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Lee S, Nolan A, Guerin J, Koons B, Matura LA, Jurgens CY, Dickson VV, Riegel B. The symptom perception processes of monitoring, awareness, and evaluation in patients with heart failure: a qualitative descriptive study. Eur J Cardiovasc Nurs 2024; 23:521-531. [PMID: 38168812 DOI: 10.1093/eurjcn/zvad116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
AIMS Patients with heart failure (HF) experience various signs and symptoms and have difficulties in perceiving them. Integrating insights from patients who have engaged in the process of symptom perception is crucial for enhancing our understanding of the theoretical concept of symptom perception. This study aimed to describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation and what influences the process. METHODS AND RESULTS Using a qualitative descriptive design, we conducted in-person semi-structured interviews with a purposeful sample of 40 adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analysed using directed qualitative content analysis. One overarching theme and three major themes emerged. Patients demonstrated Body listening, which involved active and individualized symptom monitoring tactics to observe bodily changes outside one's usual range. Trajectory of bodily change involved the patterns or characteristics of bodily changes that became apparent to patients. Three subthemes-sudden and alarming change, gradual change, and fluctuating change emerged. Patients evaluated symptoms through an Exclusionary process, sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained. Facilitators and barriers to symptom monitoring, awareness, and evaluation were identified. CONCLUSION This study elaborates the comprehensive symptom perception process used by adults with HF. Tailored nursing interventions should be developed based on the factors identified in each phase of the process to improve symptom perception in HF.
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Affiliation(s)
- Solim Lee
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, 269 E College Avenue, State College, PA 16801, USA
| | - Amy Nolan
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Julie Guerin
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Brittany Koons
- M. Lousie Fitzpatrick College of Nursing, Villanova University, 800 E. Lancaster Avenue, Villanova, PA 19085, USA
| | - Lea Ann Matura
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Corrine Y Jurgens
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
- Center for Home Care Policy & Research at VNS Health, 220 East 42nd Street, New York, NY 10017, USA
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Kleman C, Turrise S, Winslow H, Alzaghari O, Lutz BJ. Individual and systems-related factors associated with heart failure self-care: a systematic review. BMC Nurs 2024; 23:110. [PMID: 38336711 PMCID: PMC10854154 DOI: 10.1186/s12912-023-01689-9] [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: 05/24/2023] [Accepted: 12/25/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 - Dec 2021) using the Socioecological Model as a review framework. METHODS An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review. RESULTS A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level. CONCLUSION Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.
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Affiliation(s)
- Carolyn Kleman
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA.
| | - Stephanie Turrise
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| | - Heidi Winslow
- Manager of Nurse Residencies, Novant New Hanover Regional Medical Center, 2131 S. 17th Street, Wilmington, NC, 28401, USA
| | - Omar Alzaghari
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| | - Barbara J Lutz
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
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Osei Baah F, Brawner BM, Teitelman AM, Ruger JP, Riegel B. A Mixed-Methods Study of Social Determinants and Self-care in Adults With Heart Failure. J Cardiovasc Nurs 2023; 38:E59-E71. [PMID: 37816083 PMCID: PMC10593982 DOI: 10.1097/jcn.0000000000000999] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND The burden of heart failure (HF) is unequally distributed among population groups. Few study authors have described social determinants of health (SDoH) enabling/impeding self-care. AIM The aim of this study was to explore the relationship between SDoH and self-care in patients with HF. METHODS Using a convergent mixed-methods design, we assessed SDoH and self-care in 104 patients with HF using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and the Self-Care of HF Index v7.2 with self-care maintenance, symptom perception, and self-care management scales. Multiple regression was used to assess the relationship between SDoH and self-care. One-on-one in-depth interviews were conducted in patients with poor (standardized score ≤ 60, n = 17) or excellent (standardized score ≥ 80, n = 20) self-care maintenance. Quantitative and qualitative results were integrated. RESULTS Participants were predominantly male (57.7%), with a mean age of 62.4 ± 11.6 years, with health insurance (91.4%) and some college education (62%). Half were White (50%), many were married (43%), and most reported adequate income (53%). The money and resources core domain of PRAPARE significantly predicted self-care maintenance ( P = .019), and symptom perception ( P = .049) trended significantly after adjusting for other PRAPARE core domains (personal characteristics, family and home, and social and emotional health) and comorbidity. Participants discussed social connectedness, health insurance coverage, individual upbringing, and personal experiences as facilitators of self-care behavior. CONCLUSION Several SDoH influence HF self-care. Patient-specific interventions that address the broader effects of these factors may promote self-care in patients with HF.
