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Locatelli G, Iovino P, Pasta A, Jurgens CY, Vellone E, Riegel B. Cluster analysis of heart failure patients based on their psychological and physical symptoms and predictive analysis of cluster membership. J Adv Nurs 2024; 80:1380-1392. [PMID: 37788062 DOI: 10.1111/jan.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
AIM Patients with heart failure experience multiple co-occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables. DESIGN Secondary analysis of MOTIVATE-HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy. METHODS Cluster analysis was performed based on the two scores of the Hospital Anxiety-Depression scale and two scores of the Heart-Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi-square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership. RESULTS Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA-class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership. CONCLUSIONS These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms-related data is absent. IMPLICATIONS These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms-data is absent. IMPACT Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership. REPORTING METHOD The authors have adhered to the EQUATOR guidelines STROBE to report observational cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION Patients were included only for collecting their data.
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Affiliation(s)
- Giulia Locatelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | - Alessandro Pasta
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Corrine Y Jurgens
- Connell School of Nursing, Boston College, Massachusetts, Boston, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Riegel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
- School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia, USA
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Sharma P, Scheffer K, Louis M, Aitken CR, Adams L, Morris NR. Effect of experimental modulation of mood on exertional dyspnoea in chronic obstructive pulmonary disease. Respirology 2024; 29:201-208. [PMID: 38044806 DOI: 10.1111/resp.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Dyspnoea is a debilitating symptom in individuals with chronic obstructive pulmonary disease (COPD) and a range of other chronic cardiopulmonary diseases and is often associated with anxiety and depression. The present study examined the effect of visually-induced mood shifts on exertional dyspnoea in individuals with COPD. METHODS Following familiarization, 20 participants with mild to severe COPD (age 57-79 years) attended three experimental sessions on separate days, performing two 5-min treadmill exercise tests separated by a 30-min interval on each day. During each exercise test, participants viewed either a positive, negative or neutral set of images sourced from the International Affective Picture System (IAPS) and rated dyspnoea or leg fatigue (0-10). Heart rate (HR) and peripheral oxygen saturation (SpO2 ) were measured at 1-min intervals during each test. Mood valence ratings were obtained using Self-Assessment Manikin (SAM) scale (1-9). RESULTS Mood valence ratings were significantly higher when viewing positive (end-exercise mean ± SEM = 7.6 ± 0.3) compared to negative IAPS images (2.4 ± 0.3, p < 0.001). Dyspnoea intensity (mean ± SEM = 5.8 ± 0.4) and dyspnoea unpleasantness (5.6 ± 0.3) when viewing negative images were significantly higher compared to positive images (4.2 ± 0.4, p = 0.004 and 3.4 ± 0.5, p = 0.003). Eighty-five percent of participants (n = 17) met the minimal clinically important difference (MCID) criteria for both dyspnoea intensity and unpleasantness. HR, SpO2 and leg fatigue did not differ significantly between conditions. CONCLUSION These findings indicate that the negative affective state worsens dyspnoea in COPD, thereby suggesting strategies aimed at reducing the likelihood of negative mood or improving the mood may be effective in managing morbidity associated with dyspnoea in COPD.
