Supportive Care Interventions to Promote Health-Related Quality of Life in Patients Living With Heart Failure: A Systematic Review and Meta-Analysis

Coping Strategies and Health-Related Quality of Life in Individuals with Heart Failure

Background: Heart failure (HF) contributes to a poor physical and emotional health-related Quality of Life (HRQoL) and poor health outcomes. Coping strategies have been identified as essential in enhancing HRQoL. The study's purpose was to examine the relationships between the factors that influence coping (i.e., age, sex, education, income, HF duration), HF severity, coping strategies (i.e., problem-focused, active emotion-focused, avoidant emotion-focused), and physical and emotional HRQoL. Methods: A cross-sectional study was conducted using online surveys. Descriptives, Pearson's correlation, and one-way ANOVA analyses were used to analyze the data. Results: A total of 108 participants completed the study, with the majority being Black men. The result showed significant negative relationships (p < 0.05) between problem-focused and active emotion-focused coping and HF severity. Lower age was significantly related to the use of problem-focused and active emotion-focused coping (p < 0.05); females showed higher use of all coping strategies as compared with males (p < 0.05). A better physical HRQoL was significantly associated with active emotion-focused coping (r = -0.283, p = 0.005), whereas a better emotional HRQoL was significantly associated with problem-focused coping (r = -0.265, p = 0.005) and active emotion-focused coping (r = -0.373, p < 0.001). Conclusions: Findings showed that individuals with a lower HF severity, a younger age, and a higher income and education tended to predominantly utilize adaptive coping strategies. Individuals with HF who use problem-focused and active emotion-focused coping may experience better physical and emotional HRQoL, whereas those using primarily avoidant emotional-focused coping may need guidance in their coping strategies. Healthcare professionals may take factors such as HF severity into account to tailor interventions that promote adaptive coping and enhance HRQoL outcomes.

Chinese Translation and Measurement of the Heart Failure Needs Assessment Questionnaire in Mainland China

The management of heart failure in patients presents a significant challenge to global public health, marked by an increase in unaddressed needs due to the extended deterioration of health. It is crucial to conduct comprehensive assessments of patients with heart failure, thereby providing personalized care. The purpose of this study was to translate, adapt, and validate the Needs Assessment Questionnaire for people with heart failure in Mainland China and to evaluate its reliability and validity within a population of people with heart failure. A cohort of 246 individuals diagnosed with heart failure was recruited from two medical facilities in China during the period from January 2023 to June 2023. The scale was translated into Chinese using the forward post-translation technique, followed by an evaluation of its reliability and validity. Descriptive statistics, content validity assessment, and Confirmatory Factor Analysis were utilized for validation. Internal consistency, split-half reliability, and test-retest reliability assessments were conducted to assess overall reliability. The Chinese version of the Heart Failure Needs Assessment Questionnaire consists of 4 dimensions and 30 items. The Cronbach α coefficient of the overall scale was 0.90. In the validation factor analysis, the model fit results were χ2/df = 2.259, CFI = 0.933, IFI = 0.933, TLI = 0.927, RMSEA = 0.072, all of which fell within acceptable ranges. The HFNAQ demonstrates strong reliability and validity in assessing the unmet needs of patients with heart failure.

Comfort and patient activation in patients with myocardial infarction: A cross-sectional study

AIMS

To examine comfort and patient activation, affecting factors, and the relationship between comfort and patient activation in patients with myocardial infarction.

BACKGROUND

Comfort is an important requirement for managing the treatment and patients' well-being and patient activation improves patient engagement. Assessment of comfort, patient activation and associated factors are important to reduce complications and ensure adherence.

METHOD

This cross-sectional study was conducted between May and August 2023 on 138 patients in the cardiology clinic who met the inclusion criteria. The research data were collected using a Personal Information Form, a General Comfort Scale, and the Patient Activation Measure.

RESULTS

It was determined that 67.4 % of the patients were male, and the mean age of patients was 55.47 ± 13.59 years. Comfort was found to be moderate and patient activation level was in the first stage in 50.7 % of the patients. A relationship was found between comfort and gender, education status, health perception, hospitalization experience and number, complications, having chronic disease and medication use, source of information and symptoms, while education and employment status, regular exercise, having chronic disease and symptoms affected patient activation. There was a significant, positive correlation between comfort and the patient activation.

