre, Moscow, Russia
| | - D V Troshina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D A Andreev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A N Simonov
- Mental Health Research Centre, Moscow, Russia
| | - S A Zozulya
- Mental Health Research Centre, Moscow, Russia
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4
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Fatigue in Heart Failure. J Cardiovasc Nurs 2022. [DOI: 10.1097/jcn.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health. J Card Fail 2022; 28:283-315. [PMID: 34329719 PMCID: PMC8795245 DOI: 10.1016/j.cardfail.2021.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health. METHODS AND RESULTS A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue. CONCLUSIONS Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
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6
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Fomicheva A, Andreev D, Lyubavskaya A, Simonov A, Volel B. Clinical and psychopathological aspects of nosogenic reactions in chronic heart failure. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:86-94. [DOI: 10.17116/jnevro202212209186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Salyer J, Flattery M, Lyon DE. Heart failure symptom clusters and quality of life. Heart Lung 2019; 48:366-372. [DOI: 10.1016/j.hrtlng.2019.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023]
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8
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Suzuki T, Shiga T, Nishimura K, Omori H, Tatsumi F, Hagiwara N. Patient Health Questionnaire-2 Screening for Depressive Symptoms in Japanese Outpatients with Heart Failure. Intern Med 2019; 58:1689-1694. [PMID: 30799347 PMCID: PMC6630118 DOI: 10.2169/internalmedicine.2034-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective Depression is common in patients with heart failure (HF) and is a possible risk factor for adverse outcomes. The aim of this study was to determine the prevalence of depression assessed by the 2-item Patient Health Questionnaire (PHQ-2) and the effect of depression on outcomes in Japanese outpatients with HF. Methods This sub-analysis of a prospective observational study assessed 976 patients with HF (mean age 66±13 years; 26.7% female; 42.7% with an ischemic etiology). Depression was defined as a PHQ-2 score ≥3. The main composite outcome was death from any cause or hospitalization due to worsening HF. PHQ-2 items were extracted from the PHQ-9 results. To evaluate the association of PHQ-2 scores with outcomes, Cox proportional hazards models were evaluated. Results Fifty-seven (5.8%) patients were diagnosed with depression. During a median follow-up of 21 months, the incidence rates for death from any cause and hospitalization due to worsening HF in patients with and without depression were 2.2 vs. 0.9 per 100 person-years and 6.7 vs. 1.6, p<0.001, respectively. There was a higher incidence of the main outcome in patients with depression than in those without depression (p<0.001). After adjustment for conventional risk factors, depression (PHQ-2 ≥3) was an independent predictor of the main outcome (hazard ratio 2.41, 95% confidence interval 1.14-4.67, p=0.022), and a score for item 1 of the PHQ-2 (loss of interest or pleasure) ≥2 was also an independent risk factor (hazard ratio 3.57, 95% confidence interval 1.85-6.46, p<0.001). Conclusion Depression as assessed by the PHQ-2 was identified in 5.8% of Japanese outpatients with HF and was associated with outcomes.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | | | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Institute of Geriatrics, Women's Medical University, Japan
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10
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Banerjee N, Slugh M, Kaur S, Sun-Suslow N, McInerney KF, Sun X, Levin BE. Neuropsychological correlates of subjective fatigue in non-demented older adults and the moderating effect of physical activity. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:254-269. [PMID: 31025596 DOI: 10.1080/13825585.2019.1606889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the association between self-reported fatigue and neuropsychological performance in 167 middle-aged and older (age range: 50-91 years) adults without dementia. Participants completed the Fatigue Symptom Inventory, a comprehensive neuropsychological evaluation, and frailty assessment. Higher levels of fatigue were significantly associated with poorer attention/information processing, executive functioning, and psychomotor speed, even after controlling for depression, sleep quality, physical weakness, and other covariates. Participants endorsing moderate-severe fatigue faced higher odds (OR = 6.6, 95% CI = 1.1, 39.1) of exhibiting clinical attention/information processing impairments than those without. Moderation analyses showed that fatigue was related to select cognitive deficits among those reporting mean or lower levels of activity, but not high levels. These findings highlight fatigue as an important clinical marker of select cognitive deficits in non-demented older adults that is distinct from the common confounding conditions examined in this study. High levels of physical activity may buffer this relationship.
