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Nguyen DD, Spertus JA, Benton MC, Thomas M, Jones PG, Andrei AC, Wu T, Baldridge AS, Grady KL. Association of Patient Reported Outcomes With Caregiver Burden in Older Patients With Advanced Heart Failure: Insights From the SUSTAIN-IT Study. Circ Heart Fail 2024; 17:e011705. [PMID: 38910557 DOI: 10.1161/circheartfailure.124.011705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Caregivers of patients with advanced heart failure may experience burden in providing care, but whether changes in patient health status are associated with caregiver burden is unknown. METHODS This observational study included older patients (60-80 years old) receiving advanced surgical heart failure therapies and their caregivers at 13 US sites. Patient health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores are better). Caregiver burden was assessed using the Oberst Caregiving Burden Scale, which measures time on task (OCBS-time) and task difficulty (OCBS-difficulty; range, 1-5; lower scores are better). Measurements occurred before surgery and 12 months after in 3 advanced heart failure cohorts: patients receiving long-term left ventricular assist device support; heart transplantation with pretransplant left ventricular assist device support; and heart transplantation without pretransplant left ventricular assist device support. Multivariable linear regression was used to identify predictors of change in OCBS-time and OCBS-difficulty at 12 months. RESULTS Of 162 caregivers, the mean age was 61.0±9.4 years, 139 (86%) were female, and 140 (86%) were the patient's spouse. At 12 months, 99 (61.1%) caregivers experienced improved OCBS-time, and 61 (37.7%) experienced improved OCBS-difficulty (versus no change or worse OCBS). A 10-point higher baseline 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.09 [95% CI, -0.14 to -0.03]; P<0.001) and OCBS-difficulty (β=-0.08 [95% CI, -0.12 to -0.05]; P<0.001). Each 10-point improvement in the 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.07 [95% CI, -0.12 to -0.03]; P=0.002) and OCBS-difficulty (β=-0.09 [95% CI, -0.12 to -0.06]; P<0.001). CONCLUSIONS Among survivors at 12 months, baseline and change in patient health status were associated with subsequent caregiver time on task and task difficulty in dyads receiving advanced heart failure surgical therapies, highlighting the potential for serial 12-item Kansas City Cardiomyopathy Questionnaire assessments to identify caregivers at risk of increased burden. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT02568930.
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Affiliation(s)
- Dan D Nguyen
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - John A Spertus
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Mary C Benton
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Merrill Thomas
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Philip G Jones
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Adin-Cristian Andrei
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Tingqing Wu
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Abigail S Baldridge
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Kathleen L Grady
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
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Choi JY, Lee SH, Yu S. Exploring Factors Influencing Caregiver Burden: A Systematic Review of Family Caregivers of Older Adults with Chronic Illness in Local Communities. Healthcare (Basel) 2024; 12:1002. [PMID: 38786412 PMCID: PMC11121359 DOI: 10.3390/healthcare12101002] [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: 03/25/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to systematically review and analyze factors contributing to caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Specific objectives included exploring the characteristics of older adults with chronic illness and caregiver burden through an extensive literature review and identifying factors influencing caregiver burden in this population. Using Korean (RISS, KISS, and KoreaMed) and international (EMBASE, MEDLINE, CINAHL, and the Cochrane Library) databases, this study employed systematic search methods to identify relevant literature. The inclusion and exclusion criteria were systematically applied in accordance with the PRISMA guidelines, focusing on studies that addressed caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Following the database search, 15,962 articles were identified. After eliminating duplicates and applying the selection criteria, 18 studies were included in this review. These studies, representing various countries, contribute to a diverse dataset covering caregiver and care-recipient characteristics, including age, sex, chronic conditions, and various caregiver burden assessment tools. This systematic review provides a comprehensive understanding of the factors that influence caregiver burden among family caregivers of older adults with chronic illness in local communities. These findings emphasize the need for integrated nursing interventions and community efforts to address the welfare concerns of this population and support their caregivers.
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Affiliation(s)
- Jin Young Choi
- Graduate School of Nursing, Gachon University, Incheon 21936, Republic of Korea;
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Soyoung Yu
- College of Nursing, CHA University, 120, Pocheon 11160, Republic of Korea
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Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Ponti L, Cappelli F, Perfetto F, Maver P, Smorti M. Caregiver's psychological well-being and quality of relationship with cardiac amyloidosis patients. PSYCHOL HEALTH MED 2024; 29:66-78. [PMID: 38156665 DOI: 10.1080/13548506.2023.2280463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/31/2023] [Indexed: 01/03/2024]
Abstract
Caregivers' psychological well-being is linked to the quality of care provided for familiar with chronic illness. Despite caregivers of cardiac patients present an impaired psychological well-being, less investigated is the psychological well-being of caregivers of individuals with a rare disease such as the Transthyretin Cardiac Amyloidosis (ATTR-CA). Specifically, given that no study explored the well-being of the caregiver and the caregiver-patient relationship, this study aimed to analyze the prevalence of anxiety and depression in ATTR-CA caregivers and if these disorders were associated with patient's and caregiver's characteristics. Fifty-eight dyad caregiver-ATTR-CA patients completed the Hospital Anxiety and Depression Scale and the Network of Relationships Inventory. Moreover, ATTR-CA patients completed the Kansas City Cardiomyopathy Questionnaire, while caregivers completed the Multidimensional Scale of Social Support. Results showed that anxious caregivers (44%) reported higher conflict with patients. They had ATTR-CA relatives with a worse perception of cardiac symptoms and higher anxiety and depression. Depressed caregivers (39%) reported higher conflict with ATTR-CA relatives and lower perceived social support. Caregiver reported a high prevalence of anxiety and depression associated with worse personal relational well-being and to patient's psycho-physical condition. The care of ATTR-CA patient should consider the caregiver well-being.
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Affiliation(s)
- Lucia Ponti
- Department of Humanities, University of Urbino, Urbino, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - Perla Maver
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Özönder Ünal I, Ordu C. Decoding Caregiver Burden in Cancer: Role of Emotional Health, Rumination, and Coping Mechanisms. Healthcare (Basel) 2023; 11:2700. [PMID: 37830736 PMCID: PMC10573024 DOI: 10.3390/healthcare11192700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
This study aimed to elucidate the role of psychological factors in caregiver burden among caregivers of stage 4 cancer patients. Data were collected from 328 caregivers of cancer patients, employing the Zarit Care Burden Scale, Depression-Anxiety-Stress Scale (DASS-42), Dysfunctional Attitudes Scale (DAS-A), Ruminative Thought Style Questionnaire (RTSQ), and Coping Orientation to Problems Experienced Inventory (Brief COPE). Males, spouses, and caregivers of patients with a PEG or tracheostomy, or those diagnosed with pancreatic biliary cancer were found to have a significantly higher risk of caregiver burden. Age, sex, caregiver-patient relationship, caregiving duration, patient's catheter status, cancer types, depression and stress severity, rumination, dysfunctional attitudes, and dysfunctional coping strategies explained 69.7% of the variance in Zarit Care Burden Scale scores (F(14,313) = 51.457, p < 0.001), illustrating their significant predictive relationship with caregiver burden. Moderation analysis revealed significant interactions of emotional coping with depression (b = -0.0524, p = 0.0076) and dysfunctional coping with stress on caregiver burden (b = 0.014, p = 0.006). Furthermore, rumination mediated the relationships between caregiver burden, stress, and depression (p < 0.01). Overall, the results highlight the intricate relationships among caregiver burden, mental health, and coping strategies, suggesting tailored interventions to support caregiver health and quality of care.
