Cardiac Depression Scale: Mokken scaling in heart failure patients

[Self-care education during Cardiac Rehabilitation programs for patients with Heart Failure with preserved Ejection Fraction: a Delphi Study]

OBJECTIVES

To develop a decalogue of self-care competencies to manage educational intervention during Cardiac Rehabilitation (CR) programs in Heart Failure with preserved Ejection Fraction (HFpEF) patients through multidisciplinary consensus.

DESIGN

3-round e-Delphi study using an initial questionnaire of 23 competencies based on the main recommendations of the CR and self-care guidelines. SITE: It was framed under the ethics of a randomised clinical trial developed at the Regional Hospital of Malaga. The survey was designed and disseminated as an online questionnaire.

PARTICIPANTS

The expert panel comprised two patients with HFpEF and 13 healthcare professionals from Internal Medicine (n=3), Cardiology (n=2), Physiotherapy (n=3), Nursing (n=3) and Occupational Therapy (n=2).

METHOD

The analysis of results included the content validity index, the percentage of agreement, and the concordance using Fleiss Kappa and Krippendorff's alpha.

RESULTS

After the third round, 20 self-care competencies were identified, grouped into 12 domains, with sufficient consensus for their inclusion in the decalogue.

CONCLUSIONS

The decalogue of self-care competencies generated from the multidisciplinary consensus guides education in patients with HFpEF, systematically addressing educational content tailored to patients for clinical practice in CR programs.

A bibliometric analysis of research on heart failure comorbid with depression from 2002 to 2021

Heart failure (HF) with depression is a common comorbidity associated with worse clinical status and quality of life. Although there have been numerous high-quality studies and relevant reviews on HF comorbid with depression, few bibliometric analyses of this field have been reported. In order to understand the development process, research hotspots and future directions, this review analyzes the papers on HF comorbid with depression from January 2002 to December 2021 through CiteSpace and VOSviewer. Visual cooperative networks between countries, authors and institutions were conducted to understand the basic development status of HF comorbid with depression. Furthermore, we performed co-occurrence analysis, burst detection, and timeline analysis for keywords to understand this field's research directions and hotspots. Finally, a detailed review and analysis of the classical literature in this field were conducted based on co-citation analysis. This bibliometric analysis provides an overview of studies on HF comorbid with depression and emphasizes the research on comorbidity mechanisms and more effective interventions as a priority for future research.

Subjective and objective cognition 6-week post-coronary artery bypass graft surgery: A descriptive pilot study

Background

Coronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention.

Aim

The aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa.

Setting

A cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital.

Method

Socio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA).

Results

The mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive (< 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81).

Conclusions

Subjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery.

Psychometric properties of the Arabic version of the cardiac depression scale tested on Jordanian patients with cardiovascular diseases

BACKGROUND

The Cardiac Depression Scale (CDS) is an instrument to screen for depression, specifically in patients with cardiovascular diseases (CVD). The purpose of this study was to evaluate the psychometric properties of the Arabic version of the CDS in the Jordanian population.

METHOD

A cross-sectional design was used for 304 participants diagnosed with CVD. An exploratory factor analysis (EFA) was performed to explore the underlying structure of the new Arabic version of the CDS tool.

RESULTS

Cronbach's alpha for the total scale was 0.87. An EFA suggested a two-factor solution. The first factor has 18 items, measuring "My tolerance" of CVD, and the second factor has seven items, measuring "My activities" in the context of CVD. Based on the EFA simple structure, one item was removed due to its low factor loading (< 0.3). A confirmatory factor analysis (CFA) supported a two-factor model with the root mean square error of approximation (RMSEA = 0.06), comparative fit index (CFI = 0.856), and Tucker-Lewis index (TLI = 0.83) indicating acceptable fit. The Cronbach's alpha values for the first and second factors were 0.86 and 0.84, respectively.

CONCLUSION

The Arabic version of the CDS is a reliable and valid instrument to screen for depression among Jordanian patients with CVD.