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Mathews L, Ding N, Sang Y, Loehr LR, Shin JI, Punjabi NM, Bertoni AG, Crews DC, Rosamond WD, Coresh J, Ndumele CE, Matsushita K, Chang PP. Racial Differences in Trends and Prognosis of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: the Atherosclerosis Risk in Communities (ARIC) Surveillance Study. J Racial Ethn Health Disparities 2023; 10:118-129. [PMID: 35001343 PMCID: PMC9271140 DOI: 10.1007/s40615-021-01202-5] [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] [Received: 07/14/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Racial disparities in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting. METHODS In the ARIC Surveillance Study (2005-2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N). RESULTS Of 16,455 (unweighted n = 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%, p < 0.001). BB use was > 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (- 2.8% p < 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%, p < 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality. CONCLUSIONS Optimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.
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Affiliation(s)
- Lena Mathews
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ning Ding
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jung-Im Shin
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naresh M Punjabi
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wayne D Rosamond
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia P Chang
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mathews L, Ding N, Mok Y, Shin J, Crews DC, Rosamond WD, Newton A, Chang PP, Ndumele CE, Coresh J, Matsushita K. Impact of Socioeconomic Status on Mortality and Readmission in Patients With Heart Failure With Reduced Ejection Fraction: The ARIC Study. J Am Heart Assoc 2022; 11:e024057. [PMID: 36102228 PMCID: PMC9683665 DOI: 10.1161/jaha.121.024057] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
Background Low socioeconomic status (SES) is associated with a higher risk of heart failure (HF). The contribution of individual and neighborhood SES to the prognosis and quality of care for HF with reduced ejection fraction is not clear yet has important implications. Methods and Results We examined 728 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 78.2 years; 34% Black participants; 46% women) hospitalized with HF with reduced ejection fraction (ejection fraction <50%) between 2005 and 2018. We assessed associations between education, income, and area deprivation index with mortality and HF readmission using multivariable Cox models. We also evaluated the use of guideline-directed medical therapy (optimal: ≥3 of ß-blockers, mineralocorticoid receptor antagonist, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; acceptable: at least 2) at discharge. During a median follow-up of 3.2 years, 58.7% were readmitted with HF, and 74.0% died. Low income was associated with higher mortality (hazard ratio [HR], 1.52 [95% CI, 1.14-2.04]) and readmission (HR, 1.45 [95% CI, 1.04-2.03]). Similarly, low education was associated with mortality (HR, 1.27 [95% CI, 1.01-1.59]) and readmission (HR, 1.62 [95% CI, 1.24-2.12]). The highest versus lowest area deprivation index quartile was associated with readmission (HR, 1.69 [95% CI, 1.11-2.58]) but not necessarily with mortality. The prevalence of optimal guideline-directed medical therapy and acceptable guideline-directed medical therapy was 5.5% and 54.4%, respectively, but did not significantly differ by SES. Conclusions Among patients hospitalized with HF with reduced ejection fraction, low SES was independently associated with mortality and HF readmission. A targeted secondary prevention approach that focuses intensive efforts on patients with low SES will be necessary to improve outcomes of those with HF with reduced ejection fraction.