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Affiliation(s)
- Nikhil Banerjee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mitchell Slugh
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonya Kaur
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ni Sun-Suslow
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katalina F McInerney
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Xiaoyan Sun
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E Levin
- Department of Psychology, University of Miami, Coral Gables, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Auld JP, Mudd JO, Gelow JM, Lyons KS, Hiatt SO, Lee CS. Device-detected congestion is associated with worse patient-reported outcomes in heart failure. Heart Lung 2019; 48:208-214. [PMID: 30611529 DOI: 10.1016/j.hrtlng.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/07/2018] [Accepted: 12/04/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms. OBJECTIVE To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months. METHODS Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale). RESULTS The mean age of the sample (n = 49) was 62years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90days reported on average, 130% higher dyspnea (p = 0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p = 0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p = 0.003; CI 19.1%, 257%) and 40% higher anxiety (p = 0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90days were also significantly associated with a clinically meaningful decrease in HRQOL (β = -16.16 ± 6.32; p = 0.01). CONCLUSIONS Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3months.
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Affiliation(s)
- Jonathan P Auld
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA.
| | - James O Mudd
- Oregon Health & Science University, Knight Cardiovascular Institute, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA
| | - Jill M Gelow
- Oregon Health & Science University, Knight Cardiovascular Institute, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA
| | - Karen S Lyons
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA
| | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
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12
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Hägglund L, Boman K, Brännström M. A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nurs Open 2018; 5:176-185. [PMID: 29599993 PMCID: PMC5867290 DOI: 10.1002/nop2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/29/2017] [Indexed: 01/25/2023] Open
Abstract
Aims and objectives This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older. Background Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF. Design A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (N = 25) or control (N = 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self‐rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (N = 10) in the Tai Chi training group. Results No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow‐up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort. Conclusion Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.
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Affiliation(s)
| | - Kurt Boman
- Department of Medicine-Geriatric Skellefteå County Hospital Skellefteå Sweden.,Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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13
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Chen DM, Yu WC, Hung HF, Tsai JC, Wu HY, Chiou AF. The effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure: A randomized controlled trial. Eur J Cardiovasc Nurs 2017; 17:456-466. [PMID: 29189045 DOI: 10.1177/1474515117744770] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The purpose of this study was to examine the effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure. METHODS The study was a randomized controlled trial. Participants diagnosed with heart failure were recruited from two large medical centers in northern Taiwan. Participants were randomly assigned to the intervention ( n=39) or control ( n=41) groups. Patients in the intervention group underwent a 12-week Baduanjin exercise program, which included Baduanjin exercise three times per week for 12 weeks at home, a 35-minute Baduanjin exercise demonstration video, a picture-based educational brochure, and a performance record form. The control group received usual care and received no intervention. Fatigue and quality of life were assessed using a structural questionnaire at baseline, four weeks, eight weeks, and 12 weeks after the intervention. RESULTS Participants in the Baduanjin exercise group showed significant improvement in fatigue ( F=5.08, p=0.009) and quality of life ( F=9.11, p=0.001) over time from baseline to week 12 after the intervention. Those in the control group showed significantly worse fatigue ( F=3.46, p=0.033) over time from baseline to week 12 and no significant changes in quality of life ( F=0.70, p=0.518). Compared to the control group, the exercise group demonstrated significantly greater improvement in fatigue and quality of life at four weeks, eight weeks, and 12 weeks. CONCLUSIONS This simple traditional exercise is recommended for Taiwanese patients with heart failure in order to improve their fatigue and quality of life.
