Social relationships and mortality in patients with congestive heart failure

Understanding social risk factors in patients presenting to the emergency Department for Acute Heart Failure: A pilot study

BACKGROUND

The standard of care for congestive heart failure (CHF) aims to slow disease progression and maximize patient function, however there is an increase in emergency department (ED) revisits and readmissions. Social risk factors play a role in the disease management and prognosis of CHF. There is a gap in the identification of low-risk CHF patient who would be safely discharged using an initial social risk factor stratification.

OBJECTIVES

To generate a social risk profile for patients presenting to the ED with acute CHF exacerbation and identify variables that may increase the risk of 7-day and overall mortality, 30-day ED revisit, and readmission.

METHODS

We conducted a pilot prospective survey-based study among adult patients presenting to the ED with acute CHF exacerbation. The combination of a self-report questionnaire and retrospective chart review was used to generate a CHF risk profile.

RESULTS

A total of 62 patients were recruited in the pilot study with a mean age of 69.5 years. The preliminary data indicated that prior to this ED visit, 21% of patients were not aware of a previous CHF diagnosis; 64.5% of patients rated their sleep quality as poor or very poor; 72.6% reported orthopnea; and 43.5% reported recent weight gain. 37.1% of patients did not adhere to dietary recommendations and some patients did not adhere to their medication regime 100%.

CONCLUSION

This study suggests establishing a social risk profile for patients presenting to the ED with CHF can help formulate a CHF-specific care plan and optimize multidisciplinary management to reduce ED revisits and readmissions.

Relationship Between Physical Symptoms and Loneliness in Patients with Heart Failure: The Serial Mediating Roles of Activities of Daily Living and Social Isolation

OBJECTIVES

This study aimed to examine the multiple mediation effects of activities of daily living and social isolation on the relationship between physical symptoms and loneliness in patients with heart failure.

DESIGN

We adopted a cross-sectional descriptive survey.

SETTING AND PARTICIPANTS

A total of 303 patients with heart failure were recruited at 2 general hospitals in China from November 2019 to December 2020.

METHODS

Information on loneliness was assessed using the Loneliness Scale of the University of California at Los Angeles (version 3), physical symptoms were evaluated using the Symptom Status Questionnaire-Heart Failure, the Activity of Daily Living Scale was used to evaluate activities of daily living, the Lubben Social Network Scale was used to measure social isolation. The serial mediation model was examined using PROCESS macro in SPSS.

RESULTS

Of the 303 patients, 66.7% experienced mild loneliness and 21.8% experienced moderate or severe loneliness. Multiple mediation analysis showed that physical symptoms had a direct effect on loneliness (effect = 0.210; 95% confidence interval (CI) 0.099-0.320) and the link between physical symptoms and loneliness through 3 indirect pathways: (1) activities of daily living (effect = 0.043; 95% CI 0.006‒0.086), accounting for 20.48% of the total effect; (2) social isolation (effect = 0.060; 95% CI 0.005‒0.120), accounting for 28.57% of the total effect; and (3) activities of daily living and social isolation in series (effect = 0.049; 95% CI 0.024‒0.081), accounting for 23.33% of the total effect. The total mediating effect was 72.38%.

CONCLUSIONS AND IMPLICATIONS

Activities of daily living and social isolation sequentially mediated the relationship between physical symptoms and loneliness in patients with heart failure. Therefore, attention to reducing activities of daily living limitations and social isolation may be beneficial to reducing loneliness, apart from alleviating physical symptoms.

Coping strategies mediate the relation between executive functions and life satisfaction in middle and late adulthood: a structural equational analysis

Recent studies have suggested that executive functions (EF) predict life satisfaction for older adults. However, the mechanism is not known. By analyzing a sample (N = 3,287, ages 32- 84 years) from the Midlife Development in the United States 2, we examined the mediational role of coping strategies in the relation between EF and life satisfaction. Both active coping and behavioral disengagement mediated the relation between EF and life satisfaction, and age significantly moderated the mediational pathways. Specifically, the positive effect of EF on active coping was more pronounced in middle-aged and older adults than in young adults. However, the negative effect of EF on behavioral disengagement was apparent only in older adults, disappeared in middle-aged adults and reversed in younger adults. Our findings underscore EF as crucial cognitive resources that facilitate the adoption of healthy coping strategies, which in turn, affect life satisfaction in middle and late adulthood.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.