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Affiliation(s)
- Lena Mathews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- Cicarrone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Divsion of CardiologyJohns Hopkins UniversityBaltimoreMD
- School of Medicine, Johns Hopkins UniversityBaltimoreMD
| | - Ning Ding
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
| | - Yejin Mok
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
| | - Jung‐Im Shin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
| | - Deidra C. Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- School of Medicine, Johns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
- Center for Health EquityJohns Hopkins UniversityBaltimoreMD
| | - Wayne D. Rosamond
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNC
| | - Anna‐Kucharska Newton
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNC
- College of Public HealthUniversity of KentuckyLexingtonKY
| | - Patricia P. Chang
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNC
- Division of Cardiology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNC
| | - Chiadi E. Ndumele
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- Cicarrone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Divsion of CardiologyJohns Hopkins UniversityBaltimoreMD
- School of Medicine, Johns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
- Center for Health EquityJohns Hopkins UniversityBaltimoreMD
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- School of Medicine, Johns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of EpidemiologyJohns Hopkins UniversityBaltimoreMD
- School of Medicine, Johns Hopkins UniversityBaltimoreMD
- Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMD
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Delirium and its association with short-term outcomes in younger and older patients with acute heart failure. PLoS One 2022; 17:e0270889. [PMID: 35881580 PMCID: PMC9321444 DOI: 10.1371/journal.pone.0270889] [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: 11/22/2021] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Younger patients (18 to 65 years old) are often excluded from delirium outcome studies. We sought to determine if delirium was associated with short-term adverse outcomes in a diverse cohort of younger and older patients with acute heart failure (AHF). We conducted a multi-center prospective cohort study that included adult emergency department patients with confirmed AHF. Delirium was ascertained using the Brief Confusion Assessment Method (bCAM). The primary outcome was a composite outcome of 30-day all-cause death, 30-day all-cause rehospitalization, and prolonged index hospital length of stay. Multivariable logistic regression was performed, adjusting for demographics, cognitive impairment without delirium, and HF risk factors. Older age (≥ 65 years old)*delirium interaction was also incorporated into the model. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. A total of 1044 patients with AHF were enrolled; 617 AHF patients were < 65 years old and 427 AHF patients were ≥ 65 years old, and 47 (7.6%) and 40 (9.4%) patients were delirious at enrollment, respectively. Delirium was significantly associated with the composite outcome (adjusted OR = 1.64, 95%CI: 1.02 to 2.64). The older age*delirium interaction p-value was 0.47. In conclusion, delirium was common in both younger and older patients with AHF and was associated with poorer short-term outcomes in both cohorts. Younger patients with acute heart failure should be included in future delirium outcome studies.
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The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.
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Karami Salaheddin Kola M, Jafari H, Charati JY, Shafipour V. Comparing the effects of teach-back method, multimedia and blended training on self-care and social support in patients with heart failure: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:248. [PMID: 34485545 PMCID: PMC8395889 DOI: 10.4103/jehp.jehp_1481_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/10/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers. MATERIALS AND METHODS In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20-30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). RESULTS All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001). CONCLUSION According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.
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Affiliation(s)
| | - Hedayat Jafari
- Traditional and Complementary Medicine Research Center, Addiction Institute Mazandaran University of Medical Science, Sari, Iran
| | - Jamshid Yazdani Charati
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Vida Shafipour
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Narita K, Amiya E. Social and environmental risks as contributors to the clinical course of heart failure. Heart Fail Rev 2021; 27:1001-1016. [PMID: 33945055 DOI: 10.1007/s10741-021-10116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.
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Affiliation(s)
- Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan. .,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan.
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Sanchez JM, Jolly SE, Dewland TA, Tseng ZH, Nah G, Vittinghoff E, Marcus GM. Incident Strokes Among American Indian Individuals With Atrial Fibrillation. J Am Heart Assoc 2021; 10:e019581. [PMID: 33653124 PMCID: PMC8174189 DOI: 10.1161/jaha.120.019581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND American Indian individuals experience a relatively high risk for cardiovascular disease and have exhibited a higher risk of stroke compared with other racial and ethnic minorities. Although this population has the highest incidence of atrial fibrillation (AF) compared with other groups, the relationship between AF and nonhemorrhagic stroke among American Indian individuals compared with other groups has not been thoroughly studied. METHODS and RESULTS We used the Healthcare Cost and Utilization Project to evaluate risk of nonhemorrhagic stroke among American Indian individuals, with comparisons to White, Black, Hispanic, and Asian individuals, among all adult California residents receiving care in an emergency department, inpatient hospital unit, or ambulatory surgery setting from 2005 to 2011. Of 16 951 579 patients followed for a median 4.1 years, 105 822 (0.6%) were American Indian. After adjusting for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, cardiac surgery, valvular heart disease, chronic kidney disease, smoking, obstructive sleep apnea, pulmonary disease, and alcohol use, American Indian individuals with AF exhibited the highest risk of nonhemorrhagic stroke when compared with either non‐American Indian individuals with AF (hazard ratio, 1.38; 95% CI, 1.23–1.55; P<0.0001) or to each race and ethnicity with AF. American Indian individuals also experienced the highest overall risk for stroke, with no evidence that AF disproportionately heightened that risk in interaction analyses. CONCLUSIONS American Indian individuals experienced the highest risk of nonhemorrhagic stroke, whether in the presence or absence of AF. Our findings likely suggest an opportunity to further study, if not immediately address, guideline‐adherent anticoagulation prescribing patterns among American Indian individuals with AF.
