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Carpenter JS, Fagan R, Alzahrani M, Jaynes HA, Tisdale JE, Kovacs RJ, Chen CX, Draucker CB. "Quick flutter skip": midlife women's descriptions of palpitations. Menopause 2023; 30:1014-1021. [PMID: 37643379 PMCID: PMC10581607 DOI: 10.1097/gme.0000000000002244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The objective of this study is to describe peri- and postmenopausal women's experiences of palpitations (quality, frequency, severity, distress, duration and temporal pattern, aura, associated symptoms, and aggravating/alleviating factors) and related healthcare experiences. METHODS Qualitative descriptive methods were used. Semistructured interviews were conducted with women who reported palpitations and were enrolled in a larger case-control pilot study comparing electrocardiographic results between women with and without palpitations. Authors analyzed women's narratives using standard content analytic procedures. RESULTS Fourteen participants (mean age, 54.5 y [SD = 4.8 y]; range, 46-62 y; 79% postmenopausal) completed interviews. The interviews revealed that women (a) often had difficulty describing their palpitations until prompted by the interviewer; (b) experienced noteworthy variations in the quality and other dimensions of their palpitations; (c) had a wide variety of healthcare experiences related to their palpitations, including not reporting their symptoms to providers, having providers dismiss their symptoms, and having providers be aware of their symptoms and provide diagnostic tests; and (d) at times, created worst case scenarios (downward shifts) under which they would seek treatment for their palpitations, thus enabling them to minimize their symptoms and avoid healthcare. CONCLUSION This study advances understanding of how women describe their palpitations and related healthcare experiences. Findings could have implications for building research and clinical tools to guide assessment, communication, and/or education for patients and/or providers about palpitations and for developing and testing behavioral interventions to address this poorly understood symptom in peri- and postmenopausal women.
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Affiliation(s)
| | - Rileigh Fagan
- Indiana University School of Nursing, Indianapolis, IN, 46202
| | | | | | - James E. Tisdale
- Purdue University College of Pharmacy, West Lafayette, IN
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Chen X. Chen
- Indiana University School of Nursing, Indianapolis, IN, 46202
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Sheng Y, Carpenter JS, Paul SM, Conley YP, Levine JD, Miaskowski C. Patients with palpitations experience a higher symptom burden prior to breast cancer surgery. Eur J Oncol Nurs 2023; 65:102341. [PMID: 37327556 DOI: 10.1016/j.ejon.2023.102341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence suggests that palpitations, a feeling of the heart racing or pounding, may be equally common. Study purpose was to compare the severity and clinically meaningful occurrence rates of common symptoms and quality of life (QOL) outcomes between patients with breast cancer who did and did not report palpitations prior to surgery. METHODS Patients (n = 398) were classified as having or not having palpitations using a single item from the Menopausal Symptoms Scale. Valid and reliable measures were used to assess state and trait anxiety, depression, sleep disturbance, fatigue, energy, cognitive function, breast symptoms, and QOL. Between group differences were evaluated using parametric and non-parametric tests. RESULTS Patients with palpitations (15.1%) reported significantly higher severity scores for state and trait anxiety, depression, sleep disturbance, and fatigue as well as significant decrements in energy and cognitive function (all p < .05). A higher percentage of these patients had clinically meaningful levels of state anxiety, depression, sleep disturbance and decrements in cognitive function (all p < .05). Except for spiritual well-being, QOL scores were lower in the palpitations group (all p < .001). CONCLUSION Findings support the need for routine assessment of palpitations and management of multiple symptoms in women prior to breast cancer surgery.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | | | - Steven M Paul
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA; School of Medicine, University of California at San Francisco, San Francisco, CA, USA.
