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Browder SE, Rosamond WD. Preventing Heart Failure Readmission in Patients with Low Socioeconomic Position. Curr Cardiol Rep 2023; 25:1535-1542. [PMID: 37751036 PMCID: PMC10863623 DOI: 10.1007/s11886-023-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current burden of heart failure (HF) in the United States, specifically in patients with low socioeconomic position (SEP), and synthesize recommendations to prevent HF-related hospital readmissions in this vulnerable population. RECENT FINDINGS As treatments have improved, HF-related mortality has declined over time, resulting in more patients living with HF. This has led to an increase in hospitalizations, however, putting excess strain on our healthcare system. HF patients with low SEP are a particularly vulnerable group, as they experience higher rates of hospitalization and readmission compared to their high SEP counterparts. The Hospital Readmission Reduction Program (HRRP) was created to motivate interventions that reduce hospital readmissions across diseases, with HF being a primary target. Numerous readmission prevention efforts have been suggested to target the pre-hospitalization, hospitalization, and post-hospitalization phases, including addressing social determinants of health (SDoH), improving coordination of care, optimizing discharge plans, and improving adherence to follow-up care and medication regimens. Many of these proposed interventions show promise in reducing HF-related readmissions and issues surrounding adequate caregiver support may be particularly important to reduce readmissions among persons in low SEP. Reducing HF-related hospital readmissions is possible, even in vulnerable populations like those with low SEP, but this will require coordinated efforts across the healthcare system and throughout the life course of these patients. Caregiver support is a necessary part of optimized care for low SEP HF patients and future efforts should consider interventions that support these caregivers.
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Affiliation(s)
- Sydney E Browder
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA.
| | - Wayne D Rosamond
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
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2
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Harris KM, Gaffey AE, Schwartz JE, Krantz DS, Burg MM. The Perceived Stress Scale as a Measure of Stress: Decomposing Score Variance in Longitudinal Behavioral Medicine Studies. Ann Behav Med 2023; 57:846-854. [PMID: 37084792 PMCID: PMC10498818 DOI: 10.1093/abm/kaad015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The Perceived Stress Scale (PSS) is a widely used measure designed to assess perceptions of recent stress. However, it is unclear to what extent the construct assessed by the PSS represents factors that are stable versus variable within individuals, and how these components might vary over time. PURPOSE Determine the degree to which variability in repeated PSS assessments is attributable to between-person versus within-person variance in two different studies and populations. METHODS Secondary analyses utilized data from two studies with up to 13 PSS assessments: An observational study of 127 patients with heart failure followed over 39 months (Study 1), and an experimental study of 73 younger, healthy adults followed over 12 months (Study 2). Multilevel linear mixed modeling was used to estimate sources of variance in the PSS total and subscale scores across assessments. RESULTS Between-person variance accounted for a large proportion of the total variance in PSS total scores in Study 1 (42.3%) and Study 2 (51.1%); within-person variance comprised the remainder. Between-person variance was higher for shorter assessment periods (e.g., 1 week), and was comparable when examining only the first 12 months of assessments in each study (52.9% vs. 51.1%). CONCLUSIONS Within two samples differing in age and health status, between-person variance accounted for approximately half of the total variation in PSS scores over time. While within-person variance was observed, the construct assessed by the PSS may substantially reflect a more stable characteristic of how an individual perceives stressful life circumstances than previously appreciated.