METHODS

A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

AIM

The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.

METHODS

A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.

STRUCTURE

Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

Social relationships and the risk of incident heart failure: results from a prospective population-based study of older men

Aims

Limited social relationships, particularly in older adults, have been implicated as a risk factor for cardiovascular disease. However, little is known about the associations between poor social relationships and heart failure incidence.

Methods and results

Prospective study of socially representative men aged 60–79 years drawn from general practices in 24 British towns and followed up for a maximum of 18 years. A total of 3698 participants with no previous diagnosis of heart failure were included. Information on social relationships was based on a combination of marital status, living circumstances, and social contacts with friends and family. These provided information on contact frequency, contact satisfaction, and a social relationship score (low to high) combining frequency and satisfaction with contact. Heart failure included both incidents non-fatal heart failure and death from heart failure. Among 3698 participants, 330 developed heart failure. Men with low compared to high frequency of contact with family and friends had an increased risk of incident heart failure [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.15–2.18]; this remained statistically significant after adjustment for social class, behavioural, and biological risk factors. Low compared to high scores for satisfaction with contacts was associated with increased risk of heart failure (adjusted HR = 1.54; 95% CI 1.14–2.07). Lower social relationship scores (combining frequency and satisfaction with contact) were associated with greater risk of incident heart failure (adjusted HR = 1.38, 95% CI 1.02–1.87). Marital status and living alone were not significantly associated with heart failure.

Conclusion

Weaker social relationships appear to increase the risk of developing heart failure in older age. Further research is needed to investigate pathways underlying these associations and to test whether interventions to strengthen social relationships can reduce the risk of heart failure.

Relationship quality and 5-year mortality risk

OBJECTIVE

The present study examined positive and negative aspects of relationship quality with one's spouse or partner as predictors of mortality and the role of gender in moderating this link.

METHOD

Data were drawn from 2 waves, 5 years apart, of the National Social Life, Health, and Aging Project (N = 1,734). Positive aspects of relationship quality (frequency of opening up to the partner to talk about worries and relying on the partner) and negative aspects (frequency of the partner making too many demands and criticism by the partner) were assessed. Survival/mortality status was recorded at the time of Wave 2 data collection 5 years later (1,567 alive; 167 deceased). Covariates included sociodemographic variables, relationship type, health status, and the network size of close family relationships and friendships.

RESULTS

Logistic regression analyses showed that negative relationship quality with one's spouse or partner was associated with significantly higher odds for mortality after 5 years (odds ratio [OR] = 1.20, 95% CI [1.03, 1.38], p < .001), after including the statistical covariates. Also, age, gender, education, self-rated health, and medication use were significantly related to mortality. Propensity score matching replicated these findings. Follow-up analyses revealed that criticism from one's spouse or partner, in particular, was linked to a higher mortality risk (OR = 1.44, 95% CI [1.10, 1.88]). Gender did not moderate the relationship-quality-mortality link.

CONCLUSIONS

Negative relationship quality, notably, criticism received from one's spouse or partner, heightens older adults' risk of mortality. These results suggest the value of developing interventions that target reducing expressed criticism in couple relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The association of prediagnosis social support with survival after heart failure in the Cardiovascular Health Study

PURPOSE

Although social support has been shown to be associated with survival among persons with cardiovascular disease, little research has focused on whether social support, measured before the onset of heart failure, can enhance survival after diagnosis. The objective of this study was to assess the association between prediagnosis social support and postdiagnosis survival among older adults with heart failure.

METHODS

We obtained the data from the Cardiovascular Health Study, which included noninstitutionalized adults aged 65 years or older from four sites in the United States with primary enrollment in 1989-1990. We used two measures of social support, the Lubben Social Network Scale and the Interpersonal Support Evaluation List. The analytic data set included 529 participants with a social support measure within two years before diagnosis of heart failure.