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Affiliation(s)
- Pramod Sharma
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- The Prince Charles Hospital, Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Karlijn Scheffer
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Menaka Louis
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Craig R Aitken
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- The Prince Charles Hospital, Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- The Prince Charles Hospital, Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Inciardi RM, Pellicori P, Chandra A. Identification and quantification of congestion in heart failure: a work in progress. Eur J Heart Fail 2023; 25:61-62. [PMID: 36464796 DOI: 10.1002/ejhf.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alvin Chandra
- University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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Fatigue in Heart Failure. J Cardiovasc Nurs 2022. [DOI: 10.1097/jcn.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Faulkner KM, Jurgens CY, Denfeld QE, Chien CV, Thompson JH, Gelow JM, Grady KL, Lee CS. Patterns and predictors of dyspnoea following left ventricular assist device implantation. Eur J Cardiovasc Nurs 2022; 21:724-731. [PMID: 35138359 PMCID: PMC9564114 DOI: 10.1093/eurjcn/zvac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022]
Abstract
AIMS Dyspnoea is a common symptom of heart failure (HF) that often prompts patients to seek treatment. Implantation of a left ventricular assist device (LVAD) has been associated with reduced dyspnoea but it is unclear if all patients experience similar improvements in dyspnoea over time following LVAD implantation. Our aim was to identify distinct trajectories of dyspnoea symptoms over time following LVAD implantation and predictors of dyspnoea trajectory. We hypothesized that at least two, distinct trajectories of dyspnoea would be observed following LVAD implantation. METHODS AND RESULTS This was a secondary analysis of data from the Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure study. In the parent study, sociodemographic and clinical data were collected prior to LVAD implantation and at 1, 3, and 6 months following LVAD implantation from a sample (n = 101) of patients with advanced HF. Latent growth mixture modelling was performed to identify distinct trajectories of dyspnoea symptoms. Backwards stepwise logistic regression was used to identify predictors of dyspnoea trajectory. Two, distinct trajectories of dyspnoea symptoms were identified: sustained improvement and unsustained improvement. Participants who experienced sustained improvement (86.7% of sample) demonstrated large, significant improvement in dyspnoea from pre-implantation to 3 months post-implant followed by smaller, non-significant improvement from 3 to 6 months. Participants who experienced unsustained improvement (13.3% of sample) demonstrated initial improvement from pre-implantation to 3 months post-implantation followed by worsening of dyspnoea from 3 to 6 months. Greater depressive symptoms at baseline and living alone were significant predictors of unsustained improvement. CONCLUSION Patients experience different patterns of dyspnoea over time following LVAD implantation. Clinicians should inquire about living arrangements and depressive symptoms at each visit to determine risk of unsustained improvement in dyspnoea.
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Affiliation(s)
- Kenneth M Faulkner
- Corresponding author. Tel: +1 631 444 3006, ; Present address. Stony Brook University School of Nursing, 101 Nicolls Road, Health Sciences Center Level 2, Stony Brook, NY 11794, USA
| | - Corrine Y Jurgens
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, USA
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, 3455 SW U.S. Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA
| | - Christopher V Chien
- University of North Carolina REX Healthcare, 2800 Blue Ridge Road, Suite 204, Raleigh, NC 27607, USA
| | - Jessica Harman Thompson
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, USA,University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Jill M Gelow
- Providence Health, 9427 Southwest Barnes Road, Suite 599, Portland, OR 97225, USA
| | - Kathleen L Grady
- Northwestern University, 675 North Saint Clair Street, Arkes Pavilion, Suite 730, Chicago, IL 60611-3056, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, USA
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Faulkner KM, Jurgens CY, Denfeld QE, Lyons KS, Harman Thompson J, Lee CS. Identifying unique profiles of perceived dyspnea burden in heart failure. Heart Lung 2020; 49:488-494. [PMID: 32434702 PMCID: PMC7483352 DOI: 10.1016/j.hrtlng.2020.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable. OBJECTIVES Identify distinct profiles of dyspnea burden and identify predictors of dyspnea symptom profile. METHODS A secondary analysis of data from five studies completed at Oregon Health and Science University was conducted. The Heart Failure Somatic Perception Scale was used to measure dyspnea burden. Latent class mixture modeling identified distinct profiles of dyspnea burden in a sample of HF patients (n = 449). Backwards stepwise multinomial logistic regression identified predictors of latent profile membership. RESULTS Four profiles of dyspnea burden were identified: no dyspnea/not bothered by dyspnea, mild dyspnea, moderate exertional dyspnea, and moderate exertional dyspnea with orthopnea and PND. Higher age was associated with greater likelihood of not being bothered by dyspnea than having moderate exertional dyspnea with orthopnea and PND. Higher NYHA class, anxiety, and depression were associated with greater likelihood of greater dyspnea burden. CONCLUSIONS Burden of dyspnea is highly variable among HF patients. Clinicians should account for the nuances of dyspnea and the activities that induce dyspnea when assessing HF patients.