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Affiliation(s)
- Kristie M Harris
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Allison E Gaffey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph E Schwartz
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Columbia University, New York, NY, USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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3
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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Johnson AE, Routh S, Taylor CN, Leopold M, Beatty K, McNamara DM, Davis EM. Developing and Implementing a Mobile Health Heart Failure Self-Care Program to Reduce Readmissions: A Patient-Centered Outcomes Research Randomized Controlled Trial (Preprint). JMIR Cardio 2021; 6:e33286. [PMID: 35311679 PMCID: PMC8981015 DOI: 10.2196/33286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective We aimed to develop an mHealth program designed to enhance patients’ self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017
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Affiliation(s)
- Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
| | - Shuvodra Routh
- Department of Internal Medicine, UPMC, Pittsburgh, PA, United States
| | - Christy N Taylor
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Meagan Leopold
- UPMC Community Provider Services, Pittsburgh, PA, United States
| | - Kathryn Beatty
- Innovative Homecare Solutions of UPMC, Pittsburgh, PA, United States
| | - Dennis M McNamara
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
| | - Esa M Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure: Multiple Mediating Effects of Perceived Stress and Coping Strategies. J Cardiovasc Nurs 2021; 37:257-265. [PMID: 33764941 DOI: 10.1097/jcn.0000000000000799] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous investigators have demonstrated that uncertainty in illness is associated with quality of life (QoL) in patients with chronic illness. However, little is known about the mechanism underlying the relationship in patients with heart failure. OBJECTIVE The aim of this study was to examine the multiple mediating effects of perceived stress and coping strategies on the relationship between uncertainty in illness and QoL in patients with heart failure. METHODS We conducted a cross-sectional study in 302 patients with heart failure recruited at a general hospital in China from October 2016 to September 2017. Uncertainty in illness, perceived stress, coping strategies, and QoL were assessed using self-reported questionnaires. The multiple mediation model was tested using the PROCESS macro for SPSS. RESULTS Of the 302 patients, 51.7% had poor physical QoL and 45.7% had poor mental QoL (physical component summary or mental component summary score of <50 points). Uncertainty in illness had a significantly negative indirect effect on mental QoL through perceived stress and acceptance-resignation (indirect effect, -0.02; 95% confidence interval, -0.04 to -0.01). Uncertainty in illness also had a significantly negative indirect effect on mental QoL via perceived stress only (indirect effect, -0.18; 95% confidence interval, -0.26 to -0.09). CONCLUSIONS Poor QoL is prevalent in patients with heart failure. Perceived stress and acceptance-resignation are important mediating factors between uncertainty in illness and mental QoL in patients with heart failure. Interventions aimed at reducing perceived stress and acceptance-resignation coping may be beneficial for improving mental QoL in patients with heart failure.
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Lam CSP, Wood R, Vaduganathan M, Bueno H, Chin A, Luporini Saraiva G, Sörstadius E, Tritton T, Thomas J, Qin L. Contemporary economic burden in a real-world heart failure population with Commercial and Medicare supplemental plans. Clin Cardiol 2021; 44:646-655. [PMID: 33704817 PMCID: PMC8119853 DOI: 10.1002/clc.23585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited real-world data exist on healthcare resource utilization (HCRU) and associated costs of patients with heart failure (HF) with reduced ejection fraction (HFrEF) and preserved EF (HFpEF), including urgent HF visits, which are assumed to be less burdensome than HF hospitalizations (hHFs) HYPOTHESIS: This study aimed to quantify the economic burden of HFrEF and HFpEF, via a retrospective, longitudinal cohort study, using IBM® linked claims/electronic health records (Commercial and Medicare Supplemental data only). METHODS Adult patients, indexed on HF diagnosis (ICD-10-CM: I50.x) from July 2012 through June 2018, with 6-month minimum baseline period and varying follow-up, were classified as HFrEF (I50.2x) or HFpEF (I50.3x) according to last-observed EF-specific diagnosis. HCRU/costs were assessed during follow-up. RESULTS About 109 721 HF patients (22% HFrEF, 31% HFpEF, 47% unclassified EF; median 18 months' follow-up) were identified. There were 3.2 all-cause outpatient visits per patient-month (HFrEF, 3.3; HFpEF, 3.6); 69% of patients required inpatient stays (HFrEF, 80%; HFpEF, 78%). Overall, 11% of patients experienced hHFs (HFrEF, 23%; HFpEF, 16%), 9% experienced urgent HF visits (HFrEF, 15%; HFpEF, 12%); 26% were hospitalized less than 30 days after first urgent HF visit versus 11% after first hHF. Mean monthly total direct healthcare cost per patient was $9290 (HFrEF, $11 053; HFpEF, $7482). CONCLUSIONS HF-related HCRU is substantial among contemporary real-world HF patients in US Commercial or Medicare supplemental health plans. Patients managed in urgent HF settings were over twice as likely to be hospitalized within 30 days versus those initially hospitalized, suggesting urgent HF visits are important clinical events and quality improvement targets.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore Medical School, Singapore.,University Medical Centre, Groningen, The Netherlands
| | | | - Muthiah Vaduganathan
- AstraZeneca, Gaithersburg (Consultant), Maryland, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alex Chin
- AstraZeneca, Gaithersburg (Consultant), Maryland, USA
| | | | | | | | | | - Lei Qin
- AstraZeneca, Gaithersburg (Consultant), Maryland, USA
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Harris KM, Jacoby DL, Lampert R, Soucier RJ, Burg MM. Psychological stress in heart failure: a potentially actionable disease modifier. Heart Fail Rev 2020; 26:561-575. [PMID: 33215323 DOI: 10.1007/s10741-020-10056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/24/2022]
Abstract
Psychological stress is common in patients with heart failure, due in part to the complexities of effective disease self-management and progressively worsening functional limitations, including frequent symptom exacerbations and hospitalizations. Emerging evidence suggests that heart failure patients who experience higher levels of stress may have a more burdensome disease course, with diminished quality of life and increased risk for adverse events, and that multiple behavioral and pathophysiological pathways are involved. Furthermore, the reduced quality of life associated with heart failure can serve as a life stressor for many patients. The purpose of this review is to summarize the current state of the science concerning psychological stress in patients with heart failure and to discuss potential pathways responsible for the observed effects. Key knowledge gaps are also outlined, including the need to understand patterns of exposure to various heart failure-related and daily life stressors and their associated effects on heart failure symptoms and pathophysiology, to identify patient subgroups at increased risk for stress exposure and disease-related consequences, and the effect of stress specifically for patients who have heart failure with preserved ejection fraction. Stress is a potentially modifiable factor, and addressing these gaps and advancing the science of stress in heart failure is likely to yield important insights about actionable pathways for improving patient quality of life and outcomes.