RESULTS

After adjustment for demographic covariates, cardiovascular risk factors, and general health status, mortality rates were lower among participants in the highest tertile of social network scores (HR 0.74, 95% CI: 0.59, 0.93) and the middle tertile (HR 0.73 [0.58, 0.90]), compared with the lowest tertile. Results with interpersonal support were null.

CONCLUSIONS

These findings suggest that prediagnosis structural social support may modestly buffer heart failure patients from mortality.

Functional support and burden among out-of-home supporters of heart failure patients with and without depression

OBJECTIVE

Over 20% of patients with heart failure (HF) experience clinical depression, which is associated with higher rates of mortality, morbidity, and hospitalization. Support from family members or friends (whom we refer to as care partners [CPs]) can lower the risk of these outcomes. We examined whether HF patients with depression received assistance from CPs living outside of their homes. Further, we examined whether patient depression was associated with support-related strain among out-of-home CPs.

METHOD

We analyzed baseline survey data from 348 HF patients with reduced ejection fraction and their CPs. Patients with scores on the Center for Epidemiological Studies Depression Scale-10 (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993) of ≥10 were classified as having clinically significant depressive symptoms (i.e., depression). Outcomes included CP-reported hr per week helping with health care and talking with patients via telephone and scores on the Modified Caregiver Strain Index. Negative binomial regression models examined differences in the amount of in-person and telephone support for patients with and without depression, controlling for patients' comorbidities, living alone, CP geographic distance, and CP emotional closeness to the patient.

RESULTS

CPs provided more in-person support to HF patients with depression (M = 3.64 hr) compared with those without depression (M = 2.60 hr per week, incident rate ratio [IRR] = 1.40, p = .019). CPs provided more telephone support to patients with depression (M = 3.02 hr) compared with those without depression (M = 2.09 hr per week, IRR = 1.42, p < .001). Patient depression had no effect on caregiver burden (IRR = 1.00, p = .843).

CONCLUSION

Patients with clinically significant depressive symptoms receive more in-person assistance and telephonic support from CPs. Despite that additional contact, caregiver burden was not greater among the supporters of depressed patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Interplay of Self-efficacy and Social Support in Predicting Quality of Life in Cardiovascular Patients in Pakistan

The primary objective of the present study was to assess independent and interactive relations of perceived social support and self-efficacy with four quality of life (QOL) domains namely physical, psychological, social, and environmental in cardiovascular disease (CVD) patients from a South Asian region. Participants were 172 (age 22-60 years) patients recruited from three major government sector hospitals from the fifth biggest city of South Asia. It was found that overall CVD patients had a better QOL in psychological and environmental domains compared to social and psychological. Furthermore, findings from hierarchical regression analyses indicated that perceived social support and self-efficacy were positively associated with the four QOL domains. Besides main effects, a synergistic interaction between social support and self-efficacy emerged indicating that perceived social support was strongly associated with physical and social QOL in CVD patients who had higher self-efficacy levels, while, perceived social support was weakly associated with the physical and social QOL in CVD patients who had lower self-efficacy levels.

Anxiety and depression predicted quality of life among patients with heart failure

Purpose

Anxiety and depression are prevalent among patients with heart failure. However, their effect on the quality of life (QoL) is not well investigated in developing countries. Therefore, the purpose of this study was to test the effect of anxiety and depression on QoL among Jordanian patients with heart failure.

Patients and methods

Two hundred patients with a confirmed diagnosis of heart failure from 1 governmental and 1 private hospital in Amman, Jordan, were recruited between March and August, 2017. A descriptive, cross-sectional design was used. Anxiety and depression were measured using the Arabic version of the Hospital Anxiety and Depression Scale. QoL was measured using the Arabic version of the Short Form-36.

Results

Patients reported poor QoL in both physical component summary (M ± SD; 35.8±9.6) and mental component summary (M ± SD; 41.5±11.3). Prevalence rates for anxiety and depression were 62% and 65%, respectively. In stepwise regression analysis, anxiety and depression were independent predictors for poor QoL in both summaries, p<0.001.