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Affiliation(s)
- Dai-Mei Chen
- 1 Surgical Department, National Taiwan University Hospital, Taiwan
| | - Wen-Chung Yu
- 2 Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital and Faculty of Medicine, National Yang-Ming University, Taiwan
| | - Huei-Fong Hung
- 3 Cardiology Department, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Jen-Chen Tsai
- 4 School of Nursing, National Yang Ming University, Taiwan
| | - Hsiao-Ying Wu
- 4 School of Nursing, National Yang Ming University, Taiwan.,5 Department of Nursing, Taoyuan General Hospital, Taiwan
| | - Ai-Fu Chiou
- 4 School of Nursing, National Yang Ming University, Taiwan
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Wood KA, Barnes AH, Paul S, Hines KA, Jackson KP. Symptom challenges after atrial fibrillation ablation. Heart Lung 2017; 46:425-431. [PMID: 28923248 PMCID: PMC5811184 DOI: 10.1016/j.hrtlng.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear what symptom challenges occur during the recovery phase after atrial fibrillation (AF) ablation. OBJECTIVES This longitudinal pilot study explored the patient perspective of the first six months following an AF ablation. METHODS Telephone interviews and questionnaires were used with 20 patients at baseline, at 1, 3, and 6 months after AF ablation. Telephone interview data were analyzed using content analysis. Longitudinal outcomes were analyzed using repeated measures analysis of variance (ANOVA). RESULTS Mean age was 65 ± 7 years and the sample was 55% female. The severity and duration of fatigue was the most concerning symptom. Patient expectations differed from providers' expectations. Recovery was a much slower process than patients expected. CONCLUSIONS Patients struggled to manage symptoms after AF ablation. A more accurate understanding of the symptom challenges following AF ablation could lead to development of more realistic education to improve patient self-management.
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Affiliation(s)
| | | | | | | | - Kevin P Jackson
- Division of Clinical Cardiac Electrophysiology, Duke University Medical Center, USA.
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Abstract
Heart failure is a chronic, progressive illness that is increasing in prevalence in the USA. Patients with advanced heart failure experience a high symptom burden that is comparable to patients with advanced cancer. Palliative care, however, is underutilized in patients with heart failure, and symptoms may go untreated as the disease progresses. A combination of pharmacologic and non-pharmacologic interventions should be used to address symptoms and maintain quality of life. While there have been significant advances in evidence-based heart failure treatments in recent years, selection of appropriate palliative medications as symptoms progress is challenging due to limited clinical studies in this patient population. Medications that are commonly used for symptom management in other life-limiting illnesses may have little to no evidence in heart failure, or have undesirable cardiac effects that preclude use. Clinicians must extrapolate available clinical evidence and prescribing considerations relevant to heart failure to palliate symptoms as well as possible. The objectives of this paper are to review the most common and distressing symptoms in heart failure, analyze evidence, or lack thereof, for pharmacologic management of symptoms, and provide prescribing considerations based on side effect profiles and comorbid conditions.
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Affiliation(s)
- Diana Stewart
- MedStar Washington Hospital Center, Washington, DC, 20010, USA.
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17
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Williams BA. The clinical epidemiology of fatigue in newly diagnosed heart failure. BMC Cardiovasc Disord 2017; 17:122. [PMID: 28490326 PMCID: PMC5426047 DOI: 10.1186/s12872-017-0555-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF). This study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients from the community. METHODS This retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Incident HF, fatigue, and other study variables were derived from coded data within EMRs. A collection of 87 candidate predictors were evaluated to ascertain the strongest independent predictors of fatigue using logistic regression. Patients were followed for all-cause mortality for an average of 4.8 years. The associations between fatigue and 6-month, 12-month, and overall mortality were evaluated via Cox proportional hazards regression models. RESULTS Clinically documented fatigue was found in 4827 (39%) newly diagnosed HF patients. Depression demonstrated the strongest association with fatigue. Fatigue was often part of a symptom cluster, as other HF symptoms including dyspnea, chest pain, edema, syncope, and palpitations were significant predictors of fatigue. Volume depletion, lower body mass index, and abnormal weight loss were also strong predictors of fatigue. Fatigue was not significantly associated with either 6-month (HR = 1.12, p = 0.16) or overall mortality (HR = 1.00, p = 0.89) in adjusted models. CONCLUSIONS Fatigue is a commonly documented symptom among newly diagnosed HF patients, and its origins may lie in both psychologic and physiologic factors. Though fatigue did provide a prognostic signal in the short-term, this was largely explained by physiologic confounders. Proper therapeutic remediation of fatigue in HF relies on identifying underlying factors.