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Affiliation(s)
- Kenneth M Faulkner
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, United States; Stony Brook University School of Nursing, Nicolls Road, Health Sciences Center Level 2 - Room 204, Stony Brook, NY 11794, United States.
| | - Corrine Y Jurgens
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, United States
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, 3455 SW U.S. Veterans Hospital Road | Mailcode: SN-ORD, Portland, OR 97239, United States
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, United States
| | - Jessica Harman Thompson
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, United States; University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States.
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA 02467, United States.
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Shameer K, Johnson KW, Yahi A, Miotto R, Li LI, Ricks D, Jebakaran J, Kovatch P, Sengupta PP, Gelijns S, Moskovitz A, Darrow B, David DL, Kasarskis A, Tatonetti NP, Pinney S, Dudley JT. PREDICTIVE MODELING OF HOSPITAL READMISSION RATES USING ELECTRONIC MEDICAL RECORD-WIDE MACHINE LEARNING: A CASE-STUDY USING MOUNT SINAI HEART FAILURE COHORT. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2017; 22:276-287. [PMID: 27896982 DOI: 10.1142/9789813207813_0027] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Reduction of preventable hospital readmissions that result from chronic or acute conditions like stroke, heart failure, myocardial infarction and pneumonia remains a significant challenge for improving the outcomes and decreasing the cost of healthcare delivery in the United States. Patient readmission rates are relatively high for conditions like heart failure (HF) despite the implementation of high-quality healthcare delivery operation guidelines created by regulatory authorities. Multiple predictive models are currently available to evaluate potential 30-day readmission rates of patients. Most of these models are hypothesis driven and repetitively assess the predictive abilities of the same set of biomarkers as predictive features. In this manuscript, we discuss our attempt to develop a data-driven, electronic-medical record-wide (EMR-wide) feature selection approach and subsequent machine learning to predict readmission probabilities. We have assessed a large repertoire of variables from electronic medical records of heart failure patients in a single center. The cohort included 1,068 patients with 178 patients were readmitted within a 30-day interval (16.66% readmission rate). A total of 4,205 variables were extracted from EMR including diagnosis codes (n=1,763), medications (n=1,028), laboratory measurements (n=846), surgical procedures (n=564) and vital signs (n=4). We designed a multistep modeling strategy using the Naïve Bayes algorithm. In the first step, we created individual models to classify the cases (readmitted) and controls (non-readmitted). In the second step, features contributing to predictive risk from independent models were combined into a composite model using a correlation-based feature selection (CFS) method. All models were trained and tested using a 5-fold cross-validation method, with 70% of the cohort used for training and the remaining 30% for testing. Compared to existing predictive models for HF readmission rates (AUCs in the range of 0.6-0.7), results from our EMR-wide predictive model (AUC=0.78; Accuracy=83.19%) and phenome-wide feature selection strategies are encouraging and reveal the utility of such datadriven machine learning. Fine tuning of the model, replication using multi-center cohorts and prospective clinical trial to evaluate the clinical utility would help the adoption of the model as a clinical decision system for evaluating readmission status.
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Affiliation(s)
- Khader Shameer
- Department of Genetics and Genomics, Icahn Institute of Genomics and Multiscale Biology, New York, NY, USA2Institute of Next Generation Healthcare, Mount Sinai Health System, New York, NY, USA
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Barnett LA, Prior JA, Kadam UT, Jordan KP. Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care. BMJ Open 2017; 7:e015857. [PMID: 28550024 PMCID: PMC5726088 DOI: 10.1136/bmjopen-2017-015857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine characteristics associated with monthly chest pain and shortness of breath (SoB) during activity in cardiovascular disease (CVD) and trajectories of these symptoms over 10 months. STUDY DESIGN AND SETTING Baseline questionnaire was sent to patients aged ≥40 years from 10 UK general practices. Responders were sent monthly questionnaires for 10 months. For patients with CVD (ischaemic heart disease and heart failure), the association of sociodemographic characteristics, pain elsewhere and anxiety and depression with monthly reports of chest pain and SoB during activity were determined using multilevel, multinomial logistic regression. Common symptom trajectories were determined using dual trajectory latent class growth analysis. RESULTS 661 patients with CVD completed at least 5 monthly questionnaires. Multiple other pain sites (relative risk ratio: 4.03; 95% CI 1.64 to 9.91) and anxiety or depression (relative risk ratio: 3.31; 95% CI 1.89 to 5.79) were associated with reporting weekly chest pain. Anxiety or depression (relative risk ratio: 4.10; 95% CI 2.72 to 6.17), obesity (relative risk ratio: 2.53; 95% CI 1.49 to 4.30), older age (80+: relative risk ratio: 2.51; 95% CI 1.19 to 5.26), increasing number of pain sites (4+: relative risk ratio: 4.64; 95% CI 2.35 to 9.18) and female gender (relative risk ratio: 1.81; 95% CI 1.20 to 2.75) were associated with reporting weekly SoB. Eight symptom trajectories were identified, with SoB symptoms more common than chest pain. CONCLUSIONS Potentially modifiable characteristics are associated with the experience of chest pain and SoB. Identified symptom trajectories may facilitate tailored care to improve outcomes in patients with CVD.
