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Eroglu H, Metin ZG. Correlation between symptom status, health perception, and spiritual well-being in heart failure patients: A structural equation modeling approach. J Nurs Scholarsh 2024; 56:490-506. [PMID: 38328990 DOI: 10.1111/jnu.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
AIM To explore predictors of spiritual well-being behaviors among heart failure patients based on Wilson and Cleary's conceptual model of health-related quality of life and to clarify the interrelationships among these variables. DESIGN A descriptive and correlational study design was used. METHODS This study included 202 heart failure patients treated between October 2020 and July 2021. Data were collected using the Symptom Status Questionnaire-Heart Failure, Perception of Health Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale. Descriptive analysis, correlation, and structural equation modeling were performed. RESULTS Characteristic factors positively affected spiritual well-being both directly (β = 0.19, p = 0.007) and indirectly (β = 0.19; CI (0.106; 0.311)). The direct relationship between health perception and spiritual well-being was significant (β = 0.83, p < 0.05). Symptom status acted as an essential mediator between model variables and spiritual well-being (β = -0.28; CI (-0.449; -0.133)). Comorbidity and symptom status also influence spiritual well-being through health perceptions. These variables explain 77% of the variance in spiritual well-being. CONCLUSION The modified structural equation modeling based on Wilson and Cleary's conceptual model fits well in predicting spiritual well-being in patients with heart failure. Spiritual well-being was reported to be poor, and changes in spiritual well-being were predicted by age, educational level, marital status, comorbidity, symptom status, and health perception. The results can be applied to patients with heart failure and may serve as a guide for assessment and interventions for improving spiritual well-being. CLINICAL RELEVANCE This study mainly concludes that symptom status and perceived health status affect spiritual well-being in heart failure patients. Symptom relief and improvement in perceived health status interventions may help enhance spiritual well-being in this population. Future studies are needed to investigate the different predictor's effects on spiritual well-being and examine whether symptom management and health status-enhancing interventions result in improved spiritual well-being in the heart failure population. REPORTING METHOD This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Hacer Eroglu
- Healthcare Vocational School, Lokman Hekim University, Ankara, Turkey
| | - Zehra Gok Metin
- Internal Medical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
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Son YJ, Jang I. One-year trajectories of self-care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study. J Clin Nurs 2023; 32:6427-6440. [PMID: 36823709 DOI: 10.1111/jocn.16658] [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: 10/25/2022] [Revised: 12/18/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIM AND OBJECTIVES This study aimed to identify the associations between longitudinal trajectories of self-care behaviours and unplanned hospital readmissions in patients with heart failure. BACKGROUND Adherence to self-care behaviours is crucial to prevent hospital readmissions; however, self-care behaviours remain unsatisfactory among patients with heart failure. Studies of long-term trajectories of self-care behaviours and their influence on hospital readmissions are limited in this population. DESIGN A prospective, longitudinal observational study. METHODS Among 137 participants with heart failure (mean age 67.36 years, 62% men), we analysed the 1-year follow-up data to determine the association between 1-year trajectories of self-care behaviours and hospital readmissions using Kaplan-Meier analysis and multivariable Cox regression, adjusted for confounding variables. RESULTS Self-care behaviour trajectories of heart failure patients were classified as 'high-stable' (58.4%) or 'low-sustained' (41.6%). The cumulative rate of readmissions for the low-sustained class was higher than that of the high-stable class for all periods. Factors influencing readmissions included anaemia, cognitive function, frailty and self-care behaviours trajectories. The low-sustained class had a 2.77 times higher risk of readmissions within 1 year than that in the high-stable class. CONCLUSIONS Longitudinal self-care behaviours pattern trajectories of heart failure patients were stratified as high-stable and low-sustained. Routine follow-up assessment of patients' self-care behavioural patterns, including anaemia and frailty, and cognitive function can minimise unplanned hospital readmissions. RELEVANCE TO CLINICAL PRACTICE Identification of trajectory patterns of self-care behaviours over time and provision of timely and individualised care can reduce readmissions for heart failure patients. Healthcare professionals should recognise the significance of developing tailored strategies incorporating longitudinal self-care behavioural patterns in heart failure patients. REPORTING METHOD The study has been reported in accordance with the STROBE checklist (Appendix S1). PATIENT OR PUBLIC CONTRIBUTION Patients have completed a self-reported questionnaire after providing informed consent.