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Affiliation(s)
- Brent A Williams
- Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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18
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Abstract
Fatigue is a symptom experienced almost universally by people living with a chronic illness. People diagnosed with heart failure have described experiencing significant levels of fatigue. The family experience of fatigue, that is, how families perceive, respond to, and manage fatigue, is unknown. Semistructured family group interviews with 22 families ( N = 62 family members) were conducted. Thematic analysis was undertaken to explore the family experience of fatigue. Fatigue was described as a significant symptom that affected physical, emotional, and social functioning at a family level. Fatigue was described as difficult to manage, and while most family members interviewed had developed a shared understanding of fatigue, some family members found acceptance of this invisible symptom more difficult. Spouses were more likely to express concern that fatigue, and especially increased fatigue, represented a decline in health. The study highlighted the importance of a shared understanding of fatigue from a family perspective.
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Affiliation(s)
- Lisa Whitehead
- 1 Edith Cowan University, Joondalup, Western Australia, Australia
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Heo S, McSweeney J, Tsai PF, Ounpraseuth S. Differing Effects of Fatigue and Depression on Hospitalizations in Men and Women With Heart Failure. Am J Crit Care 2016; 25:526-534. [PMID: 27802954 PMCID: PMC6169317 DOI: 10.4037/ajcc2016909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In patients with heart failure, worsening of signs and symptoms and depression can affect hospitalization and also each other, resulting in synergistic effects on hospitalizations. A patient's sex may play a role in these effects. OBJECTIVES To determine the effects of fatigue and depression on all-cause hospitalization rates in the total sample and in subgroups of men and women. METHODS A secondary analysis was done of data collected January 1, 2010, through December 31, 2012 (N = 582; mean age, 63.2 years [SD, 14.4]). Data were collected on fatigue, depression, sample characteristics, vital signs, results of laboratory tests, medications, and frequency of hospitalization. Patients were categorized into 4 groups on the basis of the International Classification of Diseases, Ninth Revision: no fatigue or depression, fatigue only, depression only, and both fatigue and depression. General linear regression was used to analyze the data. RESULTS In both the total sample and the subgroups, the number of hospitalizations in patients with both fatigue and depression was greater than the number in patients without either symptom. Among women, the number of hospitalizations in the fatigue-only group and in the depression-only group was greater than that in the group with neither symptom. In men, the number of hospitalizations in the fatigue-only group was greater than that in the group without either symptom. CONCLUSION Fatigue and depression do not have synergistic effects on hospitalization, but men and women differ in the effects of these symptoms on hospitalization.
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Affiliation(s)
- Seongkum Heo
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health.
| | - Jean McSweeney
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
| | - Pao-Feng Tsai
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
| | - Songthip Ounpraseuth
- Seongkum Heo is an associate professor, Jean McSweeney is a professor and associate dean for research, and Pao-Feng Tsai is a professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Songthip Ounpraseuth is an associate professor, University of Arkansas for Medical Sciences, College of Public Health
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Zimmerman L, Pozehl B, Vuckovic K, Barnason S, Schulz P, Seo Y, Ryan CJ, Zerwic JJ, DeVon HA. Selecting symptom instruments for cardiovascular populations. Heart Lung 2016; 45:475-496. [PMID: 27686695 DOI: 10.1016/j.hrtlng.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/11/2023]
Abstract
The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.