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Affiliation(s)
- Lauren A Barnett
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - James A Prior
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Umesh T Kadam
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
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Andersson H, Ullgren A, Holmberg M, Karlsson T, Herlitz J, Wireklint Sundström B. Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care. Int Emerg Nurs 2017; 33:43-47. [PMID: 28438478 DOI: 10.1016/j.ienj.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/25/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome. METHODS This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010. RESULTS In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI). CONCLUSION This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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Affiliation(s)
- Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Andreas Ullgren
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Emergency Medical Service System, Skaraborg Hospital, Skövde, Sweden
| | - Mats Holmberg
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Thomas Karlsson
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Birgitta Wireklint Sundström
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
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Abstract
Fatigue is a symptom experienced almost universally by people living with a chronic illness. People diagnosed with heart failure have described experiencing significant levels of fatigue. The family experience of fatigue, that is, how families perceive, respond to, and manage fatigue, is unknown. Semistructured family group interviews with 22 families ( N = 62 family members) were conducted. Thematic analysis was undertaken to explore the family experience of fatigue. Fatigue was described as a significant symptom that affected physical, emotional, and social functioning at a family level. Fatigue was described as difficult to manage, and while most family members interviewed had developed a shared understanding of fatigue, some family members found acceptance of this invisible symptom more difficult. Spouses were more likely to express concern that fatigue, and especially increased fatigue, represented a decline in health. The study highlighted the importance of a shared understanding of fatigue from a family perspective.
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Affiliation(s)
- Lisa Whitehead
- 1 Edith Cowan University, Joondalup, Western Australia, Australia
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Kupper N, Bonhof C, Westerhuis B, Widdershoven J, Denollet J. Determinants of Dyspnea in Chronic Heart Failure. J Card Fail 2016; 22:201-9. [DOI: 10.1016/j.cardfail.2015.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/25/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Catalfo G, Crea L, Lo Castro T, Magnano San Lio F, Minutolo G, Siscaro G, Vaccino N, Crimi N, Aguglia E. Depression, body mass index, and chronic obstructive pulmonary disease - a holistic approach. Int J Chron Obstruct Pulmon Dis 2016; 11:239-49. [PMID: 26929612 PMCID: PMC4755693 DOI: 10.2147/copd.s84347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Several clinical studies suggest common underlying pathogenetic mechanisms of COPD and depressive/anxiety disorders. We aim to evaluate psychopathological and physical effects of aerobic exercise, proposed in the context of pulmonary rehabilitation, in a sample of COPD patients, through the correlation of some psychopathological variables and physical/pneumological parameters. Methods Fifty-two consecutive subjects were enrolled. At baseline, the sample was divided into two subgroups consisting of 38 depression-positive and 14 depression-negative subjects according to the Hamilton Depression Rating Scale (HAM-D). After the rehabilitation treatment, we compared psychometric and physical examinations between the two groups. Results The differences after the rehabilitation program in all assessed parameters demonstrated a significant improvement in psychiatric and pneumological conditions. The reduction of BMI was significantly correlated with fat mass but only in the depression-positive patients. Conclusion Our results suggest that pulmonary rehabilitation improves depressive and anxiety symptoms in COPD. This improvement is significantly related to the reduction of fat mass and BMI only in depressed COPD patients, in whom these parameters were related at baseline. These findings suggest that depressed COPD patients could benefit from a rehabilitation program in the context of a multidisciplinary approach.