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Affiliation(s)
- José M Sanchez
- Section of Cardiac Electrophysiology Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | - Stacey E Jolly
- The Department of General Internal Medicine Cleveland Clinic OH
| | - Thomas A Dewland
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Zian H Tseng
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Gregory Nah
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Eric Vittinghoff
- The Department of Epidemiology and Biostatistics University of California San Francisco CA
| | - Gregory M Marcus
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
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Ornelas C, Fadadu RP, Richardson MA, Agboghidi OH, Davis JD. Bridge the Gap: Reducing Inequity in Hospital Readmissions for African American Patients with Heart Failure Through Quality Improvement Initiatives. Health Equity 2021; 5:30-34. [PMID: 33564738 PMCID: PMC7868575 DOI: 10.1089/heq.2020.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: Heart failure (HF) disproportionately impacts African Americans. We evaluated existing quality improvement (QI) initiatives and patient and provider perceptions of barriers to HF care to develop equity-centered QI recommendations. Methods: We performed a literature review, interviewed providers and patients (N=11), and conducted a root cause analysis at a safety net hospital in San Francisco, California. Results: We have identified four elements to foster a more equitable HF care model: screening for social determinants of health, technological innovation, optimization of space, and implicit bias training. Conclusion: QI initiatives for HF should integrate health equity elements in their design and implementation.
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Affiliation(s)
- Carolina Ornelas
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Raj P. Fadadu
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Morrise A. Richardson
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Omonivie H. Agboghidi
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jonathan D. Davis
- Department of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Abstract
The history of digitalis is rich and interesting, with the first use usually attributed to William Withering and his study on the foxglove published in 1785. However, some knowledge of plants with digitalis-like effects used for congestive heart failure (CHF) was in evidence as early as Roman times. The active components of the foxglove (Digitalis purpurea and Digitalis lanata) are classified as cardiac glycosides or cardiotonic steroids and include the well-known digitalis leaf, digitoxin, and digoxin; ouabain is a rapid-acting glycoside usually obtained from Strophanthus gratus. These drugs are potent inhibitors of cellular membrane sodium-potassium adenosine triphosphatase (Na+/K+-ATPase). For most of the twentieth century, digitalis and its derivatives, especially digoxin, were the available standard of care for CHF. However, as the century closed, many doubts, especially regarding safety, were raised about their use as other treatments for CHF, such as decreasing the preload of the left ventricle, were developed. Careful attention is needed to maintain the serum digoxin level at ≤ 1.0 ng/ml because of the very narrow therapeutic window of the medication. Evidence for benefit exists for CHF with reduced ejection fraction (EF), also referred to as heart failure with reduced EF (HFrEF), especially when considering the combination of mortality, morbidity, and decreased hospitalizations. However, the major support for using digoxin is in atrial fibrillation (AF) with a rapid ventricular response when a rate control approach is planned. The strongest support of all for digoxin is for its use in rate control in AF in the presence of a marginal blood pressure, since all other rate control medications contribute to additional hypotension. In summary, these days, digoxin appears to be of most use in HFrEF and in AF with rapid ventricular response for rate control, especially when associated with hypotension. The valuable history of the foxglove continues; it has been modified but not relegated to the garden or the medical history book, as some would advocate.
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13
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Tromp J, Richards AM, Tay WT, Teng THK, Yeo PSD, Sim D, Jaufeerally F, Leong G, Ong HY, Ling LH, van Veldhuisen DJ, Jaarsma T, Voors AA, van der Meer P, de Boer RA, Lam CSP. N-terminal pro-B-type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure. ESC Heart Fail 2018; 5:279-287. [PMID: 29380931 PMCID: PMC5880675 DOI: 10.1002/ehf2.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/19/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023] Open
Abstract
Aims N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the most frequently used biomarker in heart failure (HF), but its prognostic utility across ethnicities is unclear. Methods and results This study included 546 Caucasians with HF from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure and 578 Asians with HF from the Singapore Heart Failure Outcomes and Phenotypes study. NT‐proBNP was measured at discharge after HF hospitalization. The studied outcome was a composite of all‐cause mortality and HF hospitalization at 18 months. Compared with Caucasian patients, Asian patients were younger (63 ± 12 vs. 71 ± 11 years); less often female (26% vs. 39%); and had lower body mass index (26 vs. 27 kg/m2), better renal function (61 ± 37 vs. 54 ± 20 mL/min/1.73 m2), lower rates of atrial fibrillation (25% vs. 46%), strikingly higher rates of diabetes (59% vs. 30%), and higher rates of hypertension (76% vs. 44%). Despite these clear inter‐group differences in individual drivers of NT‐proBNP, average levels were similar in Asians [2709 (1350, 6302) pg/mL] and Caucasians [2545 (1308, 5484) pg/mL] (P = 0.514). NT‐proBNP was strongly associated with outcome [hazard ratio 1.28 (per doubling), 95% confidence interval 1.18–1.39, P < 0.001], regardless of ethnicity (Pinteraction = 0.719). NT‐proBNP was similarly associated with outcome in HF with reduced and preserved ejection fraction in Asian (Pinteraction = 0.776) and Caucasian patients (Pinteraction = 0.558). Conclusions NT‐proBNP has similar prognostic performance in Asians and Caucasians with HF despite ethnic differences in known clinical determinants of plasma NT‐proBNP.