Depression and chronic heart failure in the elderly: an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including: psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Diagnosis of Dilated Cardiomyopathy: Patient Reaction and Adaptation-Case Study and Review of the Literature

Objective. Heart failure remains a major cause of morbidity and mortality. Given that heart failure generally has a chronic course, it is important to appreciate the impact it can have on the quality of life of patients and also their partners or family carers. Method. Questionnaires were given to a patient newly diagnosed with dilated cardiomyopathy, during his hospital admission, as well as after discharge. The responses are summarised and explored in the discussion section, where we used review of the literature to discuss the implications of a new diagnosis of heart failure. Results. The patient's responses to the questionnaires suggest certain anxieties that are part of his adaptation to the diagnosis of heart failure. Conclusion. Depression is a common comorbid condition in patients with heart failure. Various tools can be used to screen for depression in patients with heart failure. Both pharmacological and nonpharmacological options are available. Rapid evaluation of ongoing problems and active participation by a psychiatrist can ensure that the patient receives the best possible clinical care.

Translation and validation of the Cardiac Depression Scale to Arabic

BACKGROUND

The Cardiac Depression Scale (CDS) has been designed to measure depressive symptoms in patients with heart disease. There is no Arabic version of the CDS. We translated and validated the CDS in an Arabic sample of patients with heart disease.

METHODS

Forward and back translation of the CDS was followed by assessment of cultural relevance and content validity. The Arabic version of the CDS (A-CDS) and the Arabic version of the Hospital Anxiety and Depression Scale (A-HADS) were then administered to 260 Arab in-patients with heart disease from 18 Arabic countries. Construct validity was assessed using exploratory factor analysis with polychoric correlations. Internal consistency was assessed using ordinal reliability alpha and item-to-factor polychoric correlations. Concurrent validity was assessed using Pearson's correlation coefficient between the A-CDS and the depression subscale of the A-HADS (A-HADS-D).

RESULTS

Cultural relevance and content validity of the A-CDS were satisfactory. Exploratory factor analysis revealed three robust factors, without cross-loadings, that formed a single dimension. Internal consistency was high (ordinal reliability alpha for the total scale and the three factors were .94, .91, .86, and .87, respectively; item-to-factor correlations ranged from .77 to .91). Concurrent validity was high (r=.72). The A-CDS demonstrated a closer to normal distribution of scores than the A-HADS-D.

LIMITATIONS

Sensitivity and specificity of the A-CDS were not objectively assessed.

CONCLUSIONS

The A-CDS appears to be a valid and reliable instrument to measure depressive symptoms in a representative sample of Arab in-patients with heart disease.

The Effectiveness of a Nurse-Led Cognitive-Behavioral Therapy on the Quality of Life, Self-Esteem and Mood Among Filipino Patients Living With Heart Failure: a Randomized Controlled Trial

AIMS/OBJECTIVES

The diagnosis and complications associated with heart failure (HF) have been very well established to adversely impact an individual's physical and psychosocial well-being, and interventions such as cognitive-behavioral techniques have demonstrated potential positive benefits among patients with HF. However, the effects of such interventions among Filipino HF patients have not been studied. This study aimed to determine the effectiveness of a nurse-led cognitive-behavioral intervention program on the quality of life, self-esteem and mood among Filipino patients with HF.

METHODS

A randomized control two-group design with repeated measures and collected data before and after the intervention was used in this study. Participants were assigned to either the control (n=48) or the intervention group (n=52). Control group participants received traditional care. Intervention participants underwent a 12-week nurse-led cognitive-behavioral intervention program focusing on patient education, self-monitoring, skills training, cognitive restructuring and spiritual development. Measures of quality of life, self-esteem and mood were obtained at baseline and after the intervention.

RESULTS

At baseline, participants in both groups have poor quality of life, low self-esteem, and moderate depressive symptom scores. After the 12-week intervention period, participants in the intervention group had significant improvement in their quality of life, self-esteem and mood scores compared with those who received only standard care.

CONCLUSION

Nurse-led cognitive-behavioral intervention is an effective strategy in improving the quality of life, self-esteem and mood among Filipino patients living with HF. It is recommended that this intervention be incorporated in the optimal care of patients with this cardiac condition.