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Affiliation(s)
- Giuseppe Catalfo
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Luciana Crea
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Tiziana Lo Castro
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Francesca Magnano San Lio
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Giuseppe Minutolo
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Gherardo Siscaro
- Operative Unit Neurorehabilitation, IRCCS Fondazione Salvatore Maugeri, Sciacca, Italy
| | - Noemi Vaccino
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Nunzio Crimi
- Department of Pneumology, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
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Matura LA, McDonough A, Hanlon AL, Carroll DL. Development and initial psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS). Appl Nurs Res 2014; 28:42-7. [PMID: 24880966 DOI: 10.1016/j.apnr.2014.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/23/2014] [Accepted: 04/05/2014] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study is to report the development and psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS). BACKGROUND Patients with pulmonary arterial hypertension (PAH) experience multiple symptoms such as dyspnea, fatigue and chest pain, yet there is no comprehensive, validated symptom assessment tool to date. METHODS This study used a cross sectional design. Participants completed: socio-demographic and medical data form, the PAHSS, the Medical Outcomes Study Short Form-36 and the Profile of Mood States short form. RESULTS The PAHSS contains 17 symptoms measured on a 0 to 10 scale. Principal components analysis demonstrated a three factor solution for the PAHSS: pulmonary, diffuse, and cardiac. Coefficient alphas were good. Statistically significant Pearson coefficients were found between the PAHSS and the Medical Outcomes Study Short Form-36 and the Profile of Mood States short form. CONCLUSION Findings show that the PAHSS is a promising scale to assess symptom severity.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-4217 USA.
| | | | - Alexandra L Hanlon
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-4217 USA.
| | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, Boston, MA 02114 USA.
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Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients with chronic heart failure. Eur J Cardiovasc Nurs 2014; 14:310-6. [PMID: 24634388 DOI: 10.1177/1474515114528071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Zhu Meng
- Shandong University, PR China
- Shandong Provincial Hospital, PR China
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15
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Affiliation(s)
- Nana Waldréus
- Department of Social and Welfare Studies, Faculty of Health Sciences; Linköping University; Norrköping Sweden
- Department of Research; Södertälje Sjukhus; Södertälje Sweden
| | - Robert G. Hahn
- Department of Research; Södertälje Sjukhus; Södertälje Sweden
- Division of Anaesthesiology, Department of Medicine and Health Sciences, Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences; Linköping University; Norrköping Sweden
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16
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Hickey KT, Reiffel J, Sciacca RR, Whang W, Biviano A, Baumeister M, Castillo C, Talathothi J, Garan H. Correlating perceived arrhythmia symptoms and quality of life in an older population with heart failure: a prospective, single centre, urban clinic study. J Clin Nurs 2013; 22:434-44. [PMID: 23301579 PMCID: PMC3748605 DOI: 10.1111/j.1365-2702.2012.04307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. BACKGROUND While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. DESIGN Prospective, cross-sectional single-centre study. METHODS A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2(™) and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express(®) ) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. RESULTS Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. CONCLUSION Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. RELEVANCE TO CLINICAL PRACTICE The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life.
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17
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Seo Y, Yates B, Dizona P, LaFramboise L, Norman J. Predictors of Cognitive/Affective and Somatic Depression in Heart Failure Patients. Clin Nurs Res 2013; 23:259-80. [DOI: 10.1177/1054773812473476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.