CONCLUSIONS

Comfort and patient activation levels of patients with myocardial infarction are related to sociocultural and disease-related factors. Individualized nursing interventions should be planned in line with the affecting factors to increase comfort and patient activation. Also, controlled studies should be conducted in individuals identified as risk groups are important for clinical applications.

Chronic Heart Failure and Coronary Artery Disease: Pharmacological Treatment and Cardiac Rehabilitation

Coronary artery disease is the leading cause of acute and chronic heart failure. Patients with heart failure and ischemic heart disease need a tailored assessment to define the appropriate treatment, while a specific multidisciplinary management plan should be followed. Indeed, several factors should be assessed before starting treatment, such as heart failure symptoms and/or signs, angina, electrocardiographic features, right and left ventricular systolic and diastolic function, serological abnormalities, cardiac structural and functional integrity, and pulmonary function. New scenarios and developments have emerged recently in this field, increasing our knowledge regarding pathophysiology, exercise, and pharmacology. Effective and appropriate management and treatment reduce the risk of death and hospitalization for heart failure. Herein, we provide an updated, state-of-the-art overview of pharmacological treatment and cardiac rehabilitation in patients with chronic heart failure and coronary artery disease. Furthermore, tailored and contemporary management in clinical practice will be proposed for this specific and fragile patient population.

Components of home-based palliative and supportive care for adults with heart failure: A scoping review

BACKGROUND

Palliative care and supportive care provided in the home for people with heart failure can improve quality of life, caregiver wellbeing and reduce healthcare costs. Identifying components of home-based palliative and supportive care in heart failure is useful to inform tailored care to people with heart failure.

AIM

To identify and describe components of home-based palliative and supportive care in adults with heart failure.

DESIGN

A scoping review was undertaken in accordance with Joanna Briggs Institute guidelines. The protocol was registered prospectively with the Open Science Framework (https://doi.org/10.17605/OSF.IO/GHCME).

DATA SOURCES

Embase, PubMed, CINAHL and Cochrane databases were searched from inception in May 2023 and re-run in January 2024. Original research focussed on palliative and supportive care in the home setting that included adults diagnosed with heart failure who have not undergone nor awaiting a heart transplant was included.

RESULTS

Results were extracted from 13 papers based on eight studies. The findings highlight that nurses supported by a multidisciplinary team, providing symptom management, patient and carer education and discussion of goals of care and advance care planning, facilitates home-based palliative and supportive care for people with heart failure.

CONCLUSION

Ensuring patient and caregiver-centred care supported by a multidisciplinary team is essential to delivering home-based palliative and supportive care for people with heart failure. Further research focussed on the role of digital interventions in home-based palliative and supportive care, the composition of the multidisciplinary team and research which includes individuals across all stages of heart failure is needed.

The experience of people living with heart failure in Ethiopia: A qualitative descriptive study

BACKGROUND

Heart failure is a serious chronic medical condition that negatively impacts daily living. Living with heart failure can be challenging due to the physical symptoms, unpredictable nature of the disease, and lifestyle changes required. The objective of this study was to explore and describe the experiences of people living with heart failure and how it affects their health-related quality of life in Ethiopia.

METHODS

A qualitative descriptive design was employed to explore the experience of people living with heart failure, guided by the Theory of Symptom Management. A purposive sample of 14 participants was recruited from the cardiac outpatient clinics at two tertiary-level public hospitals in Ethiopia. Data were collected using a semi-structured interview. The recorded interviews were transcribed verbatim in Amharic, translated into English, and entered NVivo statistical software for analysis. An inductive-deductive hybrid thematic analysis method was used to analyse the data.

RESULTS

Three themes were identified deductively, while an additional three themes emerged inductively:-"Journey from diagnosis to daily life with heart failure"; "Symptom experience"; "Impact of heart failure on health-related quality of life"; "Perception of health-related quality of life and influencing factors"; "Symptom management and coping strategies"; and "Challenges faced in the journey of living with heart failure". Fatigue, and depression were the most frequently reported symptoms. Participants described how their condition affected their overall physical functioning. Participants utilized consistent follow up-care, adhered to their medications, ensured adequate rest, made dietary modifications, sought social support and engaged in spiritual activities to manage their symptoms and cope with their condition. Challenges they faced included financial difficulties, unavailability of medications, and a lack of continuity of care.

