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Walthall H, Strickland LH, Jenkinson C. The development of a patient reported outcome measure for fatigue and breathlessness for patients with chronic heart failure (OxFAB). Heart Lung 2023; 58:116-124. [PMID: 36493523 DOI: 10.1016/j.hrtlng.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue and breathlessness are the two most common and distressing symptoms for patients with chronic heart failure. They affect a patient's quality of life and ability to undertake activities of daily living. Currently there are no symptom specific measures for fatigue and breathlessness available or developed and validated for use with this patient group and no questionnaire that incorporates both symptoms into one measure. OBJECTIVE To develop a patient-reported outcome measure for patients with chronic heart failure for their fatigue and breathlessness symptoms. METHODS A three-staged, approach was used. In stage One in-depth qualitative patient-interviews on factors of fatigue and breathlessness in chronic heart failure were undertaken to provide question themes. Items from these interviews were generated and pilot questionnaires developed and tested. In Stage Two, exploratory factor analysis with item reduction and final testing of the questionnaire was performed. Stage Three involved validation testing. RESULTS In Stage One, issues raised in interviews (n = 25) were used to generate items. Pilot questionnaires were developed and tested. Items were refined in the context of cognitive debrief interviews (n = 7) for possible inclusion in the final measure. Final testing of questionnaire properties with item reduction was carried out in Stage Two (n = 112). Validity and reliability were assessed in Stage Three (n = 96). Psychometric testing showed positive results, in internal consistency (Cronbach's alpha ranging from 0.8 to 0.94) and test-retest (no difference in means), content validity and relevance to patients. CONCLUSIONS This questionnaire could be useful in the assessment of fatigue and breathlessness in patients living with chronic heart failure.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust Headley Way, Oxford, OX3 9DU, UK; NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office Room 4503, Corridor B, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Louise H Strickland
- Oxford University Hospitals NHS Foundation Trust Headley Way, Oxford, OX3 9DU, UK; NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office Room 4503, Corridor B, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Headington, Oxford, OX3 7DQ, UK
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Care Dependency in Patients with Heart Failure: A Cross-Sectional Study in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197042. [PMID: 32993058 PMCID: PMC7579023 DOI: 10.3390/ijerph17197042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients' physical deterioration.
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A decline in activities of daily living due to acute heart failure is an independent risk factor of hospitalization for heart failure and mortality. J Cardiol 2019; 73:522-529. [DOI: 10.1016/j.jjcc.2018.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
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García-Olmos L, Rodríguez-Salvanés F, Batlle-Pérez M, Aguilar-Torres R, Porro-Fernández C, García-Cabello A, Carmona M, Ruiz-Alonso S, Garrido-Elustondo S, Alberquilla Á, Sánchez-Gómez LM, Sánchez de Madariaga R, Monge-Navarrete E, Benito-Ortiz L, Baños-Pérez N, Simón-Puerta A, López Rodríguez AB, Martínez-Álvarez MÁ, Velilla-Celma MÁ, Bernal-Gómez MI. Development and validation of a risk stratification model for prediction of disability and hospitalisation in patients with heart failure: a study protocol. BMJ Open 2017; 7:e014840. [PMID: 28600367 PMCID: PMC5623349 DOI: 10.1136/bmjopen-2016-014840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition. AIM To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year. METHODS AND ANALYSIS Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort. ETHICS AND DISSEMINATION The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid, Spain
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
| | | | | | - Río Aguilar-Torres
- Cardiology Department, La Princesa University Teaching Hospital, Madrid, Spain
| | | | | | - Montserrat Carmona
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Telemedicine and e-Health Unit, Carlos III Institute of Health, Madrid, Spain
| | - Sergio Ruiz-Alonso
- Information Systems Department, Primary Care Management Division, Madrid, Spain
| | - Sofía Garrido-Elustondo
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid, Spain
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
| | - Ángel Alberquilla
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Multiprofessional Education Unit for Family and Community Care (Centre), Madrid, Spain
| | - Luis María Sánchez-Gómez
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Carlos III Institute Agency for Health Technology Assessment (Agencia de Evaluación de Tecnologías Sanitarias-Instituto Carlos III/AETS-ISCIII), Madrid, Spain