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Affiliation(s)
- Yaewon Seo
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bernice Yates
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Dizona
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Louise LaFramboise
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph Norman
- Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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18
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Kamal AH, Miriovsky BJ, Currow DC, Abernethy AP. Improving the management of dyspnea in the community using rapid learning approaches. Chron Respir Dis 2012; 9:51-61. [PMID: 22308555 DOI: 10.1177/1479972311433576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with chronic pulmonary disease often suffer from breathlessness or dyspnea. Traditional evidence generation techniques to expand upon current treatment paradigms are limited by the significant delay between study initiation and clinical implementation of findings. Rapid learning health care is a novel approach to health care delivery that relies on intelligent and continuous integration of clinical and research data sets to deliver personalized medicine using the most current evidence available. Results of important studies in the management of chronic respiratory disease are presented in brief; however, the focus of this review is on evidence supporting the implementation of a rapid learning model for symptom management. Recent findings suggest that a rapid learning system is feasible and acceptable to patients with advanced illness, helps monitor symptoms overtime, facilitates study of the impact of novel interventions, and can identify unrecognized needs and concerns. A rapid learning model improves comprehensive assessment, timeliness of intervention, and accrual of contemporaneous data to support best practice that tailors care specific to the needs of patients as their disease and lifestyle change overtime. Using the rapid learning health care model, data collected in the process of routine care can simultaneously function both as clinical information and as a resource for research on patient-centered experiences and outcomes.
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Affiliation(s)
- Arif H Kamal
- Division of Medical Oncology, Department of Medicine, Duke Cancer Care Research Program, Duke Cancer Institute, Duke University Medical Center, NC 27710, USA
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19
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Abstract
PURPOSE The purpose of this article is to provide an overview of relevant clinical issues including pathophysiology, clinical presentation, assessment/diagnosis, and treatment strategies regarding depression in the heart failure (HF) patient. This information was synthesized to create a clinical protocol to guide the practitioner in identifying, diagnosing, and treating depression in adult HF patients. This protocol was designed for use in the primary care or HF clinic setting. DATA SOURCES PubMed and CINAHL were utilized to search for articles pertaining to HF and depression. CONCLUSIONS The presence of depression in HF is associated with a worsening prognosis, increased risk of death, rehospitalization, and functional decline. The practitioner must identify predisposing factors for depression and evaluate symptoms. Self-rated screening instruments can assist the practitioner in identifying those with depression. Evidence is lacking regarding the treatment of depression in HF but selective serotonin reuptake inhibitors are likely the best option. IMPLICATIONS FOR PRACTICE Understanding depression as it occurs in patients with HF is critical. If depression is identified and properly managed it may lead to better patient outcomes.
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Affiliation(s)
- Louise Smith
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
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20
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Janssen DJA, Spruit MA, Leue C, Gijsen C, Hameleers H, Schols JMGA, Wouters EFM. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chron Respir Dis 2010; 7:147-57. [PMID: 20688892 DOI: 10.1177/1479972310369285] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients may suffer from symptoms of anxiety and depression. Whether and to what extent symptoms of anxiety and depression may be present in COPD patients entering pulmonary rehabilitation and which patient characteristics are associated with psychological distress remains currently unknown. The objective of the present study is to determine the prevalence and the determinants of clinically relevant symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Symptoms of anxiety and depression have been assessed in 701 COPD patients entering pulmonary rehabilitation using the Hospital Anxiety and Depression Scale. Additionally, disease-specific health status, pulmonary function, body composition, exercise capacity, co-existing morbidities, smoking status, symptoms, long-term oxygen therapy and the use of antidepressant and anxiolytic drugs have been recorded. Patients had mean anxiety scores of 7.6 points and mean depression scores of 7.2 points. Anxiety scores >or=10 points were present in 225 patients (32%) and depression scores >or=10 points were present in 192 patients (27%). Patients at risk of having symptoms of anxiety were female or used antidepressant or anxiolytic drugs. Patients at risk of having symptoms of depression experienced dyspnea, had a body mass index (BMI) <21 kg/m(2) or used antidepressant or anxiolytic drugs. A considerable proportion of the COPD patients entering pulmonary rehabilitation report symptoms of anxiety and/or depression, which may significantly impair disease-specific health status. Patients at risk of having symptoms of anxiety and/or depression are female, experience dyspnea, have a low BMI or use antidepressant and/or anxiolytic drugs.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
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21
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Riegel B, Dickson VV, Cameron J, Johnson JC, Bunker S, Page K, Worrall-Carter L. Symptom recognition in elders with heart failure. J Nurs Scholarsh 2010; 42:92-100. [PMID: 20487191 DOI: 10.1111/j.1547-5069.2010.01333.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information. DESIGN A cross-sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (<73 years) versus older (> or = 73 years) patients in the ability to detect and interpret their heart failure symptoms. METHODS Shortness of breath was stimulated using a 6-minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person's shortness of breath by trained registered nurse research assistants (inter-rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In-depth interviews were used to assess symptom interpretation ability. FINDINGS Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT. CONCLUSIONS These results support our theory of an age-related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection. CLINICAL RELEVANCE The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients-particularly older ones-in somatic awareness and symptom interpretation. It may be useful to explore patients' statements about how they feel: "Compared to what? How do you feel today compared to yesterday?"