CONCLUSION

People living with heart failure in Ethiopia experience various symptoms. The impact of heart failure on various aspects of their lives, combined with the challenges they face while living with heart failure, significantly affect their health-related quality of life. Health care providers caring for these people need to understand their experiences and the impact on their daily life. Effective multimodal interventions are needed to reduce the impact of heart failure and improve health-related quality of life in this population.

Dynamic analysis of the relationship between systemic lupus erythematosus disease activity and psychosocial support

Background

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that significantly affects both the physical and mental health of patients. Psychosocial support systems play a crucial role in managing chronic diseases, yet their specific impact on the disease activity of SLE patients remains unclear. This study aims to explore the dynamic relationship between disease activity in SLE patients and various types of psychosocial support systems.

Methods

We conducted a retrospective longitudinal observational study, including 150 SLE patients who received treatment at our hospital from January 2022 to January 2023. Emotional support, tangible support, social interaction support, and informational support were assessed using the revised Social Support Rating Scale. Disease activity was quantified using the European Consensus Lupus Activity Measurement. The relationship between psychosocial support and disease activity was analyzed using Spearman's rank correlation coefficient and multiple linear regression models, with Bootstrap resampling employed to test the robustness of the results.

Results

We found a significant negative correlation between psychosocial support and SLE disease activity, with emotional support, social interaction support, and informational support showing stronger negative correlations. Multiple regression analysis revealed that the inhibitory effects of emotional support, social interaction support, and informational support on disease activity increased over time. Although the impact of tangible support was not statistically significant, it gradually became more apparent over time.

Conclusion

Our findings indicate a significant negative correlation between psychosocial support and SLE disease activity, particularly with emotional support, social interaction support, and informational support. Over time, the impact of tangible support also becomes evident. These findings provide important references for the comprehensive treatment and management of SLE patients. However, due to the observational nature of the study, the causality of this relationship requires further exploration.

Heart Failure Nurses within the Primary Care Setting

Cardiology services within primary care often focus on disease prevention, early identification of illness and prompt referral for diagnosis and specialist treatment. Due to advances in pharmaceuticals, implantable cardiac devices and surgical interventions, individuals with heart failure are living longer, which can place a significant strain on global healthcare resources. Heart failure nurses in a primary care setting offer a wealth of clinical knowledge and expertise across all phases of the heart failure trajectory and are able to support patients, family members and other community services, including general practitioners. This review examines the recently published evidence on the current and potential future practice of heart failure nurses within primary care.

A mixed-methods landscape assessment of supportive care for heart failure

Aim: Understanding factors that shape leading health systems' (LHS) perspectives around heart failure (HF) treatment. Patients & methods: First of its kind study using a cross-sectional, descriptive, mixed-method design (from executives and frontline healthcare providers) with quantitative survey (n = 35) and qualitative interview (n = 12) data from 47 participants (41 different LHS). Results: 97% of LHS had dedicated HF programs, but variations in maturity highlights opportunities for care standardization. Treatment innovations continue, though practitioners may struggle to keep pace amid provider/patient barriers. HF programs strive to co-locate supportive care services to optimize treatment, but access can prove challenging. Conclusion: Opportunities exist, with external partner support, for LHS to become more comprehensive HF care providers, increasing standardization of care across LHS and improved HF treatment.

End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.

Home-based versus centre-based cardiac rehabilitation

BACKGROUND

Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017.

OBJECTIVES

To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied.

SELECTION CRITERIA

We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE.

MAIN RESULTS

We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar.

AUTHORS' CONCLUSIONS

This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.

Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease

BACKGROUND

Globally, cardiovascular diseases (CVD, that is, coronary heart (CHD) and circulatory diseases combined) contribute to 31% of all deaths, more than any other cause. In line with guidance in the UK and globally, cardiac rehabilitation programmes are widely offered to people with heart disease, and include psychosocial, educational, health behaviour change, and risk management components. Social support and social network interventions have potential to improve outcomes of these programmes, but whether and how these interventions work is poorly understood.  OBJECTIVES: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. The comparator was usual care with no element of social support (i.e. secondary prevention alone or with cardiac rehabilitation).  SEARCH METHODS: We undertook a systematic search of the following databases on 9 August 2022: CENTRAL, MEDLINE, Embase, and the Web of Science. We also searched ClinicalTrials.gov and the WHO ICTRP. We reviewed the reference lists of relevant systematic reviews and included primary studies, and we contacted experts to identify additional studies.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) of social network or social support interventions for people with heart disease. We included studies regardless of their duration of follow-up, and included those reported as full text, published as abstract only, and unpublished data.

DATA COLLECTION AND ANALYSIS

Using Covidence, two review authors independently screened all identified titles. We retrieved full-text study reports and publications marked 'included', and two review authors independently screened these, and conducted data extraction. Two authors independently assessed risk of bias, and assessed the certainty of the evidence using GRADE. Primary outcomes were all-cause mortality, cardiovascular-related mortality, all-cause hospital admission, cardiovascular-related hospital admission, and health-related quality of life (HRQoL) measured at > 12 months follow-up.  MAIN RESULTS: We included 54 RCTs (126 publications) reporting data for a total of 11,445 people with heart disease. The median follow-up was seven months and median sample size was 96 participants. Of included study participants, 6414 (56%) were male, and the mean age ranged from 48.6 to 76.3 years. Studies included heart failure (41%), mixed cardiac disease (31%), post-myocardial infarction (13%), post-revascularisation (7%), CHD (7%), and cardiac X syndrome (1%) patients. The median intervention duration was 12 weeks. We identified notable diversity in social network and social support interventions, across what was delivered, how, and by whom.  We assessed risk of bias (RoB) in primary outcomes at > 12 months follow-up as either 'low' (2/15 studies), 'some concerns' (11/15), or 'high' (2/15). 'Some concerns' or 'high' RoB resulted from insufficient detail on blinding of outcome assessors, data missingness, and absence of pre-agreed statistical analysis plans. In particular, HRQoL outcomes were at high RoB. Using the GRADE method, we assessed the certainty of evidence as low or very low across outcomes. Social network or social support interventions had no clear effect on all-cause mortality (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.49 to 1.13, I2 = 40%) or cardiovascular-related mortality (RR 0.85, 95% CI 0.66 to 1.10, I2 = 0%) at > 12 months follow-up. The evidence suggests that social network or social support interventions for heart disease may result in little to no difference in all-cause hospital admission (RR 1.03, 95% CI 0.86 to 1.22, I2 = 0%), or cardiovascular-related hospital admission (RR 0.92, 95% CI 0.77 to 1.10, I2 = 16%), with a low level of certainty. The evidence was very uncertain regarding the impact of social network interventions on HRQoL at > 12 months follow-up (SF-36 physical component score: mean difference (MD) 31.53, 95% CI -28.65 to 91.71, I2 = 100%, 2 trials/comparisons, 166 participants; mental component score MD 30.62, 95% CI -33.88 to 95.13, I2 = 100%, 2 trials/comparisons, 166 participants).  Regarding secondary outcomes, there may be a decrease in both systolic and diastolic blood pressure with social network or social support interventions. There was no evidence of impact found on psychological well-being, smoking, cholesterol, myocardial infarction, revascularisation, return to work/education, social isolation or connectedness, patient satisfaction, or adverse events.  Results of meta-regression did not suggest that the intervention effect was related to risk of bias, intervention type, duration, setting, and delivery mode, population type, study location, participant age, or percentage of male participants.  AUTHORS' CONCLUSIONS: We found no strong evidence for the effectiveness of such interventions, although modest effects were identified in relation to blood pressure. While the data presented in this review are indicative of potential for positive effects, the review also highlights the lack of sufficient evidence to conclusively support such interventions for people with heart disease. Further high-quality, well-reported RCTs are required to fully explore the potential of social support interventions in this context. Future reporting of social network and social support interventions for people with heart disease needs to be significantly clearer, and more effectively theorised, in order to ascertain causal pathways and effect on outcomes.