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3
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Carpenter JS, Cortés YI, Tisdale JE, Sheng Y, Jackson EA, Barinas-Mitchell E, Thurston RC. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause 2023; 30:18-27. [PMID: 36256921 PMCID: PMC9797427 DOI: 10.1097/gme.0000000000002082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our objectives were to identify trajectories of palpitations over the menopause transition, characterize them, and examine associations with subclinical cardiovascular disease (CVD). METHODS We analyzed the following data from the multisite, multiethnic SWAN (Study of Women Across the Nation): reported palpitations occurrence over time; baseline sociodemographic, reproductive, medication, and health-related factors; and follow-up visit subclinical CVD (carotid atherosclerosis, vascular stiffness). Trajectories of palpitations (n = 3,276), their characteristics, and their associations with subclinical CVD (n = 1,559) were identified using group-based trajectory modeling and linear and logistic regression models. RESULTS Three trajectories emerged: high probability of palpitations in perimenopause to early postmenopause diminishing in late postmenopause (15.9% of women), moderate probability of palpitations in perimenopause to early postmenopause diminishing in late postmenopause (34.3%), and sustained low probability of palpitations (49.8%). In the fully adjusted multivariable model, the high probability group had a more adverse reproductive and health-related profile at baseline (higher gravidity, early perimenopause, vasomotor symptoms, poorer overall health, higher depressive symptoms, higher perceived stress, greater sleep problems, higher blood pressure). In fully adjusted multivariable models, palpitation trajectories were not related to atherosclerosis or arterial stiffness. CONCLUSIONS Distinct patterns of palpitations emerged, with a substantial portion of women having palpitations during the perimenopause and early postmenopause. Palpitations were not associated with subclinical CVD. Findings can help identify women at risk of palpitations during the menopause transition who may need symptom relief.
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Affiliation(s)
| | - Yamnia I. Cortés
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - James E. Tisdale
- Purdue University College of Pharmacy, West Lafayette, IN 47907, USA
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ying Sheng
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
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Symptom reporting, cardiovascular disease, and mortality as women age: it is more than menopause. Menopause 2022; 29:1355-1356. [PMID: 36449931 DOI: 10.1097/gme.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Zhi X, Zhang H, Liu Y, Zhang Y, Sun J, Zhao X, Yang Y, Liu P. Tuina for perimenopausal insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28498. [PMID: 35029202 PMCID: PMC8758014 DOI: 10.1097/md.0000000000028498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Insomnia in perimenopausal women has a negative impact on quality of life and increases health care costs. With the increasing incidence of the disease, Tuina has been accepted by perimenopausal women. The purpose of this study is to explore the effectiveness and safety of Tuina for perimenopausal insomnia. METHODS We will search 9 electronic databases: Chinese Biomedical Literature Database, Cochrane Library, China National Knowledge Infrastructure, EMBASE, MEDLINE, Web of Science, PubMed, Wan fang, Chinese Scientific Journal Database, and 1 clinical trials register platform: WHO International Clinical Trials Registry Platform. All relevant randomized controlled trial using Tuina for perimenopausal insomnia will be included. Two reviewers will independently screen date, and meta-analysis will be performed with RevMan (V5.3.5) software. RESULTS This study will provide an evidence of Tuina for perimenopausal insomnia. CONCLUSION This study will provide a reliable evidence for the evaluation of the efficacy and side effects of Tuina in the treatment of perimenopausal insomnia. PROSPERO REGISTRATION NUMBER CRD42021259017. ETHICS AND DISSEMINATION This systematics review will evaluate the efficacy and safety of tuina in the treatment of perimenopausal insomnia. Since all the data included were published, the systematic review did not require ethical approval.
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Affiliation(s)
- Xiaoyu Zhi
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Hongshi Zhang
- Nursing College of Changchun University of Chinese Medicine, Changchun, China
| | - Yangshengjie Liu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Ye Zhang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | | | - Xuewei Zhao
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yuesong Yang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Peng Liu
- Department of Acupuncture and Tuina, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
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Carpenter JS, Sheng Y, Pike C, Elomba CD, Alwine JS, Chen CX, Tisdale JE. Correlates of palpitations during menopause: A scoping review. WOMEN'S HEALTH 2022; 18:17455057221112267. [PMID: 35833667 PMCID: PMC9289918 DOI: 10.1177/17455057221112267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Palpitations during peri- and post-menopause are common. It is unclear what
variables are related to palpitations in peri- and post-menopausal women.