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Affiliation(s)
- Ipek Özönder Ünal
- Department of Psychiatry, Tuzla State Hospital, Içmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla, Istanbul 34947, Turkey
| | - Cetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No: 8, Beşiktaş, Istanbul 34349, Turkey;
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Okwuosa IS, Anderson A, Petty M, Wu T, Andrei AC, Kao A, Spertus JA, Pham DT, Yancy CW, Dew MA, Hsich E, Cotts W, Hartupee J, Pamboukian S, Pagani F, Lampert B, Johnson M, Murray M, Tekeda K, Yuzefpolskaya M, Kirklin JK, Grady KL. Caregiver burden before heart transplantation and long-term mechanical circulatory support: Findings from the sustaining quality of life of the aged: Transplant or mechanical support (SUSTAIN-IT) study. J Heart Lung Transplant 2023; 42:1197-1204. [PMID: 37088337 DOI: 10.1016/j.healun.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Caregiving for heart failure (HF) patients is burdensome. We examined differences in caregiver burden for 3 groups of older advanced HF patients: (1) supported with mechanical circulatory support (MCS) before heart transplantation (HT MCS), (2) awaiting transplant without MCS (HT non-MCS), and (3) prior to long-term MCS and factors associated with burden. METHOD From October 1, 2015 to December 31, 2018, we enrolled 276 caregivers for HF patients from 13 U.S. sites: 85 HT MCS, 96 HT non-MCS, and 95 prior to long-term MCS. At enrollment, caregivers completed the Oberst Caregiving Burden Scale (15 items, 2 subscales: time (range = 1-5; higher score = more time spent on task) and difficulty (range = 1-5; higher score = higher difficulty of task) and other measures. Statistical analyses included descriptive statistics, ANOVA, chi-square tests, and linear regression. RESULT Overall, caregivers were aged 60.8 ± 9.8 years and predominantly white, female, spouses, well educated, and reported ≥1 comorbidities. Caregivers overall reported a moderate amount of time spent on tasks and slight task difficulty. Caregivers for HT non-MCS candidates reported significantly less perceived time spent on tasks than caregivers for HT MCS candidates and caregivers for patients prior to long-term MCS (2.2 ± 0.74 vs 2.4 ± 0.74 vs 2.5 ± 0.71, respectively, p = 0.02) and less perceived difficulty of tasks (1.2 ± 0.33 vs 1.4 ± 0.53 vs 1.4 ± 0.54, respectively, p = 0.01). Caregiver and patient factors were associated with caregiver burden. CONCLUSIONS Prior to HT and long-term MCS, caregiver burden was low to moderate. Caregiver factors were predominantly associated with caregiver burden. Understanding caregiver burden and factors affecting caregiver burden may enhance preoperative advanced therapies discussions and guide caregiver support.
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Affiliation(s)
- Ike S Okwuosa
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois.
| | - Allen Anderson
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois
| | - Michael Petty
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Tingqing Wu
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois
| | | | - Andrew Kao
- Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, Kansas City, Missouri
| | - John A Spertus
- Washington University in St Louis, Division of Cardiology, St. Louis, Missouri
| | - Duc T Pham
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde W Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | - Eileen Hsich
- Cleveland Clinic Foundation, Division of Cardiovascular Medicine, Cleveland, Ohio
| | - William Cotts
- Advocate Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Justin Hartupee
- Washington University in St Louis, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Salpy Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, Birmingham, Albama
| | - Francis Pagani
- University of Michigan, Division of Cardiac Surgery, Ann Arbor, Michigan
| | - Brent Lampert
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus, Ohio
| | - Maryl Johnson
- University of Wisconsin, Division of Cardiovascular Medicine, Madison, Wisconsin
| | - Margaret Murray
- University of Wisconsin, Division of Cardiothoracic Surgery, Madison, Wisconsin
| | - Koji Tekeda
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - James K Kirklin
- University of Alabama, Birmingham, Department of Surgery, Division of Cardiothoracic Surgery, Birmingham, Alabama
| | - Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Jarab AS, Hamam HW, Al-Qerem WA, Heshmeh SRA, Mukattash TL, Alefishat EA. Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study. Health Qual Life Outcomes 2023; 21:73. [PMID: 37443053 DOI: 10.1186/s12955-023-02142-w] [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: 11/22/2022] [Accepted: 06/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan. METHODS This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients. RESULTS Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients. CONCLUSIONS Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Hanan W Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Walid A Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman, 11733, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Eman A Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, 11942, Jordan.
- Center For Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
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Assessment of Caregiver Burden Prior to Implantation of Left Ventricular Assist Device: A National Survey. J Heart Lung Transplant 2023; 42:689-692. [PMID: 36973094 DOI: 10.1016/j.healun.2023.02.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Guidelines recommend incorporation of caregiver burden assessment and list significant caregiver burden as a relative contraindication when considering left-ventricular assist device (LVAD) implantation. METHODS To assess national practices regarding caregiver burden assessment, in 2019 we administered a 47-item survey to LVAD clinicians using 4 convenience samples. RESULTS Responses were obtained from 191 registered nurses, 109 advance practice providers, 71 physicians, 59 social workers, and 40 others representing 132 LVAD programs; 125 of 173 total United States programs were included in the final analysis. While most programs (83.2%) assessed caregiver burden, assessment was most frequently conducted informally during social work evaluation (83.2%), with only 8.8% incorporating validated measures of caregiver burden. Larger programs were more likely to use a validated assessment measure (OR 6.68 [1.33-33.52]). CONCLUSIONS Future research should focus on how programs can standardize caregiver burden assessment and how the level of burden may impact patient and caregiver outcomes.
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Fiscal Idrobo LM, Ospina Muñoz P, Vargas-Escobar LM, Rincon Buenhombre MC. Necesidades de cuidado paliativo del paciente con falla cardiaca: un estudio mixto. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Highlights:
La FC suele estar acompañada de otras patologías crónicas que hacen que la persona presente múltiples síntomas asociados que deben ser abordados por profesionales y equipos de cuidado paliativo.
Los profesionales de la salud reconocen la importancia del cuidado paliativo y la falta de preparación para abordar las necesidades espirituales, emocionales, sociales, de pacientes y los cuidadores con FC.
La teoría de Lenz permite identificar los síntomas fisiológicos, psicológicos y situacionales durante la FC, permitiendo a los equipos de cuidado paliativo establecer estrategias para mejorar la experiencia del síntoma.
El abordaje de cuidados paliativos en FC implica una atención integral, buscando una mejor calidad de vida y mejorar la experiencia del síntoma como lo plantea Lenz, durante toda la trayectoria de la experiencia de la enfermedad hasta la muerte del paciente.
Introducción: La presencia de signos y síntomas físicos, psicosociales y espirituales, deben ser identificados y controlados por medio de la atención en cuidados paliativos que proveen los equipos y profesionales de la salud. Objetivo: Identificar las necesidades de cuidado paliativo de las personas con falla cardíaca, sus cuidadores y el equipo multidisciplinario de una unidad de falla cardiaca. Materiales y Métodos: Estudio mixto, con diseño transformativo secuencial (DITRAS), que inicio con una fase cuantitativa en la que se aplicaron los instrumentos: Edmonton, Facit-Sp-12 y el índice de Barthel. La segunda fase cualitativa se realizó con 3 grupos focales en los que participaron 7 pacientes, 8 cuidadores y 12 profesionales del equipo multidisciplinario. El estudio tomo como guía orientadora la teoría del manejo de síntomas desagradables de Elizabeth Lenz. Resultados: Se identificaron necesidades de cuidado paliativo desde lo fisiológico: edema, fatiga y disnea; psicológico: actitud frente a la vida y disfrutar de pasatiempos y factores situacionales: como dependencia del cuidador y redes de apoyo, los cuales permitieron su comprensión a partir de la teoría de Lenz. Conclusiones: Las necesidades de cuidado paliativo en pacientes con falla cardiaca, se presentan desde un marco de síntomas que son percibidas por pacientes, cuidadores y el equipo de salud. Se requieren abordajes integrales que mejoren la experiencia del síntoma.