An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases

BACKGROUND

Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research.

METHODS

We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative.

RESULTS

The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact.

CONCLUSION

Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42020166330).

The Effectiveness of Personalized Nursing on Quality of Life in Cardiovascular Disease Patients: A Systematic Review and Meta-analysis

Aims

This study aimed to examine the potential effectiveness of personalized nursing interventions on improving the heart-related quality of life of patients with CVDs versus an usual care.

Design

A systematic review and meta-analysis. Data Sources. The study researched the article between January 2011 and December 2021 from four electronic databases: PubMed, Embase, Cochrane library, and Web of Science. Review Methods. Randomized controlled trials (RCTs) related to personalized nursing in CVDs population were included. The main variables were analyzed by standardized mean differences with 95% confidence intervals and heterogeneity was used by the I ² test and P value.

Results

Of 734 studies, fourteen articles were eligible for this study. Personalized nursing significantly improved the quality of life [SMD = 0.39, 95% CI (0.29, 0.49)] with obvious heterogeneity (P = 0.000, I ² = 66.1%) which needs to be further subgroup analyzed. The nurse-led intervention was considered the main-related effect to influence the heterogeneity with value of 0.39 (I2 = 66.1%, P = 0.000; Group 1: I2 = 48.4%, P = 0.071, and Group 2: I2 = 0.0%,. In addition, related results of athletic ability and mental health and follow-up and education in the intervention had higher level of quality of life compared to the control group [SMD = 0.27, 95% CI (0.10, 0.44); SMD = 0.21, 95% CI (0.04, 0.37); SMD = 0.39, 95% CI (0.29, 0.49) and SMD = 0.28, 95% CI (0.11, 0.44)].

Conclusion

Effectiveness studies of personalized care focus on more relevant outcomes have higher health outcomes, whereas evidence of the effectiveness of personalized nursing approach is still limited. Therefore, more and more high-quality RCT are needed.

Predictive Model for Quality of Life in Patients With Heart Failure

BACKGROUND

Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF).

OBJECTIVES

In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF.

METHODS

Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography.

RESULTS

Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (β = 0.186, P = .004, and β = -0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress.

CONCLUSIONS

These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC

Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.

Personalizing Heart Failure Care to the Patient With Cancer

PURPOSE OF REVIEW

The current review describes the role of the cardio-oncology nurse and the need for personalized heart failure care for the patient with cancer.

RECENT FINDINGS

It is a new role whereby cardiology or heart failure nurses care for patients with cancer who develop cardiotoxicity or cardiovascular diseases, either during the cancer therapy or in a later stage. Inter-disciplinary approach is important for individualized early treatment, shortened interruptions to cancer therapy, and irreversible cardiovascular injury prevention. Nurses have a key role in early evaluation and quality control of the care provided. This is a quite new clinical area and not much evidence exists for the development of clinical guidelines and pathways to support clinicians. More trials are needed for the development of clinical recommendations.

Depressive Symptoms and Quality of Life in Patients With Heart Failure and an Implantable Cardioverter-Defibrillator

BACKGROUND

Heart failure (HF) is associated with development of depressive symptoms and reduced quality of life (QoL). Patients with HF and an implantable cardioverter-defibrillator (ICD) were evaluated regarding depressive symptoms and QoL.

METHODS

The present study included 446 patients with HF and an ICD. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9), QoL was evaluated using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional ability and exercise tolerance were assessed at inclusion and after 6 months with help of the 6-min walking test (6MWT).

RESULTS

Patients included in the study had a mean age of 65.8 years and were predominantly male (83.6%), with mostly ischemic (n = 277; 62.1%) or dilated (n = 150; 33.6%) cardiomyopathy. One hundred ninety-three (43.2%) patients had depressive symptoms, of whom 75 patients (16.8%) were classified as moderate to severe depression according to the PHQ-9 at baseline. Depressive symptoms were associated with low QoL independent of NYHA functional class. High NYHA functional class, high PHQ-9 score, age and body mass index (BMI) were associated with a lower 6MWT at enrollment, while depressive symptoms (expressed as higher PHQ-9 score) and age were associated with a lower 6MWT after 6 months. Patients with history of smoking and a higher BMI showed higher PHQ-9 scores after 6 months. Patients under antidepressant medication showed improved PHQ-9 score after 6 months, indicating controlled/treated depression. However, patients with low QoL at inclusion remained with low QoL after 6 months.