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Affiliation(s)
- Youn-Jung Son
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Insil Jang
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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Liu J, Liu J, Wang J, Yan Z, Liang Q, Wang X, Wang Z, Liu M, Luan X. Prevalence and impact of malnutrition on readmission among hospitalized patients with heart failure in China. ESC Heart Fail 2022; 9:4271-4279. [PMID: 36125306 PMCID: PMC9773638 DOI: 10.1002/ehf2.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Malnutrition is common in patients with heart failure (HF) and is associated with poorer quality of life and increased mortality; however, an effective screening tool for malnutrition and its impact on the readmission of patients with HF is uncertain. Our objectives were to study (i) the nutritional status of Chinese hospitalized patients with HF and its impact on readmission and (ii) the validity of seven malnutrition screening tools. METHODS AND RESULTS In this study, univariate and multivariate analyses of Cox proportional hazards regression were used to determine important predictors of readmission. The endpoint was readmission due to HF or non-HF. A total of 402 patients were included (66.4% male, median age 62 years [range: 20-92 years], median NT-proBNP 5,229 ng/L). During a median follow-up of 159 days, 150 patients (37%) were readmitted to the hospital. After adjusting for confounders, only malnutrition assessed using the Controlling Nutritional Status (CONUT) nutrition score was independently associated with readmission (P = 0.0293). A base model for predicting readmission with a C-statistic of 0.680 and subsequent addition of various nutritional screening tools improved its performance over the base model. Patients with malnutrition had a twofold increased risk of readmission. CONCLUSIONS We found that the prevalence of malnutrition among hospitalized patients with HF in China is very high and that malnutrition significantly increases the risk of readmission in these patients. CONUT is a validated screening tool for malnutrition and may provide valuable prognostic information.
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Affiliation(s)
- Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Jing Liu
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina,University of Health and Rehabilitation Sciences266071QingdaoShandongChina
| | - Qian Liang
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Xiaoli Wang
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Mengqi Liu
- School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong University250012JinanShandongChina
| | - Xiaorong Luan
- Department of Infection ControlQilu Hospital of Shandong UniversityWenhua West Road#107250012JinanShandongChina
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Abstract
BACKGROUND Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society. OBJECTIVE The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care. METHODS A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model. RESULTS In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors ( P < .05). These associations were partly or fully mediated by self-care confidence. CONCLUSION The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.