Como citar este artículo: Fiscal Idrobo Lucely Marisel, Ospina Muñoz Priscilla, Vargas-Escobar Lina María, Rincon Buenhombre Maria Cilia. Necesidades de cuidado paliativo del paciente con falla cardiaca: un estudio mixto. Revista Cuidarte. 2023;14(1):e2539. http://dx.doi.org/10.15649/cuidarte.2539
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Kim KA, Park JS, Seo KW, Choi EY, Ahn JA. Factors affecting the quality of life of family caregivers of patients with heart failure: A cross-sectional study. Medicine (Baltimore) 2022; 101:e30042. [PMID: 36107616 PMCID: PMC9439723 DOI: 10.1097/md.0000000000030042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Heart failure is a chronic disease requiring lifetime self-management at home by patients, who often require additional support. However, the long-term nature of this self-management presents great challenges for both heart failure patients and their family caregivers. The role of family caregivers is critical, but little is known about the relationship between the burden, stress, depressive symptoms, and quality of life in the family caregivers of heart failure patients. We aimed to explore caregiver burden, stress, depressive symptoms, and quality of life in both patients with heart failure and their family caregivers and identify the factors associated with family caregivers' quality of life. The sample included 120 participants (60 heart failure patients and 60 corresponding family caregivers) from cardiovascular outpatient clinics at 2 university-affiliated hospitals in South Korea from September 2018 to July 2019. The mean ages of the heart failure patients and their caregivers were 72.72 (SD = 12.73) and 57.03 (SD = 13.42) years, respectively. Caregiver burden (r = -0.601, P < .001) and caregiver depressive symptoms (r = -0.535, P < .001) were negatively correlated with the caregivers' quality of life. The result of the hierarchical multiple regression analysis identified 3 significant factors related to the family caregivers' quality of life: caregiver's age (β = -0.257, P = .012), caregiver burden (β = -0.408, P = .002) and caregiver depressive symptoms (β = -0.298, P = .018), with overall explanatory power of 47.5%. It is necessary to develop practical strategies to improve family caregivers' quality of life by alleviating their burden and depressive symptoms. Healthcare providers should be engaged with not only heart failure patients but also their family caregivers during the disease management process to improve patients' outcomes.
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Affiliation(s)
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung-Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ah Ahn
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Korea
- *Correspondence: Jeong-Ah Ahn, College of Nursing and Research Institute of Nursing Science, Ajou University, Worldcup-ro 164, Yeongtong-gu, Suwon 16499, Republic of Korea (e-mail: )
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11
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Walavalkar A, Craswell A, Gray NA. Experiences of Caregivers of Patients With Conservatively Managed Kidney Failure: A Mixed Methods Systematic Review. Can J Kidney Health Dis 2022; 9:20543581221089080. [PMID: 35450152 PMCID: PMC9016578 DOI: 10.1177/20543581221089080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Older people with kidney failure often choose conservative kidney care. The
experiences and quality of life (QOL) of caregivers who support them are
incompletely characterized. Objective: To determine the burden, QOL, and understand experiences of caregivers
supporting patients managed conservatively. Design: Systematic review of quantitative and qualitative studies. Sources of information: PubMed, Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were
systematically searched for quantitative and qualitative studies published
between January 2000 and July 2020. Subjects: Caregivers of adults with kidney failure (estimated glomerular filtration
rate < 15 mL/min/1.73 m2) managed conservatively. Methods: Data were extracted by 2 independent reviewers using a prespecified
extraction tool. Study quality was assessed using the Critical Appraisal
Skills Program (CASP) tool. Measurements: Descriptive reports of demographics, measurement scales, and outcomes.
Thematic synthesis of qualitative data. Results: Six studies met inclusion criteria, including 3 quantitative and 3
descriptive qualitative studies. Caregivers of patients receiving
conservative kidney management (CKM) experienced significant caregiver
burden and similar impacts to their QOL as those caring for patients
receiving dialysis. Thematic synthesis revealed 5 themes: Understanding the
concept of CKM, Need for involvement in the decision for CKM, Identifying
available supports, Uncertainty about the future and negotiating
deteriorations and dying, and Burden of care impacting on QOL. Limitations: Low numbers of included studies, data collection and recruitment biases in
qualitative studies and small caregiver numbers in quantitative studies,
limit transferability of findings. Heterogeneity in study design and outcome
measures precluded meta-analysis. Conclusions: Caregivers of patients with conservatively managed kidney failure suffer
significant burden and experience QOL comparable with those caring for
patients on dialysis. Limited understanding and involvement in conservative
management decision making, and a fear of deterioration and dying, result in
anxiety in caregivers. Further research into the experiences of caregivers
will help support both caregivers and the patients who choose conservative
management. Registration: PROSPERO registration number CRD42021209811.
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Affiliation(s)
- Anisha Walavalkar
- Renal Unit, Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Alison Craswell
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Nicholas A. Gray
- Renal Unit, Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
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12
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Matsunuma R, Matsumoto K, Yamaguchi T, Sakashita A, Kizawa Y. Comprehensive Palliative Care Needs in Outpatients with Chronic Heart Failure: A Japanese Cross-Sectional Study. Palliat Med Rep 2022; 3:65-74. [PMID: 35558864 PMCID: PMC9081025 DOI: 10.1089/pmr.2021.0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The type and frequency of palliative care needs of chronic heart failure (CHF) patients have not been determined in Japan. Objectives: The aim of this study was to comprehensively assess the prevalence and characteristics of palliative care needs of CHF outpatients. Methods: Patients were recruited for this cross-sectional study from June 1 to August 31, 2020, at the Kobe University Hospital. An Integrated Palliative care Outcome Scale (IPOS) and an original questionnaire developed by multidisciplinary experts were answered once by patients themselves or with the assistance of their family. Results: A total of 101 patients (63 males and 38 females) were included. The most common distressing symptoms were dyspnea (29%; 95% confidence interval [CI] 21–39]), drowsiness (29%; 95% CI 21–39), poor mobility (25%; 95% CI 17–35), insomnia (25%; 95% CI 17–35), and anxiety (24%; 95% CI 17–35). Eighty percent (95% CI 70–87) of patients were willing to have an end-of-life (EOL) discussion. When we compared New York Heart Association class I/II with III/IV patients, the frequency of distressing symptoms was associated with the severity of the disease, but both groups exhibited a willingness for having an EOL discussion or knowing the future course of their diseases. Conclusions: Dyspnea, drowsiness, insomnia, and anxiety were frequent symptoms in CHF outpatients in Japan. Beyond distressing symptoms, most ambulatory heart failure patients have a need for EOL discussion, which was not associated with disease stage. Assessing comprehensive and multidimensional palliative care needs, including needs for EOL discussion, is advisable among outpatients with CHF.
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Affiliation(s)
- Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | | | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Palliative Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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13
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Hamatani Y, Iguchi M, Ikeyama Y, Kunugida A, Ogawa M, Yasuda N, Fujimoto K, Ichihara H, Sakai M, Kinoshita T, Nakashima Y, Akao M. Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients. ESC Heart Fail 2022; 9:1963-1975. [PMID: 35307988 PMCID: PMC9065822 DOI: 10.1002/ehf2.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Abstract
Aims Patients with heart failure (HF) may have variable unrecognized symptom burdens. We sought to investigate the details, determinants, and prognostic significance of symptom burden in hospitalized patients with HF. Methods and results We prospectively evaluated consecutive hospitalized patients with HF as primary diagnosis at our institution using the Integrated Palliative care Outcome Scale (IPOS) both on admission and at discharge. The IPOS, which is a well‐validated multi‐dimensional symptom assessment scale among advanced illness, consists of 17 questions for enquiring about physical symptoms (10 items), emotional symptoms (4 items) and communication and practical issues (3 items) using a 5‐point Likert scale (0 [best]–4 [worst] points). Clinically relevant symptoms were defined as ≥2 points for each IPOS item. Worsening symptom burden was defined as the total IPOS score at discharge being poorer than that on admission. Of 294 patients (mean age: 77.5 ± 12.0 years, male: 168 patients, New York Heart Association class IV: 96 patients, mean left ventricular ejection fraction [LVEF]: 44%, and median N‐terminal pro B‐type natriuretic peptide [NT‐proBNP] level: 4418 ng/L), the median (IQR) total IPOS score on admission was 19 (12, 27) and they were widely distributed (minimum: 0 – maximum: 52). The total IPOS score on admission was not correlated with the HF severity, including LVEF (Spearman's ρ = −0.05, P = 0.43), NT‐proBNP levels (Spearman's ρ = 0.08, P = 0.20) or in‐hospital mortality prediction model (GWTG‐HF risk score) (Spearman's ρ = 0.01, P = 0.90). Total IPOS scores significantly decreased during hospitalization as a whole (median [IQR]: 13 [6, 21] at discharge; P < 0.001 vs. those on admission). All of the four emotional symptoms (patient anxiety, depression, family anxiety and feeling at peace) remained in the top 5 of clinically relevant symptoms at discharge, whereas none of 10 physical symptoms were nominated. Worsening symptom burden was noted in 28% of the patients during hospitalization, and was independently associated with higher all‐cause mortality after discharge (hazard ratio: 2.28, 95% confidence interval: 1.02–5.09; P = 0.044) even after adjustment by age and HF mortality prediction model (MAGGIC risk score). Conclusions We revealed that hospitalized patients with HF had multi‐dimensional symptom burdens which varied among individuals and were not correlated with the disease severity. Emotional symptoms, such as anxiety and depression, were the main clinically relevant symptoms at discharge. A worsening IPOS score was noted in a quarter of patients with HF and was associated with a poor prognosis, suggesting the importance of holistic symptom assessment during the course of hospitalization for HF.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Moritake Iguchi
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Yurika Ikeyama
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Atsuko Kunugida
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Megumi Ogawa
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Natsushige Yasuda
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kana Fujimoto
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hidenori Ichihara
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Misaki Sakai
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tae Kinoshita
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yasuyo Nakashima
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masaharu Akao
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
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14
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Aljuaid M, Ilyas N, Altuwaijri E, Albedawi H, Alanazi O, Shahid D, Alonazi W. Quality of Life among Caregivers of Patients Diagnosed with Major Chronic Disease during COVID-19 in Saudi Arabia. Healthcare (Basel) 2022; 10:healthcare10030523. [PMID: 35327001 PMCID: PMC8953432 DOI: 10.3390/healthcare10030523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 12/19/2022] Open
Abstract
Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers’ QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers’ psychological onuses and physical actions/reactions). The relation between these variables was significant, X2 (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels.