CONCLUSION

Depressive symptoms correlate with low QoL and lower long-term functional status in patients with HF and an ICD. Depressive symptoms are associated with smoking and obesity, which themselves are risk factors for a poor prognosis in HF. Only a small fraction of patients with HF and ICD showing depressive symptoms receives appropriate treatment. Assessing depressive symptoms and lifestyle factors should be part of a multimodal treatment plan in patients with HF and an ICD.

Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study

Background

Patients with heart failure (HF) experience continuous changes in symptom distress, care needs, social support, and meaning in life from acute decompensation to chronic phases. The longitudinal relationship between these four factors and quality of life (QOL) was not fully explored.

Aims

To simultaneously investigate the relationship between all factors and QOL from hospitalization to 6 months after discharge, and the impact of the changes in these factors on QOL at different time points.

Methods

A longitudinal design with panel research (4 time points) was used. From January 2017 to December 2019, patients hospitalized due to acute decompensated HF were consecutively enrolled and followed up for 6 months. Patients were interviewed with questionnaires assessing symptom distress, care needs, social support, meaning in life and QOL at hospitalization and 1, 3 and 6 months after discharge.

Results

A total of 184 patients completed 6 months of follow-up. From baseline to 6 months, QOL continuously improved along with decreases in symptoms and care needs, but increases in social support and meaning in life. Better QOL was associated with younger age, higher education level, economic independence, less symptom distress and care needs, and stronger meaning in life (p < 0.05). Compared with hospitalization, decreases in care needs and increases in meaning in life at 1, 3 and 6 months were associated with an increase in physical QOL (p < 0.01). The decrease in care needs and increase in meaning in life at 3 months were associated with an increase in mental QOL (p < 0.05). The increase in social support at 6 months was associated with increases in both physical and mental QOL (p < 0.01). Changes in symptom distress were not correlated with changes in QOL from baseline to all time points. In the multivariable analysis, these findings were independent of age, educational level and economic status.

Conclusions

Although symptom distress is associated with QOL after acute decompensated HF, QOL cannot be improved only by improvement in symptoms. With differential duration of improvement in each factor, the integration of alleviation in care needs and strengthening in social support and meaning in life might provide additional benefits in QOL.

The effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure: an experimental study

BACKGROUND

Heart failure is a common and chronic heart condition with high prevalence and mortality rates. This debilitating disease as an important predictor of health outcomes is directly related to patients' quality of life. Given that one of the main goals of heart failure treatment is to promote patients' quality of life and health status, conducting effective nursing interventions seems to be necessary in this regard. Therefore, the present study aimed to determine the effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure.

METHODS

This is an experimental study in which a total of 80 patients with heart failure were recruited and randomly allocated to two groups of intervention and control (n = 40 in each group). The educational program was designed based on Pender's health promotion model and then provided for the patients in the intervention four subgroups (10 person in each group) during six sessions. Data were collected at three time-points of before, immediately after, and three months after the intervention using a demographic questionnaire, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Health-Promoting Lifestyle Profile II (HPLP-II). Data were then analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA) and p value less than 0.05 was taken as statistically significant.

RESULTS

Based on the results of the present study, no statistically significant difference was shown in terms of demographic characteristics between the two groups. It was also indicated that there was a statistically significant difference in the mean scores of all dimensions of quality of life (except in the physical dimension) between the two groups so that the overall mean score of quality of life increased significantly in the intervention group after the intervention (p < .05). Moreover, there were significant increases in the mean scores of health-promoting behaviors (except in the domain of physical activity) in the intervention group compared to the control group (p < .05) after intervention.

CONCLUSIONS

This study demonstrates a trend that Pender's health promotion model is effective in improving the quality of life of patients with heart failure except of the physical dimension, and strengthening their health-promoting behaviors in all dimensions except of the physical activity dimension.