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Reduced Gray Matter Volume Is Associated With Poorer Instrumental Activities of Daily Living Performance in Heart Failure. J Cardiovasc Nurs 2016; 31:31-41. [PMID: 25419946 DOI: 10.1097/jcn.0000000000000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure patients require assistance with instrumental activities of daily living in part because of the high rates of cognitive impairment in this population. Structural brain insult (eg, reduced gray matter volume) is theorized to underlie cognitive dysfunction in heart failure, although no study has examined the association among gray matter, cognition, and instrumental activities of daily living in heart failure. OBJECTIVES The aim of this study was to investigate the associations among gray matter volume, cognitive function, and functional ability in heart failure. METHODS A total of 81 heart failure patients completed a cognitive test battery and the Lawton-Brody self-report questionnaire to assess instrumental activities of daily living. Participants underwent magnetic resonance imaging to quantify total gray matter and subcortical gray matter volume. RESULTS Impairments in instrumental activities of daily living were common in this sample of HF patients. Regression analyses controlling for demographic and medical confounders showed that smaller total gray matter volume predicted decreased scores on the instrumental activities of daily living composite, with specific associations noted for medication management and independence in driving. Interaction analyses showed that reduced total gray matter volume interacted with worse attention/executive function and memory to negatively impact instrumental activities of daily living. CONCLUSIONS Smaller gray matter volume is associated with greater impairment in instrumental activities of daily living in persons with heart failure, possibly via cognitive dysfunction. Prospective studies are needed to clarify the utility of clinical correlates of gray matter volume (eg, cognitive dysfunction) in identifying heart failure patients at risk for functional decline and determine whether interventions that target improved brain and cognitive function can preserve functional independence in this high-risk population.
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Ziehm J, Farin E, Seibel K, Becker G, Köberich S. Health care professionals' attitudes regarding palliative care for patients with chronic heart failure: an interview study. BMC Palliat Care 2016; 15:76. [PMID: 27526940 PMCID: PMC4986383 DOI: 10.1186/s12904-016-0149-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals’ attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients’ access to palliative care in Germany. Method Problem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring’s qualitative content analysis. Results Most interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients’, public’s, and professionals’ lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients’ concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited. Conclusions Palliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients. Trial registration DRKS00007119. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0149-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeanette Ziehm
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Seibel
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Köberich
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Pflegedirektion, Heart Center University of Freiburg, Freiburg, Germany
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Seo Y, Yates B, LaFramboise L, Pozehl B, Norman JF, Hertzog M. A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure. West J Nurs Res 2016; 38:270-91. [PMID: 25956151 DOI: 10.1177/0193945915584201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η(2)) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η(2) = .015) and functional status (η(2) = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η(2) = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention's underlying physiological effect is needed.
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Affiliation(s)
- Yaewon Seo
- University of Nebraska Medical Center, Omaha, USA
| | | | | | - Bunny Pozehl
- University of Nebraska Medical Center, Omaha, USA
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Better adherence to treatment recommendations in heart failure predicts improved cognitive function at a one-year follow-up. J Clin Exp Neuropsychol 2014; 36:956-66. [PMID: 25352233 DOI: 10.1080/13803395.2014.957167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Treatment nonadherence is common in heart failure (HF) and is associated with poor health outcomes in this population. Recent cross-sectional work in heart failure and past work in other medical populations suggest that cognitive function is a key determinant of a patient's ability to adhere to treatment recommendations. However, it is also possible that treatment adherence is an important modifier and predictor of cognitive function, though no study has examined this possibility, and we sought to do so in a sample of heart failure patients. METHOD A total of 115 patients with heart failure self-reported adherence to treatment recommendations. The Modified Mini Mental State Examination (3MS), Trail Making Test Parts A and B, and the California Verbal Learning Test-II (CVLT-II) assessed cognitive function. These procedures were performed at baseline and a 12-month follow-up. RESULTS Global cognition and memory abilities improved over the 12-month period. Regression analyses controlling for baseline and medical and demographic factors showed that better baseline treatment adherence predicted improved 12-month performances on the 3MS and CVLT-II. Adherence to medication and diet regimens and smoking abstinence emerged as the most important contributors. CONCLUSIONS Better treatment adherence predicted improved cognition one year later in HF. Prospective studies that utilize objective assessments of treatment adherence are needed to confirm our findings and examine whether improved treatment adherence preserves cognitive function in heart failure.
