The mutual association between depressive symptoms and dyspnea in Chinese patients with chronic heart failure

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18).

CONCLUSIONS

This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Physical Symptoms, Depressive Symptoms, and Quality of Life in Patients With Heart Failure: Cluster Analysis

BACKGROUND

Physical and psychological symptoms are prevalent in patients with heart failure (HF) and are associated with poor quality of life (QOL) and high hospitalization rates. Thus, it is critical to identify symptom clusters to better manage patients with high-risk symptom cluster(s) and to reduce adverse effects.

OBJECTIVE

The aims of this study were to identify clusters of physical HF symptoms (ie, dyspnea during daytime, dyspnea when lying down, fatigue, chest pain, edema, sleeping difficulty, and dizziness) and depressive symptoms and to examine their association with QOL in patients with HF.

METHODS

In this secondary analysis of a cross-sectional study, data on physical HF symptoms (Symptom Status Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and general QOL (European Quality of Scale-Visual Analog Scale) were collected. We identified clusters based on the physical HF symptoms and depressive symptoms using 2-step and k -means cluster analysis methods.

RESULTS

Chest pain was removed from the model because of the low importance value. Two clusters were revealed (cluster 1, severe symptom cluster, vs cluster 2, less severe symptom cluster) based on the 7 symptoms. In cluster 1, all of the 7 symptoms were more severe, and QOL was poorer than those in cluster 2 (all P s < .001). All the mean and median scores of the 7 symptoms in cluster 1 were higher than those in cluster 2.

CONCLUSIONS

Patients with HF were clearly divided into 2 clusters based on physical HF symptoms and depressive symptoms, which were associated with QOL. Clinicians should assess these symptoms to improve patient outcomes.

The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study

BACKGROUND

Patients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients' ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours.

METHODS

This analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours.

RESULTS

A total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097).

CONCLUSIONS

Based on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients' engagement in self-care behaviour in this subpopulation.

Prevalence of depression and its association with health-related quality of life in people with heart failure in low- and middle-income countries: A systematic review and meta-analysis

INTRODUCTION

Heart failure is a growing public health concern around the world. People with heart failure have a high symptom burden, such as depression, which affects health-related quality of life (HRQoL). The objective of this systematic review and meta-analysis was to estimate the pooled prevalence of depression and evaluate its association with HRQoL among people with heart failure in low- and middle-income countries (LMICs).

METHODS

This systematic review was conducted in accordance with the JBI methodology. Electronic databases such as MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus and JBI EBP were searched to identify relevant studies published from January 2012 to August 2022. The methodological quality of each article was assessed using relevant JBI critical appraisal instruments. A random-effects model was employed to estimate the pooled prevalence of depression. Heterogeneity across the studies was investigated using Cochrane's Q test and I2 statistic. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines 2020 were followed for reporting the results. All statistical analyses were performed using STATA version 17 software.

RESULTS

After screening, a total of 21 eligible articles with 5074 participants with heart failure were included in this review. The pooled prevalence of depression among people with heart failure in LMICs was 51.5% (95% CI = 39.7, 63.3%, I2 = 99.00%). Subgroup analysis revealed, the highest prevalence in studies whose participants were in-patients, and from the Middle East and North Africa, and studies utilizing Becks Depression Inventory (BDI). Depression was positively associated with HRQoL.

CONCLUSION

This review revealed that almost half of all people with heart failure in low- and middle-income countries have comorbid depression. People with heart failure and depressive symptoms had poor HRQoL. Therefore, early screening of depression is critical for improving HRQoL in this population. Systematic review registration: PROSPERO CRD42022361759.

Clinical evidence of Xinbao Pills efficacy on chronic heart failure patients: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic heart failure (CHF) is a common cardiovascular disease and results in high rate of morbidity, mortality, hospitalizations, and disability, causing medical concern around the world. Xinbao Pill (XBP) has been widely applied to clinical practice for patients with CHF but lacks studies to verify its efficacy. This study provides a protocol of systematic review, with which we will verify the adjunctive efficacy and safety of XBP on CHF with evidence-based studies.