Conclusion

Patients with heart failure have poor QoL and high anxiety and high depression prevalence rates. Inclusion of routine assessment and management of anxiety and depression in heart failure protocols is highly recommended.

Caregiver status and outcomes after durable left ventricular assist device implantation

OBJECTIVES

To determine the relationship between caregiver status and outcomes after durable left ventricular assist device (LVAD) implantation.

BACKGROUND

The absence of a caregiver is a relative contraindication to durable LVAD support.

METHODS

Forty-three patients that underwent primary LVAD implantation were divided into three groups: those with caregivers that retained their roles for the duration of LVAD support (CG group), those with caregivers that resigned their roles (CG-QUIT group), and those implanted without an assigned caregiver (No-CG group). Group-specific characteristics and post-implant outcomes were compared.

RESULTS

In the CG-QUIT group, caregivers did not live in the same home (0.0% vs. 80.6% of CG group) and none were spouses (0.0% vs. 64.5% for CG group). Thirty-day readmission rate was highest in the CG-QUIT group (83.3% vs. 25.8% in CG group and 16.7% in No-CG group).

CONCLUSIONS

Caregiver relationships were more likely to be maintained for the duration of LVAD support when the caregiver was a spouse and resided in the same home as the patient. Carefully selected patients implanted without a designated caregiver had comparable outcomes to those who retained their original caregiver.

Stroke survivors and their families receive information and support on an individual basis from an online forum: descriptive analysis of a population of 2348 patients and qualitative study of a sample of participants

OBJECTIVE

To describe the characteristics of participants of an online stroke forum, their reasons for posting in the forum and whether responses addressed users' needs.

METHODS

Descriptive analysis of the population of 2004-2011 archives of Talkstroke, the online forum of the Stroke Association, and comparison with patients admitted to hospital with stroke (Sentinel Stroke National Audit Programme, SSNAP). Thematic analysis of posts from a sample of 59 participants representative of age at stroke and sex.

SETTINGS

UK.

MAIN OUTCOME MEASURES

Characteristics of participants: age, sex, survivor versus patient by third party, side of stroke (R, L), social class; (from the sample of 59 participants): level of disability, stroke type, classification of users' intents for writing a post in the forum, quantification of needs addressed by the forum, topics of discussion.

PARTICIPANTS

2348 participants (957 stroke survivors, 1391 patients with stroke talked about by third party).

RESULTS

Patients of both sexes and from a wide range of ages at stroke (0 to 95 years) and degrees of disability were represented in the forum, although younger than the UK stroke population (mean age 52 years vs 77 years in SSNAP). Analysis of 841 posts showed that the main users' intents for writing in the forum were requests/offers of information and support (58%) and sharing own experiences of stroke (35%). Most information needs were around stroke-related physical impairments, understanding the cause of stroke and the potential for recovery. Up to 95% of the users' intents were met by the replies received.

CONCLUSIONS

Patients' needs expressed in the online forum confirm and widen the evidence from traditional research studies, showing that such forums are a potential resource for studying needs in this population. The forum provided an opportunity for patients and families to give and receive advice and social support.

Heart failure family-based education: a systematic review

OBJECTIVE

To systematically review evidence for the efficacy of family-based education for heart failure (HF) patients and carers.

METHOD

A systematic review was conducted. Databases CINAHL, MEDLINE Complete, Cochrane, PubMed, Web of Science, EMBASE, PsycINFO, and Scopus were searched between 1 January 2005 and 1 May 2015. Randomised controlled trials included HF patient and carer dyads or carers alone. The primary outcome was HF knowledge. Secondary outcomes included self-care behaviour, dietary and treatment adherence, quality of life, depression, perceived control, hospital readmissions, and carer burden.