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Affiliation(s)
- Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11587, Saudi Arabia; (M.A.); (E.A.)
| | - Namrah Ilyas
- Centre for Clinical Psychology, University of the Punjab, Lahore 66000, Pakistan;
| | - Eman Altuwaijri
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11587, Saudi Arabia; (M.A.); (E.A.)
- Department of Administrative and Social Sciences, College of Business Applied Studies and Community Service, King Saud University, Riyadh 11587, Saudi Arabia
| | - Haddel Albedawi
- Department of Community Health, College of Applied Medical Sciences, King Saud University, Riyadh 11587, Saudi Arabia;
| | - Ohoud Alanazi
- Department of Public Administration, College of Business Administration, King Saud University, Riyadh 11587, Saudi Arabia;
| | - Duaa Shahid
- Hult International Business School, Cambridge, MA 02141, USA;
| | - Wadi Alonazi
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11587, Saudi Arabia; (M.A.); (E.A.)
- Correspondence: ; Tel.: +966-114-693-999
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15
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Smith JL, Chung ML, Miller JL, Biddle M, Schuman DL, Rayens MK, Lennie TA, Smalls B, Hammash M, Mudd-Martin G, Moser DK. Profile of informal rural Appalachian caregivers of patients with chronic illnesses. J Rural Health 2022; 38:240-250. [PMID: 33644897 PMCID: PMC8397797 DOI: 10.1111/jrh.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Caring for a family member with chronic illness increases cardiovascular disease (CVD) risk by 82%, and rurality imparts additional CVD disparities. The purpose of this study was to describe a profile of rural caregivers of patients with chronic illnesses to determine the prevalence of CVD risk factors, and psychosocial and socioeconomic burden, as well as to compare these variables across gender. METHODS Baseline data from a trial of CVD risk reduction in rural caregivers of patients with chronic illnesses were used. We measured depression and anxiety with the PHQ-9 and Brief Symptom Inventory; social, economic, and environmental factors using the MOS-Social Support and Economic and Environmental surveys; body mass index (BMI); blood pressure (BP); and lipid profile. RESULTS Of 181 caregivers (age 53±14 years, 80% female), 69% were married; 88% were caring for a family member, including 46% caring for a spouse and 18% for a parent. A total of 51% were anxious, 25% depressed, and 25% reported lack of social support. Most (51%) caregivers had one or more types of CVD; and 49% were smokers. By examination, 76% had elevated BP; 35% had total cholesterol >200; 50% low-density lipoprotein >100; 56% triglycerides >150; and 79% high-density lipoprotein <60. Based on BMI, 91.5% were overweight or obese. Gender comparisons revealed that women reported higher levels of depressive symptoms than men. CONCLUSIONS Rural caregivers, regardless of gender, are at increased risk of CVD and struggle with factors that make caregiving burdensome and contribute to their own poor cardiac health.
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Affiliation(s)
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky
- College of Nursing, Yonsei University, Seoul, Korea
| | | | - Martha Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Donna L. Schuman
- College of Social Work, University of Kentucky, Lexington, Kentucky
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Brittany Smalls
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Muna Hammash
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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16
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Le N, Rahman T, Kapralik JL, Ibrahim Q, Lear SA, Van Spall HG. The Hospital at Home Model vs Routine Hospitalization for Acute Heart Failure: A Survey of Patients’ Preferences. CJC Open 2021; 4:263-270. [PMID: 35386130 PMCID: PMC8978061 DOI: 10.1016/j.cjco.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/15/2021] [Indexed: 10/31/2022] Open
Abstract
Background Methods Results Conclusions
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17
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Carboni-Jiménez A, Rice DB, Levis B, Cañedo-Ayala M, Imran M, Chiovitti M, Benedetti A, Thombs BD. Intensity of care and perceived burden among informal caregivers to persons with chronic medical conditions: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:6230-6246. [PMID: 34455877 DOI: 10.1080/09638288.2021.1966675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Informal caregivers provide ongoing assistance to a loved one with a health condition. No studies have compared caregiving intensity and perception of burden across chronic medical conditions. MATERIALS AND METHODS Databases were searched from inception through 11 September 2020 to identify studies that included the Level of Care Index or the Zarit Burden Inventory (ZBI) among caregivers for people with chronic diseases. Pooled mean ZBI scores and 95% confidence intervals by medical condition were calculated using a random effects model and heterogeneity with I2. RESULTS Ninety-seven included articles reported on 98 unique samples across 21 chronic diseases. No study used the Level of Care Index. Among 12 disease groups with more than one study, heterogeneity was too high (I2 range: 0-99.6%, ≥76.5% in 11 groups) to confidently estimate burden. The percent of studies rated high risk of bias ranged from 0% to 98%, but all external validity items were rated as high-risk in >50% of studies. CONCLUSIONS Findings highlight the need for studies on caregiver burden to improve sampling techniques; better report sampling procedures and caregiver and care recipient characteristics; and develop a standard set of outcomes, including a measure of caregiving intensity. Systematic Review Registration: CRD42017080962IMPLICATIONS FOR REHABILITATIONThe amount of burden reported by caregivers to loved ones is associated with reduced physical and mental health.We found considerable heterogeneity in perceived burden reported by informal caregivers across different studies within disease groups, which is likely related to methodological issues, including sampling techniques.Health care providers who use research on caregiver burden should assess how representative study samples may be and exercise caution in drawing conclusions.
