Gender and racial differences in psychosocial factors of low-income patients with heart failure

Exploration of subgroups and associated factors of the uncertainty in illness among older adults with chronic heart failure: A latent profile analysis

BACKGROUND

Uncertainty in illness is regarded as a source of stress, and tends to have adverse consequences on quality of life among older adults with chronic heart failure (CHF).

OBJECTIVE

The purpose of this study was to identify distinct subgroups in uncertainty in illness, and to explore associated factors within the population of older adults with CHF.

METHODS

We conducted a cross-sectional study using convenience sampling to survey 311 hospitalized older adults with CHF. The Mishel Uncertainty in Illness Scale, the 14-item Fatigue Scale, and the Perceived Social Support Scale were administered through self-reported questionnaires. Statistical analyses were conducted using latent profile analysis to precisely categorize participants based on the variable of uncertainty in illness, and multinomial logistic regression was applied to identify factors associated with subgroup heterogeneity.

RESULTS

Participants were classified as four subgroups: overall low uncertainty group (27.3%), moderate uncertainty-inconsistency fluctuations group (43.7%), moderate uncertainty-strong inconsistency group (21.2%) and overall high uncertainty group (7.8%). In comparison to the first subgroup (the overall low uncertainty group), the marital status, educational background, monthly household income, number of comorbidities, fatigue level, and social support were associated with heterogeneity of uncertainty in illness among participants in other three subgroups.

CONCLUSION

The findings identified four distinct subgroups characterized by uncertainty in illness among older adults with CHF and revealed the demographic and clinical factors associated with each subgroup. Healthcare professionals should prioritize precise assessments and consider developing tailored interventions to reduce chronic uncertainty in illness among older patients.

Gender differences? Factors related to quality of life among patients with Heart failure

Heart failure (HF) is a chronic, progressive disease that substantially decreases patients' quality of life. Few studies have compared quality of life and its related factors across genders in patients with HF. To explore gender differences in quality of life and related factors among adult patients with HF. A comparative study was conducted with 245 HF patients recruited from a medical center and a regional teaching hospital in Taiwan from February 2009 to February 2011. Descriptive and inferential statistics were used, including stepwise multiple regressions. The mean quality of life scores of males were significantly higher than those of females (87.78 ± 13.99 vs. 84.49 ± 11.85). The factors significantly related to quality of life for the male HF patients, in descending order of strength of association were depressive symptoms, physical symptoms, and monthly family income-less than USD 1,000; for the females, the significantly related factors were physical symptoms, depressive symptoms, and monthly family income-less than USD 1,000. The amount variance for which quality of life accounted for male and female HF patients was similar (60% vs. 64%). The results could be used for health professionals to provide more appropriate assessments and care according to gender in the future.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Patients With Heart Failure

BACKGROUND AND PURPOSE

Low social support is associated with worse outcomes in patients with heart failure. Thus, the purpose of this study was to examine the reliability and validity of the Multidimensional Scale of Perceived Social Support (MSPSS).

METHODS

We performed a secondary analysis of registry data from patients (n = 475) with confirmed heart failure.

RESULTS

The MSPSS demonstrated excellent internal consistency reliability. Factor analysis yielded 3 factors that explained 83% of the variance in perceived social support. More than half of the sample had depressive symptoms (56%). Hypothesis testing demonstrated that worse perceived social support was a predictor of depressive symptoms.

CONCLUSION

The MSPSS is a reliable and valid instrument to measure perceived social support in patients with heart failure.

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.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care

BACKGROUND

Social dimensions of health are known to contribute to what is often termed "patient complexity," which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs.

OBJECTIVES

To examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM's perceived applicability for use in a complex patient population.

DESIGN

Two studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population.

RESULTS

Use of the PCAM did not impact patient satisfaction or perception of practitioners' empathy, but it did increase both the number of onward referrals per referred patient (9-12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients' lives, and found it to be highly relevant for use in populations with known high complexity.

CONCLUSIONS

The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

Congestive heart failure adherence redesign trial: a pilot study

OBJECTIVE

Heart failure (HF) continues to be a leading cause of hospital admissions, particularly in underserved patients. We hypothesised that providing individualised self-management support to patients and feedback on use of evidence-based HF therapies (EBT) to physicians could lead to improvements in care and decrease hospitalisations. To assess the feasibility of conducting a larger trial testing the efficacy of this dual-level intervention, we conducted the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a proof-of-concept, quasi-experimental, feasibility pilot study.

SETTING

A large tertiary care medical centre in Chicago.