RESULT

Six trials reported in nine papers were included. Wide variation in the quality of the studies was found. Two studies only examined HF knowledge; a significant improvement among patients and carers was reported. Other significant findings were enhanced patient self-care, boosted dietary and treatment adherence, enriched patient quality of life, improved perceived control among patients but not carers, and reduced carer burden

CONCLUSION

Modest evidence was found for family-based education among HF patients and carers. Methodological shortcomings of trials signify the need for empirically sound future research.

PRACTICE IMPLICATION

Family-based HF education needs to include strategies that are tailored to the HF patient and carer, and sustainable in nature.

Spiritual peace predicts 5-year mortality in congestive heart failure patients

OBJECTIVE

Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness.

METHOD

Participants were 191 CHF patients (64% male; M age = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for 5 years.

RESULTS

Nearly 1/3 of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, whereas alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. Although both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors.

CONCLUSIONS

Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions.

Association Between Characteristics of Hospitalized Heart Failure Patients With Their Needs

Introduction:

During recent years that life expectancy of heart failure patients has been increased, health professionals put more emphasis on assessing their needs in daily clinical practice. The aim of the present study was to explore the association between characteristics of hospitalized heart failure patients with their needs.

Methods:

A sample of 190 hospitalized patients with HF, recruited from public hospitals in Greece, was enrolled in the study. Data were collected by the completion of a questionnaire which included socio-demographic and clinical characteristics and the questionnaire “Needs of hospitalized patients with coronary artery disease” which is consisted of 6 subscales. Statistical methods used were Kruskal wallis-test or Mann-Whitney test and Spearmans’ rho coefficient. Multiple regression analysis was performed in order to evaluate the association between patients’ characteristics and the significance of their needs.

Results:

124 (65.3%) of hospitalized heart failure participants were men and 89 (46.8%) of participants were more than 70 years old. 145 (76.3%) had prior experience of hospitalization due to heart failure. The need for support and guidance was statistically significantly associated with the degree of information, (p=<0.001). The need for information from the medical and nursing staff was significantly associated with marital status and degree of information (p=0.001 and p<0.001 respectively). The need for need for being in contact with other patient groups, and ensuring communication with relatives was statistically significantly associated with the professional status and degree of information, (p=0.037 and p=<0.001 respectively). The need for individualized treatment and the need for patient’s personal participation to his/her treatment as well as the need to meet the emotional and physical needs were statistically significant associated with the degree of information, (p=<0.001, p=<0.001 respectively). Lastly, the need to trust the medical and nursing staff was statistically significantly associated with the place of residence and the degree of information, (p=0.023 and p<0.001). These results were confirmed by the multiple linear regression after controlling for potential confounders.

Conclusions:

Information seems to be of vital importance when assessing the needs of heart failure patients. Therefore, providing elaborate information should be an integral part of their therapeutic regimen.

Poor social support is associated with increases in depression but not anxiety over 2 years in heart failure outpatients

BACKGROUND

Heart failure (HF) is a major health problem in the United States, affecting 5.7 million American adults. Psychosocial distress, in particular depression, contributes to morbidity and mortality in patients with HF. Little is known about the interrelationship among disease severity, social support, and depression.

OBJECTIVE

The aim of this study was to examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of outpatients with HF.

METHODS

Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study completed the Beck Depression Inventory-II, the State Trait Anxiety Inventory, and the Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years.

RESULTS

At baseline, 30% of the patients were depressed and 42% were anxious. Social support amount contributed to changes in depression (P = .044) but not anxiety (P = .856). Depression increased over time for patients who had lower initial social support amount. Depression did not increase for those with higher initial social support amount. Neither New York Heart Association class nor treatment group (placebo or implantable cardioverter defibrillator) interacted with time to predict depression, which indicates that changes in depression were parallel for patients with New York Heart Association class II and class III HF and for those who received implantable cardioverter defibrillators and those who did not. Assessment of patients with HF should include depression and social support. Interventions to enhance social support among patients with HF who have low social support may help alleviate the development of depression.

CONCLUSIONS

Reducing psychological distress and increasing social support may improve health outcomes among HF outpatients. It is important for studies of HF to include assessment of depression, anxiety, and social support and evaluate their contributions to health outcomes.