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Affiliation(s)
- Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Mara Cañedo-Ayala
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Matthew Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada.,Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Canada
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18
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Gilotra NA, Pamboukian SV, Mountis M, Robinson SW, Kittleson M, Shah KB, Forde-McLean RC, Haas DC, Horstmanshof DA, Jorde UP, Russell SD, Taddei-Peters WC, Jeffries N, Khalatbari S, Spino CA, Richards B, Yosef M, Mann DL, Stewart GC, Aaronson KD, Grady KL. Caregiver Health-Related Quality of Life, Burden, and Patient Outcomes in Ambulatory Advanced Heart Failure: A Report From REVIVAL. J Am Heart Assoc 2021; 10:e019901. [PMID: 34250813 PMCID: PMC8483456 DOI: 10.1161/jaha.120.019901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Heart failure (HF) imposes significant burden on patients and caregivers. Longitudinal data on caregiver health-related quality of life (HRQOL) and burden in ambulatory advanced HF are limited. Methods and Results Ambulatory patients with advanced HF (n=400) and their participating caregivers (n=95) enrolled in REVIVAL (Registry Evaluation of Vital Information for VADs [Ventricular Assist Devices] in Ambulatory Life) were followed up for 24 months, or until patient death, left ventricular assist device implantation, heart transplantation, or loss to follow-up. Caregiver HRQOL (EuroQol Visual Analog Scale) and burden (Oberst Caregiving Burden Scale) did not change significantly from baseline to follow-up. At time of caregiver enrollment, better patient HRQOL by Kansas City Cardiomyopathy Questionnaire was associated with better caregiver HRQOL (P=0.007) and less burden by both time spent (P<0.0001) and difficulty (P=0.0007) of caregiving tasks. On longitudinal analyses adjusted for baseline values, better patient HRQOL (P=0.034) and being a married caregiver (P=0.016) were independently associated with better caregiver HRQOL. Patients with participating caregivers (versus without) were more likely to prefer left ventricular assist device therapy over time (odds ratio, 1.43; 95% CI, 1.03-1.99; P=0.034). Among patients with participating caregivers, those with nonmarried (versus married) caregivers were at higher composite risk of HF hospitalization, death, heart transplantation or left ventricular assist device implantation (hazard ratio, 2.99; 95% CI, 1.29-6.96; P=0.011). Conclusions Patient and caregiver characteristics may impact their HRQOL and other health outcomes over time. Understanding the patient-caregiver relationship may better inform medical decision making and outcomes in ambulatory advanced HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Neal Jeffries
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Shokoufeh Khalatbari
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | | | - Blair Richards
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | - Matheos Yosef
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
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19
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McHorney CA, Mansukhani SG, Anatchkova M, Taylor N, Wirtz HS, Abbasi S, Battle L, Desai NR, Globe G. The impact of heart failure on patients and caregivers: A qualitative study. PLoS One 2021; 16:e0248240. [PMID: 33705486 PMCID: PMC7951849 DOI: 10.1371/journal.pone.0248240] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background Heart failure is rising in prevalence but relatively little is known about the experiences and journey of patients and their caregivers. The goal of this paper is to present the symptom and symptom impact experiences of patients with heart failure and their caregivers. Methods This was a United States-based study wherein in-person focus groups were conducted. Groups were audio recorded, transcribed and a content-analysis approach was used to analyze the data. Results Ninety participants (64 patients and 26 caregivers) were included in the study. Most patients were female (52.0%) with mean age 59.3 ± 8 years; 55.6% were New York Heart Association Class II. The most commonly reported symptoms were shortness of breath (81.3%), fatigue/tiredness (76.6%), swelling of legs and ankles (57.8%), and trouble sleeping (50.0%). Patients reported reductions in social/family interactions (67.2%), dietary changes (64.1%), and difficulty walking and climbing stairs (56.3%) as the most common adverse disease impacts. Mental-health sequelae were noted as depression and sadness (43.8%), fear of dying (32.8%), and anxiety (32.8%). Caregivers (mean age 55.5 ± 11.2 years and 52.0% female) discussed 33 daily heart failure impacts, with the top three being reductions in social/family interactions (50.0%); being stressed, worried, and fearful (46.2%); and having to monitor their “patience” level (42.3%). Conclusions There are serious unmet needs in HF for both patients and caregivers. More research is needed to better characterize these needs and the impacts of HF along with the development and evaluation of disease management toolkits that can support patients and their caregivers.
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Affiliation(s)
| | | | - Milena Anatchkova
- Patient Centered Research, Evidera, Bethesda, MD, United States of America
- * E-mail:
| | - Natalie Taylor
- Patient Centered Research, Evidera, Bethesda, MD, United States of America
| | - Heidi S. Wirtz
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
| | - Siddique Abbasi
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
| | - Lynwood Battle
- Patient Author from Cincinnati, Cincinnati, OH, United States of America
| | - Nihar R. Desai
- Yale School of Medicine, New Haven, CT, United States of America
| | - Gary Globe
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
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20
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IsHak WW, Korouri S, Darwish T, Vanle B, Dang J, Edwards G, Black JT, Aronow H, Kimchi A, Spiegel B, Hedrick R, Chernoff R, Diniz MA, Mirocha J, Manoukian V, Harold J, Ong MK, Wells K, Hamilton M, Danovitch I. Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial. PLoS One 2021; 16:e0244453. [PMID: 33412562 PMCID: PMC7790529 DOI: 10.1371/journal.pone.0244453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. Conclusions The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. Registration ClinicalTrials.Gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- * E-mail:
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jeanne T. Black
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Harriet Aronow
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Asher Kimchi
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Brennan Spiegel
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Vicki Manoukian
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John Harold
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Michele Hamilton
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Abstract
BACKGROUND Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution. OBJECTIVE The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries. METHODS This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α. RESULTS Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale. CONCLUSIONS Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.
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The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure. Heart Lung 2020; 49:737-744. [PMID: 32977035 DOI: 10.1016/j.hrtlng.2020.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/10/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health. OBJECTIVES The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver. METHODS A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2). RESULTS Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life. CONCLUSIONS The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.
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Abed MA, Khalifeh AH, Khalil AA, Darawad MW, Moser DK. Functional health literacy and caregiving burden among family caregivers of patients with end-stage renal disease. Res Nurs Health 2020; 43:529-537. [PMID: 32757227 DOI: 10.1002/nur.22060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/21/2020] [Indexed: 01/11/2023]
Abstract
Family caregivers of patients with end-stage renal disease (ESRD) experience significant caregiver-related burden, yet the contribution of their functional health literacy (FHL) to caregiving burden has not been elucidated. We investigated the magnitude of FHL and caregiving burden and their association in a descriptive, correlational cross-sectional study of family caregivers of Jordanian patients with ESRD (N = 88). The short versions of the FHL for Adults and the Zarit Burden Interview were used for assessment of caregivers. Demographic and clinical information of patients and their family caregivers were self-reported. Of family caregivers, 41% had limited FHL and 38% experienced high caregiver burden. FHL and history of comorbidity in family caregivers predicted caregiving burden independent of demographic and clinical factors. Consideration of FHL in support interventions for family caregivers may minimize some of the high perceived caregiving burden, but clinical trials of such interventions are needed to confirm this conclusion.
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Affiliation(s)
- Mona A Abed
- Department of Adult Health Nursing, College of Nursing, Hashemite University, Zarqa, Jordan
| | - Anas H Khalifeh
- Department of Nursing, Prince Hamzah Hospital, Ministry of Health, Amman, Jordan.,Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Amani A Khalil
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Muhammad W Darawad
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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24
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Changes in Social Support and Relational Mutuality as Moderators in the Association Between Heart Failure Patient Functioning and Caregiver Burden. J Cardiovasc Nurs 2020; 36:212-220. [PMID: 32740225 DOI: 10.1097/jcn.0000000000000726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Caregivers to patients with heart failure (HF) may experience substantial burden in their roles, yet little is known about factors that exacerbate caregiver burden over time. OBJECTIVES We test the moderating role of changes in caregivers' social support and patient-caregiver relationship mutuality in the association between HF patient functioning and caregiver burden. METHODS Data were analyzed using Stata 13.1 for 100 HF primary caregivers, the majority of whom were female (81%), living with the patient (87%), and married or partnered to the patient (70%). Patients reported on dyspnea, disability level, and symptom severity, and caregivers reported on patient-caregiver mutuality, social support, and perceived caregiver burden at both baseline and a 12-month follow-up. RESULTS Regression analyses using the Structural Equation Modeling framework revealed that declines in caregiver-patient mutuality over the 12 months of the study amplified the association between patient functioning (ie, dyspnea, symptom severity, and disability) and caregiver burden. Change in social support did not significantly moderate the association between any of the patient functioning variables and caregiver burden. CONCLUSIONS Caregivers' relationships with their care recipient shape how they respond to and interpret the demands of caregiving, and relationships experiencing negative changes over time contribute to caregiver burden. Promoting and sustaining positive social relationships within the caregiver-patient dyad is thus a promising avenue for interventions aimed at reducing the burden experienced by caregivers to patients with HF.
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25
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Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e654-e685. [DOI: 10.1161/cir.0000000000000747] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.