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Lee HJ, Son YJ. Associated Factors and Health Outcomes of Health Literacy and Physical Frailty Among Older Adults: A Systematic Review. Res Gerontol Nurs 2021; 15:39-52. [PMID: 34807795 DOI: 10.3928/19404921-20211117-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The current review aimed to systematically describe and synthesize health outcomes and factors associated with health literacy and physical frailty among older adults. Seven electronic databases were searched for observational studies published in English, from database inception to March 31, 2021. The study protocol was registered with PROSPERO. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Among the 479 studies identified, nine (6,337 participants) met eligibility criteria. Common factors associated with health literacy and physical frailty were lower educational level, multiple comorbidities, and cognitive dysfunction. Health literacy was mainly associated with self-reported outcomes, whereas physical frailty was related to clinical outcomes. Prospective studies are required to identify the impact of limited health literacy, combined with frailty, on long-term health outcomes in older adults. Health literacy interventions should consider the older adult population with multiple comorbidities. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Höhn EM, Hediger H, Hermann M, Petry H, Schmid-Mohler G. [Differences in epaAC© in heart failure patients with or without readmission: A retrospective case-control study]. Pflege 2021; 35:85-94. [PMID: 34708668 DOI: 10.1024/1012-5302/a000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Differences in epaAC© in heart failure patients with or without readmission: a retrospective case-control study Abstract. Background: Heart failure is one of the most frequent reasons for hospitalization in elderly people. In heart failure, approximately 22.8 % of hospitalised patients are rehospitalised within 30 days. The nursing assessment tool epaAC could provide information on risk factors for readmission. Aim: The aim of this study was to identify possible group differences in the items and scores of the epaAC discharge assessment with regard to the endpoint of unplanned readmissions within 30 days after discharge from index-hospitalisation. Methods: Using a retrospective case-control design, differences in the epaAC variables were investigated by descriptive and comparative statistics. Chi-square test, Wilcoxon test and t-test were performed with two-sided alpha level α < 0.05. Alpha error accumulation was accounted for by Benjamini & Hochberg correction. Results: No significant group differences were found in all items and scores of the discharge epaAC. There is only weak evidence that the presence of acute respiratory impairment at time of discharge is higher in the patient with rehospitalisation than in those without rehospitalisation. Conclusions: The items and scores of the nursing assessment instrument epaAC did not significantly differ between patients with or without 30-days readmission. Further exploration to assess the epaAC's potential to predict rehospitalisation in heart failure is needed.
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Affiliation(s)
- Eva-Maria Höhn
- Medizinbereich Herz-Gefäss-Thorax, Universitätsspital Zürich.,Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur
| | - Hannele Hediger
- Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur
| | - Matthias Hermann
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Heidi Petry
- Zentrum für Klinische Pflegewissenschaft, Universitätsspital Zürich
| | - Gabriela Schmid-Mohler
- Medizinbereich Herz-Gefäss-Thorax, Universitätsspital Zürich.,Zentrum für Klinische Pflegewissenschaft, Universitätsspital Zürich
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Han Q, Ren J, Tian J, Yang H, Zhang Q, Wang R, Zhao J, Han L, Li C, Yan J, Wang K, Zheng C, Han Q, Zhang Y. A nomogram based on a patient-reported outcomes measure: predicting the risk of readmission for patients with chronic heart failure. Health Qual Life Outcomes 2020; 18:290. [PMID: 32854729 PMCID: PMC7450976 DOI: 10.1186/s12955-020-01534-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health-related quality of life, as evaluated by a patient-reported outcomes measure (PROM), is an important prognostic marker in patients with chronic heart failure. This study aimed to use PROM to establish an effective readmission nomogram for chronic heart failure. METHODS Using a PROM as a measurement tool, we conducted a readmission nomogram for chronic heart failure on a prospective observational study comprising of 454 patients with chronic heart failure hospitalized between May 2017 to January 2020. A Concordance index and calibration curve were used to evaluate the discriminative ability and predictive accuracy of the nomogram. A bootstrap resampling method was used for internal validation of results. RESULTS The median follow-up period in the study was 372 days. After a final COX regression analysis, the gender, income, health care, appetite-sleep, anxiety, depression, paranoia, support, and independence were identified and included in the nomogram. The nomogram showed moderate discrimination, with a concordance index of 0.737 (95% CI 0.673-0.800). The calibration curves for the probability of readmission for patients with chronic heart failure showed high consistency between the probability, as predicted, and the actual probability. CONCLUSIONS This model offers a platform to assess the risk of readmission for different populations with CHF and can assist clinicians with personalized treatment recommendations.
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Affiliation(s)
- Qiang Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Jia Ren
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, 030001, Shanxi Province, China
| | - Jing Tian
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, 030001, Shanxi Province, China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Qing Zhang
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, 030001, Shanxi Province, China
| | - Ruoya Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Jinghua Zhao
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Linai Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, 030001, Shanxi Province, China
| | - Chenhao Li
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Ke Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Chu Zheng
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China
| | - Qinghua Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, 030001, Shanxi Province, China.
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China.
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, 030001, Shanxi Province, China.
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