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Affiliation(s)
- Michael L Alosco
- a Department of Psychological Sciences , Kent State University , Kent , OH , USA
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Alosco ML, Spitznagel MB, Sweet LH, Josephson R, Hughes J, Gunstad J. Cognitive dysfunction mediates the effects of poor physical fitness on decreased functional independence in heart failure. Geriatr Gerontol Int 2014; 15:174-81. [PMID: 24533907 DOI: 10.1111/ggi.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2013] [Indexed: 11/26/2022]
Abstract
AIM Heart failure (HF) patients require assistance with activities of daily living (ADL). Poor physical fitness has recently been identified as a contributor to the high rates of disability in HF, though the mechanisms for such effects are unclear. Although not previously examined, decreased fitness might adversely impact ADL in HF through its known association with cognitive impairment, a key correlate of self-care abilities in this population. We sought to test this possibility using a model-based approach. METHODS A total of 197 patients with HF completed a physical fitness test and a neuropsychological test battery. A total ADL composite was derived from the Lawton Brody scale. Structural equation modeling tested whether cognitive function mediated the association between physical fitness and total ADL. RESULTS Fitness was reduced, and cognitive dysfunction and impaired ADL were prevalent. The initially significant association between fitness and total ADL was attenuated when cognitive function was introduced as a mediator. This model showed good fit (comparative fit index=0.91: root mean-square error of approximations=0.077) with a significant indirect pathway between physical fitness and total ADL through cognitive function: Decreased physical fitness was associated with cognitive dysfunction (β=0.35), which predicted greater assistance with ADL (β=0.22). CONCLUSIONS Poor physical fitness might lead to decreased functional independence in HF through its negative effects on cognitive function. Prospective studies are required to confirm our findings, identify other mechanisms by which poor fitness impacts ADL, and examine whether exercise interventions can improve cognition and help preserve ADL independence in HF.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, Ohio, USA
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Köberich S, Lohrmann C, Dassen T. Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies. Scand J Caring Sci 2013; 28:665-74. [DOI: 10.1111/scs.12091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Stefan Köberich
- Pflegedirektion; University Heart Center Freiburg-Bad Krozingen; Freiburg Germany
| | - Christa Lohrmann
- Institute of Nursing Science; Medical University of Graz; Graz Austria
| | - Theo Dassen
- Department of Nursing Science; Charité - Universitätsmedizin Berlin; Berlin Germany
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Colbert LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Reduced cognitive function predicts functional decline in patients with heart failure over 12 months. Eur J Cardiovasc Nurs 2013; 13:304-10. [PMID: 23754840 DOI: 10.1177/1474515113494026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 03/20/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Occurrences of impaired activities of daily living (ADL) are common in heart failure (HF) patients and contribute to the elevated mortality and hospitalization rates in this population. Cognitive impairment is also prevalent in HF, though its ability to predict functional decline over time is unknown. AIMS This study examined the longitudinal pattern of activities of daily living (ADL) in HF persons and whether reduced baseline cognitive status predicts functional decline in this population. METHODS Altogether 110 persons with HF completed the Lawton-Brody Instrumental Activities of Daily Living (IADL) scale and were administered the Modified Mini-Mental Status Examination (3MS) at baseline and a 12-month follow-up. Three composite scores were derived from the Lawton-Brody scale, including total, instrumental, and basic ADL. RESULTS HF patients reported high rates of baseline impairments in instrumental ADL, including shopping, food preparation, housekeeping duties, laundry, among others. Repeated measures analyses showed significant declines in total and instrumental ADL from baseline to the 12-month follow-up in HF (p<0.05). Hierarchical regression analyses showed that poorer baseline performance on the 3MS predicted worse total ADL performance at 12-months (β=0.15, p=0.049), including greater dependence in shopping, driving, feeding, and physical ambulation (p<0.05 for all). CONCLUSION The current results show that HF patients report significant functional decline over a 12-month period and brief cognitive tests can identify those patients at highest risk for decline. If replicated, such findings encourage the use of cognitive screening measures to identify HF patients most likely to require assistance with ADL tasks.
