Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis

Exploring the Relationship of Anxiety and Depressive Symptoms and Impulsiveness with the Quality of Life of Older Patients with Cardiovascular Disease: A Cross-Sectional Study

BACKGROUND

This study aimed to evaluate the relationship of selected clinical (i.e., body mass index, BMI) and psychological factors (i.e., anxiety, depression, and impulsiveness) with the quality of life (QoL) of elderly patients with cardiovascular disease (CVD) in a single clinical center in Italy.

METHODS

A total of 238 patients of older age (≥65 years) with CVD who voluntarily attended a single clinical center for weight loss and cardiac rehabilitation were sequentially recruited and tested upon admission to the hospital based on pre-established inclusion criteria.

RESULTS

The findings indicated that anxiety and depressive symptoms were moderately associated with lower QoL. Additionally, there were noteworthy but minor negative connections between impulsivity and QoL. Furthermore, BMI was inversely associated with the perceived QoL of the participants, and when incorporated into the regression analysis, BMI alone significantly accounted for 11.8% of the variability in QoL. This percentage increased to 18.4% with the inclusion of impulsiveness in the model and further to 34.3% with the addition of anxiety and depressive symptoms. However, after introducing anxiety and depression, the association between impulsivity and QoL ceased to be statistically significant.

CONCLUSIONS

Integrating the routine assessment and treatment of psychological factors into the care of older patients with CVD is important for optimizing their overall health outcomes and improving their QoL.

Development and validation of a Chinese version chronic wound health-related quality of life instrument: A methodological study

AIMS AND OBJECTIVES

To develop a Chinese version of a chronic wound health-related quality of life (QoL) instrument and to examine the psychometric properties of this instrument.

BACKGROUND

Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care.

DESIGN

A methodological study.

METHODS

The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was .89.

RESULTS

A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were .807, .773, .799 and .713, respectively.

CONCLUSION

The Chinese version of a chronic wound health-related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity.

RELEVANCE TO CLINICAL PRACTICE

This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health-related QoL. Scholars in Chinese-speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds.

PATIENT OR PUBLIC CONTRIBUTION

Two hundred twenty-six participants provided their perspectives on health-related QoL.

Association of living alone with clinical outcomes in patients with heart failure: A systematic review and meta-analysis

Living alone is an objective sign of social isolation. It is uncertain whether living alone worsens clinical outcomes in heart failure (HF) patients. We aimed to assess how living alone affected clinical outcomes in individuals with HF. We searched the electronic databases of PubMed, Embase, and Cochrane from 1990 to April 2022 for studies comparing living alone with HF. A random-effects model with inverse variance was used to pool adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Seven studies were deemed to meet the standards. In patients with HF, compared with living with others, living alone was associated with an elevated risk of any hospitalization at the 30-day (HR: 1.78, 95% CI: 1.09-2.89), 90-day (HR: 1.24, 95% CI: 1.02-1.51), or ≥1-year (HR: 1.14, 95% CI: 1.04-1.26) follow-up periods. HF patients living alone also had a greater risk of any hospitalization or death at the 30-day (HR: 1.56, 95% CI: 1.15-2.11), 90-day (HR: 1.26, 95% CI: 1.05-1.50), and ≥1-year (HR: 1.18, 95% CI: 1.09-1.28) follow-up periods. However, patients living alone had no increased risk of all-cause death at the 30-day (HR: 1.0, 95% CI: 0.19-5.36), 90-day (HR: 0.46, 95% CI: 0.03-7.42), or ≥ 1-year (HR: 1.10, 95% CI: 0.73-1.67) follow-up periods. In comparison to living with others, living alone was associated with an increased risk of any hospitalization but not all-cause death in HF patients.

Depression Subtypes in Systolic Heart Failure: A Secondary Analysis From a Randomized Controlled Trial

BACKGROUND

Heart failure (HF) is associated with an elevated risk of morbidity, mortality, hospitalization, and impaired quality of life. One potential contributor to these poor outcomes is depression. Yet the effectiveness of treatments for depression in patients with HF is mixed, perhaps due to the heterogeneity of depression.

METHODS

This secondary analysis applied latent class analysis (LCA) to data from a clinical trial to classify patients with systolic HF and comorbid depression into LCA subtypes based on depression symptom severity, and then examined whether these subtypes predicted treatment response and mental and physical health outcomes at 12 months follow-up.

RESULTS

In LCA of 629 participants (mean age 63.6 ± 12.9; 43% females), we identified 4 depression subtypes: mild (prevalence 53%), moderate (30%), moderately severe (12%), and severe (5%). The mild subtype was characterized primarily by somatic symptoms of depression (e.g., energy loss, sleep disturbance, poor appetite), while the remaining LCA subtypes additionally included nonsomatic symptoms of depression (e.g., depressed mood, anhedonia, worthlessness). At 12 months, LCA subtypes with more severe depressive symptoms reported significantly greater improvements in mental quality of life and depressive symptoms compared to the LCA mild subtype, but the incidence of cardiovascular- and noncardiovascular-related readmissions, and mortality was similar among all subtypes.

CONCLUSIONS

In patients with depression and systolic heart failure those with the LCA mild depression subtype may not meet full criteria for major depressive disorder, given the overlap between HF and somatic symptoms of depression. We recommend requiring depressed mood or anhedonia as a necessary symptom for major depressive disorder in patients with HF.

A meta-review of systematic reviews and meta-analyses on outcomes of psychosocial interventions in heart failure

Introduction

Chronic heart failure is a severe condition that influences not just the physical dimension but also the mental dimension in patients. Comorbidity of depression and anxiety are prevalent and the quality of life is reduced. Despite the psychological impact there are no recommendations in the guidelines for psychosocial interventions for people with heart failure. The aim of this meta-review is to synthesize results of systematic reviews and meta-analyses on the outcomes of psychosocial interventions in heart failure.

Methods

Searches were conducted in PubMed, PsychInfo, Cinahl and the Cochrane Library. In total, seven articles were included after screening 259 studies for eligibility.

Results

The included reviews had, in total, 67 original studies included. The measured outcomes in the systematic reviews and meta-analyses were; depression, anxiety, quality of life, hospitalization, mortality, self-care and physical capacity. The results are inconsistent but show some short-term benefit of psychosocial interventions for reduced depression and anxiety and improved quality of life. However, the long-term effects were sparsely followed up.

Discussion

This meta-review appears to be the first in the field of the efficacy of psychosocial interventions in chronic heart failure. This meta-review identifies gaps in the current available evidence that need to be further explored, such as booster sessions, longer follow-up time for evaluation and incorporating clinical outcomes and measures of stress processes.

The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis

The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.