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Affiliation(s)
- Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Wan Ting Tay
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,School of Population Health, University of Western Australia, Nedlands, WA, Australia
| | | | - David Sim
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | - Lieng Hsi Ling
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Carolyn S P Lam
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-National University of Singapore, Singapore, Singapore
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14
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Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants. PLoS One 2017; 12:e0187358. [PMID: 29117200 PMCID: PMC5695597 DOI: 10.1371/journal.pone.0187358] [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: 06/22/2016] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme. METHODS AND RESULTS After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p<0.001). Contact attempts by programme staff were significantly less successful in Turkish (52%) than in German patients (60%, p = 0.005) due to significantly higher rate of missing phone numbers (36% vs 25%), invalid address data (28% vs 7%) and being unreachable by phone more frequently (39% vs 26%, all p<0.001). Consent rate was significantly higher in successfully contacted Turkish (63%) compared to German patients (50%, p<0.001). CONCLUSION The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients. TRIAL REGISTRATION DRKS00007780.
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15
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Kabra R, Girotra S, Vaughan Sarrazin M. Refining Stroke Prediction in Atrial Fibrillation Patients by Addition of African-American Ethnicity to CHA2DS2-VASc Score. J Am Coll Cardiol 2017; 68:461-470. [PMID: 27470453 DOI: 10.1016/j.jacc.2016.05.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prior studies show that African-American patients have a higher risk of stroke compared with Caucasians. OBJECTIVES This study hypothesized addition of African-American ethnicity to CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke, vascular disease, age 65 to 74, and female sex) score might improve stroke prediction in patients with atrial fibrillation (AF). METHODS Medicare claims from January 2010 to December 2012 identified patients with newly diagnosed AF. The CHA2DS2-VASc was calculated on the basis of diagnoses in claims incurred during 12 months before first AF diagnosis. Ethnicity was identified from the Beneficiary Summary File. CHA2DS2-VASc-R score was calculated by giving 1 additional point for African-American ethnicity. The primary outcome was stroke, defined by primary diagnosis on acute inpatient admissions after the initial AF diagnosis. We used proportional hazards regression to determine the relationship between stroke and the CHA2DS2-VASc or a revised CHA2DS2-VASc-R score. RESULTS Of 460,417 patients with AF, 390,590 (85%) were non-Hispanic whites, 31,702 (7%) were non-Hispanic African Americans, and the remainder were other non-white ethnicities. Mean age was 79.2 ± 8.0 years, with 60% females. Overall, 16,703 stroke events occurred, and 151,441 (32.7%) patients died during a mean follow-up period of 18.0 months. Compared with CHA2DS2-VASc, CHA2DS2-VASc-R score improved the fit of the model significantly as measured by the log likelihood ratio statistic (p < 0.001). Among individual risk factors in CHA2DS2-VASc-R score, only prior stroke, age ≥75 years, and female sex had a stronger association with incident stroke than African-American ethnicity. CONCLUSIONS In patients >65 years of age with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.
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Affiliation(s)
- Rajesh Kabra
- Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis Tennessee
| | - Saket Girotra
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Mary Vaughan Sarrazin
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
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16
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Hayes-Watson C, Nuss H, Tseng TS, Parada N, Yu Q, Celestin M, Guillory D, Winn K, Moody-Thomas S. Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40749-017-0022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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17
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Abstract
Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.