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26
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Thomson P, Howie K, Leslie SJ, Angus NJ, Andreis F, Thomson R, Mohan ARM, Mondoa C, Chung ML. Evaluating emotional distress and health-related quality of life in patients with heart failure and their family caregivers: Testing dyadic dynamics using the Actor-Partner Interdependence Model. PLoS One 2020; 15:e0227129. [PMID: 31914152 PMCID: PMC6948731 DOI: 10.1371/journal.pone.0227129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE 1) To compare levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and 2) to examine whether patients' and caregivers' emotional symptoms were associated with their own, as well as their partner's health-related quality of life. METHOD In this cross-sectional study, 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed all nine dimensions of the Brief Symptom Inventory and the Minnesota Living with Heart failure Questionnaire. Dyadic data were analysed for 6 sub-scales of the Brief Symptom Inventory, using the Actor-Partner Interdependence Model. RESULTS There were no statistically significant differences in emotional symptoms and health-related quality of life between patients with heart failure and their caregivers. Patients' and caregivers' emotional symptoms were associated with their own health-related quality of life. Caregivers' anxiety, phobic anxiety, obsession-compulsion, depression and hostility negatively influenced their partner's (i.e. the patient's) health-related quality of life. There were no partner effects of patients' emotional symptoms on the health-related quality of life of caregivers. CONCLUSIONS The results of this study suggest that patients may be particularly vulnerable to the emotional distress, i.e. thoughts, impulses and actions of their caregivers. It may be possible to improve patients' health-related quality of life by targeting specific detrimental emotional symptoms of caregivers.
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Affiliation(s)
- Patricia Thomson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
- * E-mail:
| | - Kate Howie
- Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Stephen J. Leslie
- Cardiac Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, United Kingdom
| | - Neil J. Angus
- Centre for Health Science, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Robert Thomson
- College of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Andrea R. M. Mohan
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Catherine Mondoa
- Cardiology Unit, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, Scotland, United Kingdom
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, KY, United States of America
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27
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The Relationship Between Caregiver Reactions and Psychological Distress in Family Caregivers of Patients With Heart Failure. J Cardiovasc Nurs 2020; 35:234-242. [PMID: 31904686 DOI: 10.1097/jcn.0000000000000636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Providing care often causes negative reactions and psychological distress in family caregivers of patients with heart failure. How these 2 constructs are related has not been fully explored. OBJECTIVE The aims of this study were to describe caregiver reactions to caregiving and psychological distress and to determine the associations between caregiver reactions to caregiving and psychological distress in family caregivers of patients with heart failure. METHODS In this secondary analysis of a cross-sectional study, the sample included 231 patients and their family caregivers. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess psychological distress (ie, symptoms of anxiety and depression), and the Caregiver Reaction Assessment was used to measure both negative and positive caregiver reactions to caregiving, including financial problems, impact on schedule, health problems, lack of family support, and self-esteem. RESULTS Of the participants, 15.2% and 25.5% of caregivers reported symptoms of depression and anxiety, respectively. Impact on schedule was the most common caregiver reaction, followed by financial problems. Impact on schedule was related to both the caregivers' symptoms of depression (odds ratio [OR], 1.705; P = .001) and anxiety (OR, 1.306; P = .035), whereas financial problems were only related to symptoms of anxiety (OR, 1.273; P = .011). CONCLUSIONS The findings suggest that interventions for reducing the negative impact on schedule of caregiving and helping to solve the caregivers' financial concerns might help to relieve their symptoms of depression and anxiety.
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28
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Khalili Y, Hamediseresht M, Asghari R, Taghavi S, Amin A, Naderi N. Evaluation of the reliability and validity of the Iranian caregiver burden questionnaire for heart failure. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nimmon L, Kimel G, Lingard L, Bates J. Can a complex adaptive systems perspective support the resiliency of the heart failure patient - informal caregiver dyad? Curr Opin Support Palliat Care 2019; 13:9-13. [PMID: 30507631 DOI: 10.1097/spc.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers' well being, and in turn heart failure patients' health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient - informal caregiver dyad. RECENT FINDINGS Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples' functional capacity. SUMMARY The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients' social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy
| | - Gil Kimel
- St. Paul's Hospital, Palliative Care Program, Division of Internal Medicine, Department of Medicine
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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Chuzi S, Pak ES, Desai AS, Schaefer KG, Warraich HJ. Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient. Curr Heart Fail Rep 2019; 16:220-228. [DOI: 10.1007/s11897-019-00440-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Lacerda MS, Prado PRD, Barros ALBLD, Lopes JDL. Depressive symptoms in the family caregivers of patients with heart failure: an integrative review. ACTA ACUST UNITED AC 2019; 40:e20180057. [PMID: 31188982 DOI: 10.1590/1983-1447.2019.20180057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022]
Abstract
AIMS Identify the occurrence of depressive symptoms in family caregivers of patients with heart failure and the correlation of other variables with depressive symptoms. DESIGN/METHOD The literature review was conducted in the Web of Science, Medline, LILACS and PubMed databases in March 2017. Papers published between 2004 and 2016, written in English, Spanish or Portuguese were included. The descriptors used were health, heart failure, depression, caregivers, and family. RESULTS 26 papers were selected. 6% to 64% reported depressive symptoms. Depressive symptoms were associated with patients' and caregivers' characteristics. In most cases, depressive symptoms were greater among family caregivers than in the general population and were mainly associated with care burden and quality of life. CONCLUSIONS The studies report depressive symptoms in caregivers of patients with heart failure.
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Affiliation(s)
- Marianna Sobral Lacerda
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Patrícia Rezende do Prado
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Alba Lúcia Bottura Leite de Barros
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
| | - Juliana de Lima Lopes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Programa de Pós-Graduação em Enfermagem. São Paulo, São Paulo, Brasil
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Petruzzo A, Biagioli V, Durante A, Emberti Gialloreti L, D'Agostino F, Alvaro R, Vellone E. Influence of preparedness on anxiety, depression, and quality of life in caregivers of heart failure patients: Testing a model of path analysis. PATIENT EDUCATION AND COUNSELING 2019; 102:1021-1028. [PMID: 30611564 DOI: 10.1016/j.pec.2018.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 12/23/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Testing the influence of heart failure (HF) caregiver preparedness on anxiety and depression, and the influence of HF caregiver anxiety and depression on caregiver physical and mental QOL. METHODS In this cross-sectional study, we used the Caregiver Preparedness Scale (CPS), the Hospital Anxiety and Depression Scale (HADS) with the anxiety (HADS-A) and depression (HADS-D) subscales, and the Short-Form 12 (SF-12) measuring the physical component summary (PCS) and the mental component summary (MCS) of QOL. Socio-demographic data and patients' clinic data were also collected. Data analysis was conducted with descriptive statistics, correlations, and path analysis. RESULTS A total of 366 HF caregiver and patient dyads were enrolled. Caregivers were mostly females (73.3%) with a mean age of 58.61 (SD = 15.66) years. The tested model showed excellent fit indices with the following significant paths: CPS scores predicted HADS-D scores; HADS-A scores predicted MCS scores; and HADS-D scores predicted both PCS and MCS scores. Also, HADS-D mediated the relationship between CPS and MCS scores. CONCLUSION Preparedness influences HF caregiver depression and depression influences caregiver physical and mental QOL. Depression mediates between preparedness and HF caregiver mental QOL. PRACTICE IMPLICATIONS Interventions focused on improving HF caregiver preparedness may improve caregivers' depression and QOL.
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Affiliation(s)
- Antonio Petruzzo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
| | - Valentina Biagioli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
| | - Angela Durante
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
| | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
| | - Fabio D'Agostino
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy; Saint Camillus International University of Health and Medical Sciences, via di S. Alessandro, 8, 00131 Rome, Italy.
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", via Montpellier, 1, 00133 Rome, Italy.
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Lyons KS, Hiatt SO, Gelow JM, Auld J, Mudd JO, Chien CV, Lee CS. Depressive symptoms in couples living with heart failure: the role of congruent engagement in heart failure management. Aging Ment Health 2018; 22:1585-1591. [PMID: 28959891 DOI: 10.1080/13607863.2017.1381945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF. METHOD A cross-sectional design was used to examine 60 couples living with HF. Multilevel modeling was used to examine partner and within-dyad effects of engagement in HF behaviors on depressive symptoms. RESULTS Just over one quarter (27%) of couples had both members experiencing at least mild depressive symptoms. Controlling for stage of HF and one's own level of engagement, one's partner's level of engagement was significantly associated with one's level of depressive symptoms; higher levels of engagement by one's partner were associated with lower levels of depressive symptoms. Additionally, spouses had lower levels of depressive symptoms when they had similar levels of engagement to their partner with HF; spouses had higher levels of depressive symptoms when they had higher levels of engagement than their partner with HF. CONCLUSION Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple.