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Affiliation(s)
- Lani Zimmerman
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA.
| | - Bunny Pozehl
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Karen Vuckovic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Susan Barnason
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Paula Schulz
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Yaewon Seo
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Catherine J Ryan
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Julie J Zerwic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Holli A DeVon
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
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Schjoedt I, Sommer I, Bjerrum MB. Experiences and management of fatigue in everyday life among adult patients living with heart failure. ACTA ACUST UNITED AC 2016; 14:68-115. [DOI: 10.11124/jbisrir-2016-2441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wang TC, Huang JL, Ho WC, Chiou AF. Effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure: a randomised controlled trial. Eur J Cardiovasc Nurs 2015; 15:157-67. [PMID: 26585292 DOI: 10.1177/1474515115618567] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/28/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue is a common symptom in patients with heart failure that is easy to ignore. In addition, fatigue may affect patients' physical function and psychosocial conditions that can impair their quality of life. An effective nursing care programme is required to alleviate patients' fatigue and improve their quality of life. AIM To investigate the effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure. METHODS A randomised controlled trial design was used. Ninety-two patients with heart failure were randomly assigned to an intervention group (n=47) or a control group (n=45). The patients in the intervention group participated in 12 weeks of a supportive educational nursing care programme including fatigue assessment, education, coaching self-care and evaluation. The intervention was conducted by a cardiac nurse during four face-to-face interviews and three follow-up telephone interviews. Fatigue and quality of life were assessed at the baseline and 4 weeks, 8 weeks and 12 weeks after enrollment in both groups. RESULTS The participants in the intervention group exhibited a significant decrease in the level of fatigue after 12 weeks, whereas those in the control group exhibited no significant changes. Compared with the control group, the intervention group exhibited a significantly greater decrease in the level of fatigue and significantly greater improvement in quality of life after 12 weeks of intervention. CONCLUSIONS The supportive educational nursing care programme was recommended to alleviate fatigue and improve quality of life in patients with heart failure.
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Affiliation(s)
- Tzu-Chieh Wang
- School of Nursing, National Yang-Ming University, Taiwan
| | - Jin-Long Huang
- School of Nursing, National Yang-Ming University, Taiwan
| | - Wen-Chao Ho
- School of Nursing, National Yang-Ming University, Taiwan
| | - Ai-Fu Chiou
- School of Nursing, National Yang-Ming University, Taiwan
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Comparisons of Dyspnea, Fatigue, and Exercise Intolerance Between Individuals with Heart Failure with High Versus Low Knee Extensor Muscle Strength. Cardiopulm Phys Ther J 2014. [DOI: 10.1097/01823246-201403000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schjoedt I, Sommer I, Bjerrum M. Adult patients living with heart failure: Experiences and management of fatigue in everyday life - a systematic review protocol of qualitative evidence. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/01938924-201311040-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fink AM, Gonzalez RC, Lisowski T, Pini M, Fantuzzi G, Levy WC, Piano MR. Fatigue, inflammation, and projected mortality in heart failure. J Card Fail 2013; 18:711-6. [PMID: 22939040 DOI: 10.1016/j.cardfail.2012.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/28/2012] [Accepted: 07/11/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fatigue is a prominent and poorly understood symptom of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to determine whether fatigue correlated with immune biomarkers and prognosis. METHODS/RESULTS In patients with HFrEF (N = 59) and healthy controls (N = 25), we prospectively measured fatigue (Profile of Mood States), depressive symptoms (Patient Health Questionnaire-8), sleep quality (Pittsburgh Sleep Quality Index), and immune biomarkers (plasma C-reactive protein [CRP], tumor necrosis factor-α [TNFα], and interleukins [IL-6 and IL-10]). Seattle Heart Failure Model (SHFM) mortality risk scores were determined. Patients with HFrEF had significantly greater fatigue and depressive symptoms and poorer sleep quality compared to control subjects. When controlling for depressive symptoms, however, fatigue did not differ significantly between patients with HFrEF and controls. Patients with HFrEF had significantly lower levels of IL-10 compared to controls. Cytokines did not correlate significantly with fatigue, but fatigue was significantly associated with higher SHFM scores. CONCLUSIONS Depressive symptoms were an important covariate of fatigue in patients with HFrEF. Our study findings were the first to show a positive association between fatigue and the SHFM score, indicating that fatigue was associated with poorer prognosis.