METHODS

Included studies will be retrieved according to inclusion and exclusion criteria from five English databases (the MEDLINE via PubMed, the Cochrane Library, EMBASE, the Web of Science and Ovid database), and four Chinese databases (China Science and Technology Journal Database [VIP], Chinese Biomedical Literature Database [CBM], Wan-fang Database, China National Knowledge Infrastructure [CNKI]) from October 1990 to October 2018. The New York Heart Association (NYHA), heart rate and mortality will be marked as major outcomes. We will use RevMan V.5.3 software to calculate the data synthesis and will conduct meta-analysis based on the collected data.

RESULTS

Mortality, NYHA function classification, heart rate, the left ventricular ejection fractions (LVEF), 6-minute walk test (6MWT), hospitalization or rehospitalization, NT-proBNP, and adverse effects will be measured and comprehensively assessed to evaluate the adjunctive effect of XBP on CHF from this systematic review and meta-analysis with current clinical evidence.

CONCLUSION

The systematic review and meta-analysis will assess the adjunctive effect of XBP in the treatment of CHF with up-to-date clinical evidence.

Testing of a health-related quality of life model in patients with heart failure: A cross-sectional, correlational study

Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.

Depressive symptoms and their associated factors in heart failure patients

Objectives

Depressive symptoms are common in heart failure (HF) patients and they may exacerbate the progression of HF. Thus, identifying associations with depressive symptoms is essential to develop effective interventions to alleviate patients’ depressive symptoms. Therefore, this study aimed to explore the factors related to HF patients’ depressive symptoms.

Methods

Potential hospitalized patients were recruited from a university-affiliated hospital by convenience sampling. This study included 321 HF patients who had completed information about depressive symptoms, functional capacity, social support, dispositional optimism, self-care confidence, and health literacy. Descriptive statistics were used to characterize the sample. Independent group t-tests and one-way analysis of variance were used to assess the difference in depressive symptoms score in demographic and clinical characteristics, while Pearson's correlation was used to assess the associations among continuous variables.

Results

The scores for functional capacity, social support, dispositional optimism, self-care confidence, and health literacy were negatively associated with the score for depressive symptoms. The interaction effect between the functional capacity and the dispositional optimism on depressive symptoms was significant.

Conclusions

Interventions targeted improving the above-mentioned factors may be beneficial to reduce depressive symptoms in HF patients.

Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure

BACKGROUND

In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined.

OBJECTIVE

The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL.

METHODS

We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose.

RESULTS

Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL.

CONCLUSION

Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.

The Associations of Diagnoses of Fatigue and Depression With Use of Medical Services in Patients With Heart Failure

BACKGROUND

Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ.

PURPOSE

We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates.

METHODS

Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data.

RESULTS

A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R = 54%) and patients with reduced LVEF (β = .13, P = .008, R = 54%) and also preserved LVEF (β = .21, P < .001, R = 54%), controlling for all covariates, but a diagnosis of depression was not.

CONCLUSIONS

This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.

Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys

BACKGROUND

Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China.

METHODS

The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender.

RESULTS

Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%).

CONCLUSIONS

This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.

Significance of Dyspnoea as a symptom in the Emergency Department of the Primary Healthcare Centre

Background/Aim: Dyspnoea represents a subjective feeling of laboured breathing of different intensity. The aim of this study was to determine how often patients come with dyspnoea to a local Emergency Department of the Primary Healthcare Centre (EDPHC) and to analyse the assumed aetiology, diagnostics and therapy of the dyspnoeic patients. Methods: The records of the EDPHC of the City of Banja Luka for the period between 1 October 2019 to 31 December 2019 of all patients older than 15 years of age that have reported laboured breathing were identified and analysed. Following parameters were recorded: age, gender, diagnostics performed, administered therapy, whether the patient was examined in the field or in the ambulance, as well as whether the patient was referred to a hospital (Cardiology, Pulmonology or another department) or not. Results: Laboured breathing was reported by 665 patients. Out of this number, 108 patients were examined by their family doctor, 407 patients in EDPHC ambulance and 150 patients in the field. The average age of the patient was 61.03 ± 19.17, with an equal distribution in males and females. The aetiology of dyspnoea was cardiac and pulmonary in one-third of patients each, whereas the diagnosis in the other patients was versatile, from anxiety disorders, musculoskeletal diseases and active malignancy to unspecified chest pain that could not receive a definitive diagnosis. One half of the patients (N = 261 or 46.86 %) was completely taken care of in the ambulance or in the field, 199 (35.73 %) patients were sent to a cardiologist, 87 (15.62 %) to a pulmonologist and 10 (1.80 %) of patients to another specialist. Referral to hospital was registered more often in men (ch2 = 9.195, p = 0.027), elderly (ch2 = 53.29, p < 0.001), people with lower peripheral oxygen saturation (SpO2 ) (ch2 = 120.61, p < 0.001) and people with significant deviation of normal blood pressure values (ch2 = 120.61, p < 0.001). Conclusion: Dyspnoea can be caused by an array of different diseases and more than one diagnostic method is necessary to confirm/exclude any of the most common causes of dyspnoea. A broader diagnostical palette in ED would be preferred for purposes of ascertaining a timely diagnosis.