A qualitative meta-synthesis of patients with heart failure perceived needs

Supportive care may have significant input into the treatment of patients with heart failure (HF). Support, understanding and being treated as a whole and unique person are vital for patients with HF. In order to develop a person-centred program, it is important to know patients' needs from their perspectives. The aim of the current review and meta-synthesis was to explore the needs of patients with HF from their perspective. A qualitative review was conducted using the keywords: ("needs" OR "need") AND ("heart failure") AND ("qualitative") in four databases. Pre-defined inclusion and exclusion criteria were set. The 'Consolidated criteria for reporting qualitative studies' item checklist was used to assess the research methodologies of the included studies. A "thematic synthesis" methodological approach was used: (1) Line by line coding of the findings from primary studies. (2) The resulting codes were organized into related areas thus building descriptive themes. (3) Analytical themes were developed. Eleven articles were included in the present review. The results from the meta-synthesis extracted five different categories covering patents' needs: Self-management, palliative care, supportive care, social support and continuing person-centred care. The need for continuing empowerment and support to meet those needs was also identified, revealing the core theme: 'Wind beneath my wings'. The meta-synthesis quotations highlighted the necessity for dynamic and interactive continuing person-centred care focusing on the ongoing patients' needs through the HF trajectory. Giving more emphasis to the human dimension and holistic approach of patients with HF, along with cardiology medicine development might be a key factor in improving clinical outcomes and health related quality of life.

The COVID-19 pandemic: challenges in providing supportive care to those with cardiovascular disease in a time of plague

PURPOSE OF REVIEW

COVID-19 has permeated the very essence of human existence and society and disrupted healthcare systems. The attrition stemming from this highly contagious disease particularly affects those rendered vulnerable by age and infirmity, including those with underlying cardiovascular disease. This article critically reviews how best to integrate supportive care into the management of those affected.

RECENT FINDINGS

Numerous studies have described the pathophysiology of COVID-19, including that specifically arising in those with cardiovascular disease. Potential treatment strategies have emerged but there is limited guidance on the provision of palliative care. A framework for implementation of this service needs to be developed, perhaps involving the training of non-specialists to deliver primary palliative care in the community, bolstered by the use of telemedicine. The appropriate use of limited clinical resources has engendered many challenging discussions and complex ethical decisions. Prospective implementation of future policies requires the incorporation of measures to assuage moral distress, burnout and compassion fatigue in healthcare staff who are psychologically and physically exhausted.

SUMMARY

Further research based on patient-centred decision making and advance care planning is required to ensure the supportive needs of COVID-19 patients with cardiovascular disease are adequately met. This research should focus on interventions applicable to daily healthcare practice and include strategies to safeguard staff well-being.

Hotspot and Frontier Analysis of Exercise Training Therapy for Heart Failure Complicated With Depression Based on Web of Science Database and Big Data Analysis

Background: Exercise training has been extensively studied in heart failure (HF) and psychological disorders, which has been shown to worsen each other. However, our understanding of how exercise simultaneously protect heart and brain of HF patients is still in its infancy. The purpose of this study was to take advantage of big data techniques to explore hotspots and frontiers of mechanisms that protect the heart and brain simultaneously through exercise training.

Methods: We studied the scientific publications on related research between January 1, 2003 to December 31, 2020 from the WoS Core Collection. Research hotspots were assessed through open-source software, CiteSpace, Pajek, and VOSviewer. Big data analysis and visualization were carried out using R, Cytoscape and Origin.

Results: From 2003 to 2020, the study on HF, depression, and exercise simultaneously was the lowest of all research sequences (two-way ANOVAs, p < 0.0001). Its linear regression coefficient r was 0.7641. The result of hotspot analysis of related keyword-driven research showed that inflammation and stress (including oxidative stress) were the common mechanisms. Through the further analyses, we noted that inflammation, stress, oxidative stress, apoptosis, reactive oxygen species, cell death, and the mechanisms related to mitochondrial biogenesis/homeostasis, could be regarded as the primary mechanism targets to study the simultaneous intervention of exercise on the heart and brain of HF patients with depression.

Conclusions: Our findings demonstrate the potential mechanism targets by which exercise interferes with both the heart and brain for HF patients with depression. We hope that they can boost the attention of other researchers and clinicians, and open up new avenues for designing more novel potential drugs to block heart-brain axis vicious circle.