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA 9104-6096, USA.
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22
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Fini A, Cruz DDALMD. Propriedades psicométricas da Dutch Fatigue Scale e Dutch Exertion Fatigue Scale: versão brasileira. Rev Bras Enferm 2010; 63:216-21. [DOI: 10.1590/s0034-71672010000200008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 03/06/2010] [Indexed: 11/22/2022] Open
Abstract
Fadiga é uma resposta humana em diversas situações agudas e crônicas e também na população geral. Este artigo relata estudo realizado para estimar confiabilidade e validade da Dutch Fatigue Scale (DUFS) e da Dutch Exertion Fatigue Scale (DEFS) adaptadas para o Brasil. Trezentos pacientes ambulatoriais com insuficiência cardíaca e 64 voluntários responderam a DUFS e a DEFS vertidas para o português. Análise fatorial sobre o conjunto de itens das duas escalas produziu solução com um fator para cada escala (variância explicada = 53,9%) e boas estimativas de confiabilidade pelo alfa de Chronbach (DUFS=0,85 e DEFS=0,92) foram obtidas. Na amostra de pacientes, os escores nas escalas foram positivamente associados com a classe funcional da insuficiência cardíaca (DUFS e DEFS p=0,000), com os escores de depressão (DUFS r s=0,63; p=0,00 e DEFS r s=0,55; p=0,00) e com distúrbio de sono (DUFS e DEFS p=0,000). As versões brasileiras mostraram propriedades semelhantes as das escalas originais.
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Jurgens CY, Moser DK, Armola R, Carlson B, Sethares K, Riegel B. Symptom clusters of heart failure. Res Nurs Health 2009; 32:551-60. [PMID: 19650069 PMCID: PMC3234105 DOI: 10.1002/nur.20343] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N = 687) was conducted. The sample was 51.7% female, mean age 71 +/- 12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of nine items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact.
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Affiliation(s)
- Corrine Y Jurgens
- School of Nursing, Stony Brook University, HSC L2-223, Stony Brook, NY 11794-8240, USA
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24
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Fini A, Cruz DDALMD. Characteristics of fatigue in heart failure patients: a literature review. Rev Lat Am Enfermagem 2009; 17:557-65. [DOI: 10.1590/s0104-11692009000400019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 03/03/2009] [Indexed: 11/22/2022] Open
Abstract
This is a literature review report to describe characteristics (frequency, intensity and correlates) of fatigue in cases of heart failure. MedLine and LILACS were the examined databases. Out of 89 articles identified, 27 were selected for data extraction. Fatigue frequency ranged from 69% to 88% and fatigue intensities are incomparable due to differences in measurement scales. Quality of life, illness progression, physical activity, social and demographic variables, comorbidity, treatment and who assessed the fatigue were variables studied in relation to fatigue. The diversity of fatigue assessment methods causes difficulties to integrate results on fatigue frequency, characteristics and related factors. No study was found on fatigue characteristics in samples of Brazilian heart failure patients.
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25
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Huang TY, Moser DK, Hsieh YS, Lareau SC, Durkin AC, Hwang SL. Validation of Chinese Version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire With Heart Failure Patients in Taiwan. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.5.436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Dyspnea is a distressing and functionally limiting symptom that patients with heart failure commonly experience. A valid instrument to quantify dyspnea for comparison of groups and for illness management is important.
Objective To validate the Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire.
Methods The Chinese version was developed by using translation and back translation and was tested in Taiwan in 88 patients who had heart failure but no pulmonary disease or comorbid conditions limiting physical function. Data on a Taiwanese subsample (n=30) were compared with data on 30 patients in the United States matched by sex, age, and severity of disease to determine the equivalence of the Chinese and English versions. Construct validity was assessed by testing the hypothesis that health-related quality of life measured by using the Minnesota Living With Heart Failure Questionnaire is associated with the score on the dyspnea questionnaire. Reliability was assessed by using the Cronbach α and item-total correlations.