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Affiliation(s)
- Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
| | - Melissa Zajdel
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
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18
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Liu AY, Cohen SE, Vittinghoff E, Anderson PL, Doblecki-Lewis S, Bacon O, Chege W, Postle BS, Matheson T, Amico KR, Liegler T, Rawlings MK, Trainor N, Blue RW, Estrada Y, Coleman ME, Cardenas G, Feaster DJ, Grant R, Philip SS, Elion R, Buchbinder S, Kolber MA. Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services. JAMA Intern Med 2016; 176:75-84. [PMID: 26571482 PMCID: PMC5042323 DOI: 10.1001/jamainternmed.2015.4683] [Citation(s) in RCA: 485] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Several randomized clinical trials have demonstrated the efficacy of preexposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition. Little is known about adherence to the regimen, sexual practices, and overall effectiveness when PrEP is implemented in clinics that treat sexually transmitted infections (STIs) and community-based clinics serving men who have sex with men (MSM). OBJECTIVE To assess PrEP adherence, sexual behaviors, and the incidence of STIs and HIV infection in a cohort of MSM and transgender women initiating PrEP in the United States. DESIGN, SETTING, AND PARTICIPANTS Demonstration project conducted from October 1, 2012, through February 10, 2015 (last date of follow-up), among 557 MSM and transgender women in 2 STI clinics in San Francisco, California, and Miami, Florida, and a community health center in Washington, DC. Data were analyzed from December 18, 2014, through August 8, 2015. INTERVENTIONS A combination of daily, oral tenofovir disoproxil fumarate and emtricitabine was provided free of charge for 48 weeks. All participants received HIV testing, brief client-centered counseling, and clinical monitoring. MAIN OUTCOMES AND MEASURES Concentrations of tenofovir diphosphate in dried blood spot samples, self-reported numbers of anal sex partners and episodes of condomless receptive anal sex, and incidence of STI and HIV acquisition. RESULTS Overall, 557 participants initiated PrEP, and 437 of these (78.5%) were retained through 48 weeks. Based on the findings from the 294 participants who underwent measurement of tenofovir diphosphate levels, 80.0% to 85.6% had protective levels (consistent with ≥4 doses/wk) at follow-up visits. African American participants (56.8% of visits; P = .003) and those from the Miami site (65.1% of visits; P < .001) were less likely to have protective levels, whereas those with stable housing (86.8%; P = .02) and those reporting at least 2 condomless anal sex partners in the past 3 months (88.6%; P = .01) were more likely to have protective levels. The mean number of anal sex partners declined during follow-up from 10.9 to 9.3, whereas the proportion engaging in condomless receptive anal sex remained stable at 65.5% to 65.6%. Overall STI incidence was high (90 per 100 person-years) but did not increase over time. Two individuals became HIV infected during follow-up (HIV incidence, 0.43 [95% CI, 0.05-1.54] infections per 100 person-years); both had tenofovir diphosphate levels consistent with fewer than 2 doses/wk at seroconversion. CONCLUSIONS AND RELEVANCE The incidence of HIV acquisition was extremely low despite a high incidence of STIs in a large US PrEP demonstration project. Adherence was higher among those participants who reported more risk behaviors. Interventions that address racial and geographic disparities and housing instability may increase the impact of PrEP.
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Affiliation(s)
- Albert Y. Liu
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, California
| | - Peter L. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | | | - Oliver Bacon
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Wairimu Chege
- National Institutes of Health, Division of AIDS, Bethesda, Maryland
| | | | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | | | - Teri Liegler
- University of California, San Francisco, San Francisco, California
| | | | - Nikole Trainor
- San Francisco Department of Public Health, San Francisco, California
| | | | - Yannine Estrada
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | | | | | - Robert Grant
- Gladstone Institutes, San Francisco, California
- San Francisco AIDS Foundation, San Francisco, California
| | - Susan S. Philip
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Richard Elion
- Whitman-Walker Health, Washington, DC
- George Washington University School of Medicine
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
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19
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Dickson VV, Knafl GJ, Riegel B. Predictors of medication nonadherence differ among black and white patients with heart failure. Res Nurs Health 2015; 38:289-300. [PMID: 25962474 DOI: 10.1002/nur.21663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.
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Affiliation(s)
- Victoria Vaughan Dickson
- Assistant Professor College of Nursing, New York University, 433 First Avenue, #742, New York, NY, 10010
| | - George J Knafl
- Professor School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Barbara Riegel
- Professor and Edith Clemmer Steinbright Chair of Gerontology School of Nursing, University of Pennsylvania, Philadelphia, PA
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