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. J Cardiovasc Nurs 2012; 26:359-67. [PMID: 21099698 DOI: 10.1097/jcn.0b013e3181f16f88] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) patients with inadequate health literacy are at increased risk for poor self-care and negative health outcomes such as hospital readmission. The purpose of the present study was to examine the prevalence of inadequate health literacy, the reliability of the Dutch HF Knowledge Scale (DHFKS) and the Self-care of Heart Failure Index (SCHFI), and the differences in HF knowledge, HF self-care, and 30-day readmission rate by health literacy level among patients hospitalized with HF. The convenience sample included adults (n = 95) admitted to a large, urban, teaching hospital whose primary diagnosis was HF. Measures included the Short Test of Functional Health Literacy in Adults, the DHFKS, the SCHFI, and readmission at 30 days after discharge. The sample was 59 ± 14 years in age, 51% male, and 67% African American; 35% had less than a high school education, 35% were employed, 73% lived with someone who helps with their HF care, and 16% were readmitted within 30 days of index admission. Health literacy was inadequate for 42%, marginal for 19%, and adequate for 39%. Reliability of the DHFKS and SCHFI scales was comparable to prior reports. Mean knowledge score was 11.43 ± 2.26; SCHFI subscale scores were 56.82 ± 17.12 for maintenance, 63.64 ± 18.29 for management, and 65.02 ± 16.34 for confidence. Those with adequate health literacy were younger and had higher education level, HF knowledge scores, and HF self-care confidence compared with those with marginal or inadequate health literacy. Self-care maintenance and management scores and 30-day readmission rate did not differ by health literacy level. These findings demonstrate the high prevalence of inadequate and marginal health literacy and that health literacy is an important consideration in promoting HF knowledge and confidence in self-care behaviors, particularly among older adults and those with less than a high school education.
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Steptoe A, Wikman A, Molloy GJ, Kaski JC. Anaemia and the development of depressive symptoms following acute coronary syndrome: longitudinal clinical observational study. BMJ Open 2012; 2:e000551. [PMID: 22307099 PMCID: PMC3274712 DOI: 10.1136/bmjopen-2011-000551] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Depressive symptoms are common following acute coronary syndrome (ACS) and predict subsequent cardiovascular morbidity. Depression in acute cardiac patients appears to be independent of clinical disease severity and other cardiovascular measures. One factor that has not been considered previously is anaemia, which is associated with fatigue and adverse cardiac outcomes. This study assessed the relationship between anaemia on admission and depressive symptoms following ACS. DESIGN Longitudinal clinical observational study. SETTING Coronary care unit. PATIENTS 223 patients with documented ACS. MAIN OUTCOME MEASURES Depressive symptoms measured with the Beck Depression Inventory 3 weeks after admission. RESULTS Anaemia was defined with WHO criteria and was present in 30 (13.5%) patients. Anaemia predicted raised depression scores 3 weeks later independently of age, gender, marital status, educational attainment, smoking, Global Registry of Acute Cardiac Events (GRACE) risk scores, negative mood in hospital and history of depression (p=0.003). The odds of a Beck Depression Inventory score ≥10 among anaemic patients were 4.03 (95% CIs 1.48 to 11.00), adjusted for covariates. Sensitivity analyses indicated that effects were also present when haemoglobin was analysed as a continuous measure. Anaemia also predicted major adverse cardiac events over the subsequent 12 months. CONCLUSIONS Anaemia appears to contribute to depression following ACS and is associated with future cardiac morbidity. Studies evaluating the effects of anaemia management will help delineate the role of this pathway more precisely.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anna Wikman
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gerard J Molloy
- Department of Psychology, University of Stirling, Stirling, Scotland
| | - Juan-Carlos Kaski
- Division of Cardiac and Vascular Sciences, St. George's, University of London, London, UK
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Supportive and palliative care for adults dying from congenital heart defect. Curr Opin Support Palliat Care 2011; 5:291-6. [DOI: 10.1097/spc.0b013e3283492aa3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Fatigue Symptom Inventory: a systematic review of its psychometric properties. Support Care Cancer 2010; 19:169-85. [DOI: 10.1007/s00520-010-0989-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
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