Results Equivalence between the US and Taiwanese samples was high, from 0.67 to 0.91 for each item of the questionnaire and for the total score. Satisfactory correlations between the Chinese dyspnea and the Minnesota questionnaires, especially in the physical dimension (r=0.71, P<.001), provided support for the construct validity of the Chinese questionnaire. Reliability of the Chinese questionnaire was adequate (α=0.94).
Conclusions The Chinese Modified Pulmonary Functional Status and Dyspnea Questionnaire is a reliable and valid measure for dyspnea that can be used in Taiwanese patients with heart failure.
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Affiliation(s)
- Tsuey-Yuan Huang
- Tsuey-Yuan Huang is a senior lecturer at the Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Debra K. Moser
- Debra K. Moser is a professor and holds the Gill Endowed Chair of Nursing at the College of Nursing, University of Kentucky in Lexington. She is also the editor of the Journal of Cardiovascular Nursing
| | - Yeu-Sheng Hsieh
- Yeu-Sheng Hsieh is a professor in the Department of Agriculture Extension, National Taiwan University
| | - Suzanne C. Lareau
- Suzanne C. Lareau is a senior instructor, College of Nursing, University of Colorado, Denver
| | - Adelaide Caroci Durkin
- Adelaide Caroci Durkin is an assistant professor at Kettering College of Medical Arts, Dayton, Ohio
| | - Shiow-Li Hwang
- Shiow-Li Hwang is a professor at and the president of Chang Gung Institute of Technology, Taoyuan, Taiwan
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Seo Y, Roberts BL, Piña I, Dolansky M. Predictors of Motor Tasks Essential for Daily Activities Among Persons With Heart Failure. J Card Fail 2008; 14:296-302. [DOI: 10.1016/j.cardfail.2008.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 01/07/2008] [Accepted: 01/11/2008] [Indexed: 11/16/2022]
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Abstract
Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.
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Spruit MA, Pennings HJ, Janssen PP, Does JD, Scroyen S, Akkermans MA, Mostert R, Wouters EFM. Extra-pulmonary features in COPD patients entering rehabilitation after stratification for MRC dyspnea grade. Respir Med 2007; 101:2454-63. [PMID: 17765532 DOI: 10.1016/j.rmed.2007.07.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 06/25/2007] [Accepted: 07/05/2007] [Indexed: 11/18/2022]
Abstract
Experts have stated that referral for rehabilitation of patients with chronic obstructive pulmonary disease (COPD) becomes appropriate when these patients become aware of their disability (e.g. usually grade 3 to 5 on the Medical Research Council (MRC) dyspnea scale). However, patients with MRC dyspnea grade 1/2 may also suffer from extra-pulmonary features, such as abnormal body composition, exercise intolerance and reduced disease-specific health status. In the present study, we have studied whether and to what extent chronic obstructive pulmonary disease (COPD) patients with MRC dyspnea grade 1/2 have extra-pulmonary features compared to patients with grade 3, 4 or 5? Pulmonary function, body composition, 6-min walking distance, peak exercise capacity, anxiety, depression and disease-specific health status have been assessed in 333 outpatients who had been referred for pulmonary rehabilitation. On average, patients with MRC dyspnea grade 1/2 had a better exercise tolerance and disease-specific health status compared to patients with grade 4 or 5. Nevertheless, grade 1/2 patients had a higher prevalence of muscle mass depletion. In addition, these patients did still have aberrant values in one or more of the aforementioned outcomes. On average, patients with MRC dyspnea grade 1/2 may clearly suffer from extra-pulmonary features, indicating the necessity to refer these patients for rehabilitation. Therefore, MRC dyspnea scale alone does not appear to be a suitable measure to identify most patients with COPD who have to be referred for rehabilitation.
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Affiliation(s)
- Martijn A Spruit
- Department of Research, Development & Education, Centre for Integrated Rehabilitation of Organ Failure (CIRO), Horn, The Netherlands.
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