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Affiliation(s)
- Karen S Lyons
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Shirin O Hiatt
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Jill M Gelow
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Jonathan Auld
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - James O Mudd
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher V Chien
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher S Lee
- c School of Nursing/Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
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Noonan MC, Wingham J, Taylor RS. 'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review. BMJ Open 2018; 8:e020927. [PMID: 29997137 PMCID: PMC6082485 DOI: 10.1136/bmjopen-2017-020927] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors. DATA ANALYSIS/SYNTHESIS A results-based convergent synthesis was conducted. RESULTS Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time. CONCLUSION Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required. TRIAL REGISTRATION NUMBER CRD42016053412.
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Affiliation(s)
- Miriam Catherine Noonan
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Jennifer Wingham
- Royal Cornwall Hospitals NHS Trust, Research, Development and Innovation, F37, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall & University of Exeter, Exeter, UK
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Al-Rawashdeh SY, Lennie TA, Chung ML. Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure. J Cardiovasc Nurs 2018; 31:E21-E28. [PMID: 27617563 PMCID: PMC5069100 DOI: 10.1097/jcn.0000000000000348] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF). PURPOSE The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF. METHODS A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach's α and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms). RESULTS Cronbach's α for the ZBI was .921. The ZBI had good item-total (r = 0.395-0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient's dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient's future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 ± 6.8 vs 3.1 ± 4.3; P < .01). CONCLUSION The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.
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Affiliation(s)
- Sami Y Al-Rawashdeh
- Sami Y. Al-Rawashdeh, PhD, RN Assistant Professor, Faculty of Nursing, Hashemite University, Zarqa, Jordan. Terry A. Lennie, PhD, RN, FAAN Professor, University of Kentucky College of Nursing, Lexington. Misook L. Chung, PhD, RN, FAHA, FAAN Professor, University of Kentucky College of Nursing, Lexington
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Abstract
BACKGROUND Despite evidence from the broader caregiving literature about the interdependent nature of the caregiving dyad, few studies in heart failure (HF) have examined associations between caregiver and patient characteristics. OBJECTIVE The aim of this study is to quantitatively synthesize the relationships between caregiver well-being and patient outcomes. METHODS The MEDLINE, PsycINFO, and CINAHL databases were searched for studies of adult HF patients and informal caregivers that tested the relationship between caregiver well-being (perceived strain and psychological distress) and patient outcomes of interest. Summary effects across studies were estimated using random effects meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 15 articles meeting inclusion criteria were included in the meta-analysis. Taking into account differences across studies, higher caregiver strain was associated significantly with greater patient symptoms (Fisher z = 0.22, P < .001) and higher caregiver strain was associated significantly with lower patient quality of life (Fisher z = -0.36, P < .001). Relationships between caregiver psychological distress and both patient symptoms and quality of life were not significant. Although individual studies largely found significant relationships between worse caregiver well-being and higher patient clinical event-risk, these studies were not amenable to meta-analysis because of substantial variation in event-risk measures. CONCLUSIONS Clinical management and research approaches that acknowledge the interdependent nature of the caregiving dyad hold great potential to benefit both patients and caregivers.
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Nimmon L, Bates J, Kimel G, Lingard L. Patients with heart failure and their partners with chronic illness: interdependence in multiple dimensions of time. J Multidiscip Healthc 2018; 11:175-186. [PMID: 29588596 PMCID: PMC5858542 DOI: 10.2147/jmdh.s146938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Informal caregivers play a vital role in supporting patients with heart failure (HF). However, when both the HF patient and their long-term partner suffer from chronic illness, they may equally suffer from diminished quality of life and poor health outcomes. With the focus on this specific couple group as a dimension of the HF health care team, we explored this neglected component of supportive care. Materials and methods From a large-scale Canadian multisite study, we analyzed the interview data of 13 HF patient-partner couples (26 participants). The sample consisted of patients with advanced HF and their long-term, live-in partners who also suffer from chronic illness. Results The analysis highlighted the profound enmeshment of the couples. The couples' interdependence was exemplified in the ways they synchronized their experience in shared dimensions of time and adapted their day-to-day routines to accommodate each other's changing health status. Particularly significant was when both individuals were too ill to perform caregiving tasks, which resulted in the couples being in a highly fragile state. Conclusion We conclude that the salience of this couple group's oscillating health needs and their severe vulnerabilities need to be appreciated when designing and delivering HF team-based care.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship.,Department of Occupational Science and Occupational Therapy
| | - Joanna Bates
- Centre for Health Education Scholarship.,Department of Family Practice, Faculty of Medicine, University of British Columbia
| | - Gil Kimel
- Palliative Care Program, St Paul's Hospital.,Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, BC
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Glotzbach K, May L, Wray J. Health related quality of life and functional outcomes in pediatric cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.001] [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: 10/18/2022]
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Bangerter LR, Griffin JM, Dunlay SM. Qualitative study of challenges of caring for a person with heart failure. Geriatr Nurs 2018; 39:443-449. [PMID: 29452768 DOI: 10.1016/j.gerinurse.2017.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) is a chronic health condition that causes significant morbidity among older adults, many of whom receive support and care from an informal caregiver. Caregiving is a difficult role with many responsibilities and challenges. An in-depth understanding of these challenges is necessary to develop services, resources, and interventions for HF caregivers. The goal of this study was to qualitatively ascertain the most significant challenges facing HF caregivers. We conducted semi-structured interviews with 16 caregivers of a person with HF (PHF). Content analysis revealed challenges rooted within the PHF (negative affect, resistant behavior, independence, and illness) Caregiver (balancing employment, lack of support, time, and caregiver health) and Relational level (PHF/caregiver dyadic relationship and other relationships). These findings can be used to inform interventions and support services for HF caregivers.
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Affiliation(s)
- Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Hu X, Hu X, Su Y, Qu M. Quality of Life Among Primary Family Caregivers of Patients with Heart Failure in Southwest China. Rehabil Nurs 2018; 43:26-34. [DOI: 10.1002/rnj.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chen YW, Wang CY, Lai YH, Liao YC, Wen YK, Chang ST, Huang JL, Wu TJ. Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure. Medicine (Baltimore) 2018; 97:e9629. [PMID: 29369178 PMCID: PMC5794362 DOI: 10.1097/md.0000000000009629] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exercise tolerance and cardiac output have a major impact on the quality of life (QOL) of patients experiencing heart failure (HF). Home-based cardiac rehabilitation can significantly improve not only exercise tolerance but also peak oxygen uptake ((Equation is included in full-text article.)peak), and the QOL in patients with HF. The aim of this prospective study was to evaluate the beneficial effects of home-based cardiac rehabilitation on the quality of medical care in patients with chronic HF. METHODS This study was a randomized prospective trial. HF patients with a left ventricular ejection fraction (LVEF) of less than 50% were included in this study. We randomly assigned patients to the control group (n = 18) and the interventional group (n = 19). Within the interventional group, we arranged individualized rehabilitation programs, including home-based cardiac rehabilitation, diet education, and management of daily activity over a 3-month period. Information such as general data, laboratory data, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) results, and the scores for the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before and after the intervention, was collected from all patients in this study. RESULTS Patients enrolled in the home-based cardiac rehabilitation programs displayed statistically significant improvement in (Equation is included in full-text article.)peak (18.2 ± 4.1 vs 20.9 ± 6.6 mL/kg/min, P = .02), maximal 6-Minute Walking Distance (6MWD) (421 ± 90 vs 462 ± 74 m, P = .03), anaerobic threshold (12.4 ± 2.5 vs 13.4 ± 2.6 mL/kg/min, P = .005), and QOL. In summary, patients receiving home-based cardiac rehabilitation experienced a 14.2% increase in (Equation is included in full-text article.)peak, a 37% increase in QOL score, and an improvement of 41 m on the 6MWD test. The 90-day readmission rate for patients reduced to 5% from 14% after receiving cardiac rehabilitation. CONCLUSION Home-based cardiac rehabilitation offered the most improved results in functional capacity, QOL, and a reduced the rate of readmission within 90 days.