Patients’ Beliefs About Causes and Consequences of Heart Failure Symptoms

Patients’ perceptions of the causes and consequences of heart failure (HF) symptoms may impact effective self-management. The purpose of this study was to describe and explore patients’ perceptions of HF symptom status and the causes and consequences on their daily lives in patients with HF. Descriptive and qualitative data were obtained from 20 patients using a semistructured interview guide. Data were analyzed using content analysis and descriptive statistics. Participants reported 15 symptoms (median = 4). Five themes were (a) multiple causes and multiple symptoms; (b) knowing some causes, but still unclear; (c) not being able to live life as previously did; (d) facing emotional distress due to HF symptoms; and (e) development of new priorities and lifestyles. The findings demonstrate that all participants perceived considerable difficulties living with HF symptoms. More comprehensive interventions need to be delivered to patients to manage multiple causes and symptoms effectively.

Heart Failure Symptoms Profile Associated With Depressive Symptoms

Heart failure (HF) symptoms are known to influence depressive symptoms, yet a symptom profile has not been identified. HF symptoms relative to symptom experience (frequency, severity, interference with physical activity and enjoyment of life) associated with depressive symptoms were examined. Data from three HF studies (N = 308) which used the Heart Failure Symptom Survey were included in this cross-sectional secondary analysis. Supervised classification for and identification of symptoms most associated with depressive symptoms were accomplished using random forest algorithms via conditional inference trees. The HF symptom profile associated with depressive symptoms across all four symptom experience domains included fatigue, dizziness, and forgetfulness/difficulty concentrating. Abdominal bloating, worsening cough, and difficulty sleeping were also important, but did not consistently rank in the top 5 for symptom importance relative to all symptom experience domains. Symptom profiling may enhance early identification of patients at risk for depressive symptoms and inform symptom management interventions.

Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study

BACKGROUND

Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.

OBJECTIVE

To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.

METHODS

This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).

RESULTS

Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.

CONCLUSIONS

A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China.

Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care

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.

Predictors of depression in outpatients with heart failure: An observational study

BACKGROUND

Depression is a common comorbidity of heart failure. Little is known about the influence of heart failure symptomatology and coping resources, such as social support and social problem-solving, on depression.

OBJECTIVE

To examine whether individual and clinical characteristics, heart failure symptomatology, and the subcomponents of social support and social problem-solving increase the likelihood of depression in outpatients with heart failure.

METHODS

A secondary data analysis of a cross sectional study with 201 outpatients with heart failure was conducted. The following self-report questionnaires were used to collect data: the Heart Failure Symptom Survey, the Interpersonal Support Evaluation List-12, the Graven and Grant Social Network Survey, the Social Problem-Solving Inventory Revised-Short, and the Center for Epidemiological Studies - Depression scale. Descriptive statistics examined patient characteristics. Logistic regression explored predictors of depression from among individual and clinical characteristics, heart failure symptomatology, and subcomponents of social support (i.e., belonging, tangible, and appraisal support) and social problem-solving (i.e., positive and negative problem orientation; rational, impulsiveness/carelessness, and avoidance problem-solving styles).

RESULTS

The sample was primarily Caucasian (86.1%) male (62.6%) with an average age of 72.57 years. Individuals who were unmarried, experienced a higher symptom burden, and those who perceived less belonging support were more likely to be depressed. The subcomponents of social problem-solving did not influence depression.

CONCLUSIONS

Belonging support was the most beneficial type of social support related to depression. Components of social problem-solving were not related to depression. Assessment of marital status, heart failure symptomatology, and perceived belonging support is needed to identify potential stressors and available social support in order to promote psychological adaptation.