PARTICIPANTS

Low-income patients (<US$30,000/year) hospitalised for exacerbation of systolic HF (ejection fraction ≤50%) and their physicians. Twenty physicians and 33 patients were enrolled, of whom 23 patients completed the study.

INTERVENTIONS

Physicians received HF guidelines and periodic individualised feedback on their adherence to EBT. Patients received HF education, support and self-management training for diet and medication adherence by a trained nurse through 11 interactive sessions over a 4-month period. Evaluations were conducted pre-enrolment and 1 month postintervention completion.

OUTCOME MEASURES

Feasibility was assessed by the ability to deliver intervention to patients and physicians. Exploratory outcomes included changes in medication and sodium intake for patients and adherence to EBT for physicians.

RESULTS

Eighty-seven per cent and 82% of patients received >80% of interventions at 1 month and by study completion, respectively. Median sodium intake declined (3.5 vs 2.0 g; p<0.01). There was no statistically significant change in medication adherence based on electronic pill cap monitoring or the Morisky Medication Adherence Scale (MMAS); however, there was a trend towards improved adherence based on MMAS. All physicians received timely intervention.

CONCLUSIONS

This pilot study demonstrated that the protocol was feasible. It provided important insights about the need for intervention and the difficulties in treating patients with a variety of psychosocial problems that undercut their effective care.

Pathophysiological Relationships Between Heart Failure and Depression and Anxiety

Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.

Personal characteristics predictive of depressive symptoms in Hispanics with heart failure

Depression is a significant problem in heart failure (HF). The purposes of this study were to assess the prevalence of depressive symptoms in Hispanics with HF and to examine the personal characteristics predicting depressive symptoms at baseline and at 6-months follow-up in a telephone case management intervention. In this secondary data analysis based on 87 subjects, patient characteristics hypothesized to influence depressive symptoms included age, gender, education, living situation, co-morbidity, social support, New York Heart Association (NYHA) class, and acculturation. DSM-IV major depression was present in 39.1% (n = 35) of the participants at baseline and 1.1% (n = 1) at the 6-month follow-up. In regression analysis, factors associated with depressive symptoms at baseline were gender and NYHA class. At 6-month follow-up, acculturation, co-morbidity, and NYHA were significantly related to the presence of depressive symptoms. Depressive symptoms were highly prevalent in Hispanics with HF. Easily identifiable personal characteristics can be useful in designing interventions to reduce depression associated with HF.

Impact of troponin I-autoantibodies in chronic dilated and ischemic cardiomyopathy

The aim of this study was to investigate the prognostic value of circulating troponin I (TNI)-autoantibodies in plasma of patients with chronic heart failure. Sera of 390 heart failure patients were tested for the presence of anti-TNI antibodies by enzyme-linked immunosorbent assay (ELISA), including 249 (63.8% of total) patients with dilated cardiomyopathy (DCM) and 141 (36.2% of total) patients with ischemic cardiomyopathy (ICM). A total of 72 patients (18.5% of total) were female and 318 (81.5% of total) were male. Mean patient age was 54.6 ± 11.3 years and mean follow-up time was 3.8 ± 3.2 years. TNI-autoantibodies (titer of ≥1:40) were detected in 73 out of 390 patients (18.7% of total). In TNI-autoantibody positive patients mean left ventricular ejection fraction (LVEF) was 27.6 ± 5.8%, compared to 25.8 ± 5.9% in TNI-autoantibody negative patients, P = 0.03. The combined end-point of death (n = 118, 30.3% of total) or heart transplantation (HTX) (n = 44, 11.3% of total) was reached in 162 patients (41.5% of total). Kaplan-Meier analysis demonstrated superior survival (combined end-point of death or HTX) in patients with DCM versus ICM (P = 0.0198) and TNI-autoantibody positive patients versus TNI-autoantibody negative patients (P = 0.0348). Further subgroup analysis revealed a favorable outcome in TNI-positive patients with heart failure if the patients suffered from DCM (P = 0.0334), whereas TNI-autoantibody status in patients with ICM was not associated with survival (P = 0.8486). In subsequent multivariate Weibull-analysis, a positive TNI serostatus was associated with a significantly lower all-cause mortality in DCM patients (P = 0.0492). The presence of TNI-autoantibodies in plasma is associated with an improved survival in patients with chronic DCM, but not ICM. This might possibly indicate a prophylactic effect of TNI-autoantibodies in this subgroup of patients, encouraging further studies into possible protective effects of antibodies against certain cardiac target structures.