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Affiliation(s)
- Kristie M Harris
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA. .,VA Connecticut Healthcare System, Department of Cardiology, West Haven, CT, USA.
| | - Daniel L Jacoby
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Rachel Lampert
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Richard J Soucier
- Saint Francis Hospital and Medical Center, Trinity Health of New England, Hartford, CT, USA
| | - Matthew M Burg
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, Department of Cardiology, West Haven, CT, USA.,Yale School of Medicine, Department of Anesthesiology, New Haven, CT, USA
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Endrighi R, Dimond AJ, Waters AJ, Dimond CC, Harris KM, Gottlieb SS, Krantz DS. Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure. Psychol Health 2019; 34:1250-1266. [PMID: 31111738 DOI: 10.1080/08870446.2019.1609676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA
| | - Andrew J Dimond
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | | | - Kristie M Harris
- Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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Dar T, Radfar A, Abohashem S, Pitman RK, Tawakol A, Osborne MT. Psychosocial Stress and Cardiovascular Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:23. [PMID: 31028483 DOI: 10.1007/s11936-019-0724-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses potential therapies against stress-related CVD, and identifies future research directions. RECENT FINDINGS Metabolic activity of the amygdala (a neural center that is critically involved in the response to stress) can be measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) yielding a neurobiological signal that independently predicts subsequent CVD events. Furthermore, a serial pathway from ↑amygdalar activity → ↑hematopoietic tissue activity → ↑arterial inflammation → ↑CVD events has been elucidated, providing new insights into the mechanism linking stress to CVD. Psychosocial stress and stress conditions are independently associated with CVD in a manner that depends on the degree and duration of stress as well as the individual response to a stressor. Nevertheless, the fundamental biology remains incompletely defined, and stress is often confounded by adverse health behaviors. Thus, most clinical guidelines do not yet recognize psychosocial stress as an independent CVD risk factor or advocate for its treatment in CVD prevention. Clarification of this neurobiological pathway provides a better understanding of the underlying pathophysiology and suggests opportunities to develop novel preventive strategies and therapies.
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Affiliation(s)
- Tawseef Dar
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Azar Radfar
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Shady Abohashem
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed Tawakol
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Michael T Osborne
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA. .,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
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De Maria M, Vellone E, Ausili D, Alvaro R, Di Mauro S, Piredda M, De Marinis M, Matarese M. Self-care of patient and caregiver DyAds in multiple chronic conditions: A LongITudinal studY (SODALITY) protocol. J Adv Nurs 2018; 75:461-471. [DOI: 10.1111/jan.13834] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/05/2018] [Accepted: 08/06/2018] [Indexed: 01/22/2023]
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Keith F, Krantz DS, Chen R, Harris KM, Ware CM, Lee AK, Bellini PG, Gottlieb SS. Anger, hostility, and hospitalizations in patients with heart failure. Health Psychol 2017. [PMID: 28650197 DOI: 10.1037/hea0000519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Heart failure patients have a high hospitalization rate, and anger and hostility are associated with coronary heart disease morbidity and mortality. Using structural equation modeling, this prospective study assessed the predictive validity of anger and hostility traits for cardiovascular and all-cause rehospitalizations in patients with heart failure. METHOD 146 heart failure patients were administered the STAXI and Cook-Medley Hostility Inventory to measure anger, hostility, and their component traits. Hospitalizations were recorded for up to 3 years following baseline. Causes of hospitalizations were categorized as heart failure, total cardiac, noncardiac, and all-cause (sum of cardiac and noncardiac). RESULTS Measurement models were separately fit for Anger and Hostility, followed by a Confirmatory Factor Analysis to estimate the relationship between the Anger and Hostility constructs. An Anger model consisted of State Anger, Trait Anger, Anger Expression Out, and Anger Expression In, and a Hostility model included Cynicism, Hostile Affect, Aggressive Responding, and Hostile Attribution. The latent construct of Anger did not predict any of the hospitalization outcomes, but Hostility significantly predicted all-cause hospitalizations. Analyses of individual trait components of each of the 2 models indicated that Anger Expression Out predicted all-cause and noncardiac hospitalizations, and Trait Anger predicted noncardiac hospitalizations. None of the individual components of Hostility were related to rehospitalizations or death. CONCLUSION The construct of Hostility and several components of Anger are predictive of hospitalizations that were not specific to cardiac causes. Mechanisms common to a variety of health problems, such as self-care and risky health behaviors, may be involved in these associations. (PsycINFO Database Record