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Affiliation(s)
- Yan-Wen Chen
- Department of Physical Medicine and Rehabilitation
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Yuan-Hui Lai
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Health Business Administration, Hung Kuang University, Taichung
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Yan-Kai Wen
- Department of Physical Medicine and Rehabilitation
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei
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42
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The Need for Heart Failure Advocacy in Canada. Can J Cardiol 2017; 33:1450-1454. [DOI: 10.1016/j.cjca.2017.08.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022] Open
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Nicholas Dionne-Odom J, Hooker SA, Bekelman D, Ejem D, McGhan G, Kitko L, Strömberg A, Wells R, Astin M, Metin ZG, Mancarella G, Pamboukian SV, Evangelista L, Buck HG, Bakitas MA. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review. Heart Fail Rev 2017; 22:543-557. [PMID: 28160116 PMCID: PMC5544594 DOI: 10.1007/s10741-017-9597-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms "heart failure" AND "caregiver." Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients' unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | - Stephanie A Hooker
- Department of Psychology, University of Colorado, Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - David Bekelman
- Veterans Affairs Eastern Colorado Health Care System, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, 1055 Clermont Street, Research 151, Denver, CO, 80220, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gwen McGhan
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Lisa Kitko
- College of Nursing, Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Campus University Hospital, Linköping University, Building 511-001, 581 85, Linköping, Sweden
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Meka Astin
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zehra Gok Metin
- Department of Internal Medicine Nursing, Hacettepe University, 06100, Ankara, Turkey
| | - Gisella Mancarella
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL, 35294, USA
| | - Lorraine Evangelista
- Program in Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
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Grigorovich A, Lee A, Ross H, Woodend AK, Forde S, Cameron JI. A longitudinal view of factors that influence the emotional well-being of family caregivers to individuals with heart failure. Aging Ment Health 2017; 21:844-850. [PMID: 27077788 DOI: 10.1080/13607863.2016.1168361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Caring for community-residing patients with heart failure can affect caregivers' emotional wellbeing. However, few studies have examined caregivers' well-being longitudinally, or identified factors associated with positive and negative outcomes. The objective of this longitudinal cohort study was to examine changes in caregivers' well-being over time, and to identify patient and caregiver factors associated with positive and negative outcomes. METHOD Fifty caregiver/heart failure patient dyads were recruited from an acute care facility and followed in the community. All participants completed surveys at hospital admission and 3, 6 and 12 months later. Caregivers completed assessments of depression symptoms and positive affect and standardized measures to capture assistance provided, mastery, personal gain, social support, participation restriction, and patients' behavioral and psychological symptoms. From patients, we collected demographic characteristics and health-related quality of life. Individual Growth Curve modelling was used to analyze the data. RESULTS Caregivers' negative and positive emotions remained stable over time. Depression symptoms were associated with higher participation restriction in caregivers. Positive affect was associated with more personal gain and more social support. Patients' health-related quality of life and their behavioral and psychological symptoms were not significantly associated with caregivers' emotional outcomes. CONCLUSION Interventions should be offered based on caregivers' needs rather than patients' health outcomes, and should focus on fostering caregivers' feelings of personal gain, assisting them with securing social support, and engaging in valued activities.
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Affiliation(s)
- Alisa Grigorovich
- a Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
| | - Adrienne Lee
- b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Heather Ross
- c Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network , Toronto , ON , Canada
| | - A Kirsten Woodend
- d Trent-Fleming School of Nursing, Trent University , Peterborough , ON , Canada
| | - Samantha Forde
- b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Jill I Cameron
- a Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada.,b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.,e Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
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Cook JL, Colvin M, Francis GS, Grady KL, Hoffman TM, Jessup M, John R, Kiernan MS, Mitchell JE, Pagani FD, Petty M, Ravichandran P, Rogers JG, Semigran MJ, Toole JM. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e1145-e1158. [PMID: 28559233 DOI: 10.1161/cir.0000000000000507] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Paturzo M, Hiatt SO, Alvaro R, Lee CS. Caregiver determinants of patient clinical event risk in heart failure. Eur J Cardiovasc Nurs 2017; 16:707-714. [PMID: 28513209 DOI: 10.1177/1474515117711305] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes. AIMS To quantify the influence of patient and caregiver characteristics on patient clinical event risk in HF. METHODS This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers ( n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient New York Heart Association (NYHA) Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression. RESULTS Over the course of follow up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival. CONCLUSION Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event risk in HF.
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Affiliation(s)
- Julie T Bidwell
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA.,a Present institution/address: Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | | - Karen S Lyons
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Barbara Riegel
- 3 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Shirin O Hiatt
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Christopher S Lee
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA.,4 Oregon Health & Science University Knight Cardiovascular Institute, Portland, OR, USA
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Petruzzo A, Paturzo M, Naletto M, Cohen MZ, Alvaro R, Vellone E. The lived experience of caregivers of persons with heart failure: A phenomenological study. Eur J Cardiovasc Nurs 2017; 16:638-645. [DOI: 10.1177/1474515117707666] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Petruzzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marco Paturzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Monica Naletto
- Department of Surgery, Hospital of Perugia, Perugia, Italy
| | - Marlene Z Cohen
- University of Nebraska Medical Center, College of Nursing, Omaha, NE, USA
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Tan JY, Molassiotis A, Lloyd-Williams M, Yorke J. Burden, emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28417550 DOI: 10.1111/ecc.12691] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/15/2022]
Abstract
This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty-three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver-reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index-Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient-reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non-anxious and non-depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non-depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.
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Affiliation(s)
- J-Y Tan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - M Lloyd-Williams
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - J Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
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Care Burden and Social Support Levels of Caregivers of Patients with Chronic Obstructive Pulmonary Disease. Holist Nurs Pract 2017; 30:227-35. [PMID: 27309411 DOI: 10.1097/hnp.0000000000000153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This descriptive study was conducted to determine the care burden and social support levels of caregivers to patients with chronic obstructive pulmonary disease (COPD). The primary caregivers of 112 patients with COPD hospitalized in the chest diseases service of a university hospital were involved in the study. Data of the study were collected by using the Patient and Caregiver Information Form, which was prepared by reviewing the literature, Katz Index of Independence in Activities of Daily Living, Zarit Burden Interview, and Multidimensional Scale of Perceived Social Support. While the care burden mean score of caregivers of patients with COPD was 40.91 ± 20.58, the mean score of Multidimensional Scale of Perceived Social Support was 54.13 ± 18.84. In this study, it was determined that female caregivers, as well as individuals stating that their physical and psychological health was affected and those having difficulty giving care and needing help, had higher levels of care burden, whereas the spouses, as well as individuals with lower levels of income and those stating that their physical and psychological health was affected, had lower levels of social support.
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50
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Nakken N, Janssen DJ, van Vliet M, de Vries GJ, Clappers-Gielen GA, Michels AJ, Muris JW, Vercoulen JH, Wouters EF, Spruit MA. Gender differences in partners of patients with COPD and their perceptions about the patients. Int J Chron Obstruct Pulmon Dis 2016; 12:95-104. [PMID: 28096665 PMCID: PMC5207329 DOI: 10.2147/copd.s118871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/objectives Chronic obstructive pulmonary disease (COPD) not only affects patients but also their partners. Gender-related differences in patients with COPD are known, for instance regarding symptoms and quality of life. Yet, research regarding gender differences in partners of patients with COPD has been conducted to a lesser extent, and most research focused on female partners. We aimed to investigate differences between male and female partners of patients with COPD regarding their own characteristics and their perceptions of patients’ characteristics. Design Cross-sectional study. Setting Four hospitals in the Netherlands. Participants One hundred and eighty-eight patient–partner couples were included in this cross-sectional study. Measurements General and clinical characteristics, health status, care dependency, symptoms of anxiety and depression, social support, caregiver burden, and coping styles were assessed during a home visit. Results Female partners had more symptoms of anxiety and a worse health status than male partners. Social support and caregiver burden were comparable, but coping styles differed between male and female partners. Female partners thought that male patients were less care dependent and had more symptoms of depression, while these gender differences did not exist in patients themselves. Conclusion Health care providers should pay attention to the needs of all partners of patients with COPD, but female partners in particular. Obtaining an extensive overview of the patient–partner couple, including coping styles, health status, symptoms of anxiety, and caregiver burden, is necessary to be able to support the couple as effectively as possible.
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Affiliation(s)
| | - Daisy Ja Janssen
- Department of Research and Education, CIRO, Horn; Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), Maastricht
| | | | | | | | | | - Jean Wm Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht
| | - Jan H Vercoulen
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen
| | - Emiel Fm Wouters
- Department of Research and Education, CIRO, Horn; Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
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