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Affiliation(s)
| | - Mary Beth Spitznagel
- Department of Psychology, Kent State University, USA Department of Psychiatry, Akron City Hospital, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, University of Florida, USA
| | | | | | - Richard Josephson
- University Hospitals Case Medical Center, USA Case Western Reserve University School of Medicine, USA
| | - Joel Hughes
- Department of Psychology, Kent State University, USA Department of Psychiatry, Akron City Hospital, USA
| | - Jim Rosneck
- Department of Psychiatry, Akron City Hospital, USA
| | - John Gunstad
- Department of Psychology, Kent State University, USA Department of Psychiatry, Akron City Hospital, USA
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Alosco ML, Spitznagel MB, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, van Dulmen M, Hughes J, Rosneck J, Gunstad J. Executive dysfunction is independently associated with reduced functional independence in heart failure. J Clin Nurs 2013; 23:829-36. [PMID: 23650879 DOI: 10.1111/jocn.12214] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the independent association between executive function with instrumental activities of daily living and health behaviours in older adults with heart failure. BACKGROUND Executive function is an important contributor to functional independence as it consists of cognitive processes needed for decision-making, planning, organising and behavioural monitoring. Impairment in this domain is common in heart failure patients and associated with reduced performance of instrumental activities of daily living in many medical and neurological populations. However, the contribution of executive functions to functional independence and healthy lifestyle choices in heart failure patients has not been fully examined. DESIGN Cross-sectional analyses. METHODS One hundred and seventy-five heart failure patients completed a neuropsychological battery and echocardiogram. Participants also completed the Lawton-Brody Instrumental Activities of Daily Living Scale and reported current cigarette use. RESULTS Hierarchical regressions revealed that reduced executive function was independently associated with worse instrumental activity of daily living performance with a specific association for decreased ability to manage medications. Partial correlations showed that executive dysfunction was associated with current cigarette use. CONCLUSIONS Our findings suggest that executive dysfunction is associated with poorer functional independence and contributes to unhealthy behaviours in heart failure. Future studies should examine whether heart failure patients benefit from formal organisation schema (i.e. pill organisers) to maintain independence. RELEVANCE TO CLINICAL PRACTICE Screening of executive function in heart failure patients may provide key insight into their ability to perform daily tasks, including the management of treatment recommendations.
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Masterson Creber R, Polomano R, Farrar J, Riegel B. Psychometric properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Eur J Cardiovasc Nurs 2012; 11:197-206. [PMID: 22457379 DOI: 10.1177/1474515111435605] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-established instrument used to evaluate the health status of heart failure (HF) patients. There has been a lack of clarity about the best way to conceptualize the KCCQ. The purpose of this investigation of the KCCQ was to: (1) explore the factor structure with an exploratory factor analyses; (2) perform reliability and validity testing to determine the best factor solution for item groupings; and (3) determine the most meaningful components of health status captured by the KCCQ. METHODS AND RESULTS A secondary analysis of data from 280 adults with stage-C HF enrolled from three US northeastern sites was conducted to test the KCCQ subscale structure. Criterion-related validity for the Self-efficacy subscale was tested with the Dutch Heart Failure Knowledge Scale and the Self-care of Heart Failure Index Self-care Confidence Scale. Overall, internal consistency reliability (Cronbach's alpha) for the KCCQ and subscales was 0.92, social interference (seven items, 0.90), physical limitation (four items, 0.84), symptoms (eight items, 0.86), independent care (two items, 0.80), and self-efficacy (two items, 0.63). Two items failed to correspond to a previously identified factor so the independent care subscale was added. Items intending to measure quality of life were loaded in the social interference subscale. CONCLUSIONS We recommend eliminating the quality of life subscale and including those items in the social interference subscale, and eliminating the self-efficacy items and re-evaluating the items related to independent care.
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