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Affiliation(s)
- Felicia Keith
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Rusan Chen
- Center for New Designs in Learning and Scholarship, Georgetown University
| | | | - Catherine M Ware
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Amy K Lee
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Paula G Bellini
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Stephen S Gottlieb
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine
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12
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Harris KM, Krantz DS, Kop WJ, Marshall J, Robinson SW, Marshall JM, Gottlieb SS. A New Clinically Applicable Measure of Functional Status in Patients With Heart Failure: The 60-Foot Walk Test. JACC-HEART FAILURE 2017; 5:411-420. [PMID: 28501523 DOI: 10.1016/j.jchf.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study reports the development and predictive value of the 60-foot walk test (60ftWT), a brief functional status measure for patients with heart failure (HF). The goal was to develop a test suitable for clinical settings and appropriate for patients with walking impairments. BACKGROUND The 6-min walk test (6MWT) has considerable predictive value, but requires a long walking course and has limited utility in patients with mobility-related comorbidities. A shorter, more clinically practical test is therefore needed. METHODS A total of 144 patients (age 57.4 ± 11.4 years; 111 males) with symptomatic HF received baseline assessments using the 60ftWT, 6MWT, and self-reported symptom and health status. Patients were tested 3 months later to determine stability of assessments. HF hospitalizations or death from any cause were recorded for 3.5 years following baseline. RESULTS Median 60ftWT completion time was 26 s (interquartile range: 22 to 31 s). Longer 60ftWT time was associated with shorter 6MWT distance (r = -0.75; p < 0.001), and with higher symptom severity at baseline (r = -0.40; p < 0.001). Longer 60ftWT times also predicted increases in 6MWT and symptoms from baseline to 3 months (p < 0.01). Both WTs predicted long-term clinical outcomes, with patients taking longer than 31 s to complete the 60ftWT at greatest risk for HF hospitalization or death (hazard ratio: 2.13; 95% confidence interval: 1.18 to 3.84; p = 0.01). CONCLUSIONS The 60ftWT is an easily administered functional status measure that predicts adverse events, symptoms, and health status. It has the potential for considerable clinical utility to help identify patients at risk for future events and to calibrate treatments designed to improve functional status and quality of life.
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Affiliation(s)
- Kristie M Harris
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Joanne Marshall
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Shawn W Robinson
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Jennifer M Marshall
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
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Abstract
OBJECTIVE The aim of the study was to examine how psychological stress changes over time in young and middle-aged patients after experiencing an acute myocardial infarction (AMI) and whether these changes differ between men and women. METHODS We analyzed data obtained from 2358 women and 1151 men aged 18 to 55 years hospitalized for AMI. Psychological stress was measured using the 14-item Perceived Stress Scale (PSS-14) at initial hospitalization and at 1 month and 12 months after AMI. We used linear mixed-effects models to examine changes in PSS-14 scores over time and sex differences in these changes, while adjusting for patient characteristics and accounting for correlation among repeated observations within patients. RESULTS Overall, patients' perceived stress decreased over time, especially during the first month after AMI. Women had higher levels of perceived stress than men throughout the 12-month period (difference in PSS-14 score = 3.63, 95% confidence interval = 3.08 to 4.18, p < .001), but they did not differ in how stress changed over time. Adjustment for patient characteristics did not alter the overall pattern of sex difference in changes of perceived stress over time other than attenuating the magnitude of sex difference in PSS-14 score (difference between women and men = 1.74, 95% confidence interval = 1.32 to 2.16, p < .001). The magnitude of sex differences in perceived stress was similar in patients with versus without post-AMI angina, even though patients with angina experienced less improvement in PSS-14 score than those without angina. CONCLUSIONS In young and middle-aged patients with AMI, women reported higher levels of perceived stress than men throughout the first 12 months of recovery. However, women and men had a similar pattern in how perceived stress changed over time.
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