The purpose of this scoping review was to summarize potential correlates of
palpitations in women transitioning through menopause. Methods: The review followed the Preferred Reporting Items for Systematic reviews and
Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Authors included
English-language, full-length, peer-reviewed, cross-sectional research
articles on palpitations in menopausal women published through December 18,
2021, from PubMed, Cumulative Index to Nursing and Allied Health Literature
(CINAHL), and PsycINFO searches. Following de-duplication, screening of
titles and abstracts, and review of full-texts, independent reviewers
extracted data on variables studied in relationship to palpitations from 84
articles and resolved discrepancies. Authors extracted data on (1)
demographic, clinical, biomarker, and symptom/quality of life variables and
(2) data analysis method (bivariate, multivariate). Authors classified each
variable as a likely, unlikely, or unclear correlate of palpitations. Results: Articles were diverse in region of origin, sample sizes, and variables
assessed in relationship to palpitations. Evidence for any one variable was
sparse. Likely correlates of palpitations included race/ethnicity, lower
physical activity, worse vasomotor symptoms (VMSs), worse sleep, and worse
quality of life. Unlikely correlates included age, employment, education,
marital status, socioeconomic status, comorbidities, body mass index, and
sexual difficulties. Unclear correlates due to equivocal evidence were
menopausal status, smoking, and depression. Unclear correlates due to
insufficient evidence (less than three articles) included all of the
assessed biomarkers, anxiety, and stress. Conclusion: Likely correlates were identified including race/ethnicity, physical
activity, VMS, sleep, and quality of life. However, additional research is
needed to better understand potential correlates of palpitations.
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Affiliation(s)
| | - Ying Sheng
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Caitlin Pike
- University Library, Indiana University–Purdue University Indianapolis, Indianapolis, IN, USA
| | | | | | - Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - James E Tisdale
- Purdue University College of Pharmacy, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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Carpenter JS, Tisdale JE, Larson JC, Sheng Y, Chen CX, Von Ah D, Kovacs R, Reed SD, Thurston RC, Guthrie KA. MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women. Menopause 2021; 29:144-150. [PMID: 35084374 PMCID: PMC8797016 DOI: 10.1097/gme.0000000000001897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women. METHODS We analyzed baseline data from 293 women who were eligible for a 3 × 2 factorial trial of exercise or yoga versus routine activity, and omega-3 fish oil versus placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over 2 consecutive days and reported distress from heart racing or pounding during the past 2 weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t tests, and repeated measure linear regression models. RESULTS Participants were on average 54.6 (SD = 3.6) years old, most were White (67%) postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-min) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared with those without distress (P ≤ 0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (-0.25 [-0.45 to -0.04], P = 0.02). CONCLUSIONS Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.
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Affiliation(s)
| | - James E. Tisdale
- Purdue University College of Pharmacy, West Lafayette, IN 47907
- Indiana University School of Medicine, Indianapolis, IN 46202
| | - Joseph C. Larson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ying Sheng
- Indiana University School of Nursing, Indianapolis, IN 46202
| | - Chen X. Chen
- Indiana University School of Nursing, Indianapolis, IN 46202
| | - Diane Von Ah
- Indiana University School of Nursing, Indianapolis, IN 46202
| | - Richard Kovacs
- Indiana University School of Medicine, Indianapolis, IN 46202
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Ak Sözer G, Güdül Öz H, Yangın H. Relationship between menopausal symptoms and perceived stress during the COVID-19 pandemic. J Women Aging 2021; 34:675-686. [PMID: 34661513 DOI: 10.1080/08952841.2021.1985374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study aimed to examine the relationship between menopausal symptoms and perceived stress in middle-aged women during the COVID-19 pandemic. In this cross-sectional study, data were collected online from 239 middle-aged women using the Personal Information Form, Menopause Rating Scale (MRS) and Perceived Stress Scale-14 (PSS-14). A positive correlation was found between the total MRS score and the total PSS-14 score. The COVID-19 pandemic usually restrict access to healthcare visit. The COVID-19 pandemic has created an urgent need to implement specific menopausal programs to promote the psychological health of middle-aged women and reduce stress during this or similar crises.
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Affiliation(s)
- Gülşen Ak Sözer
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
| | - Hatice Güdül Öz
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
| | - Hatice Yangın
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
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Sheng Y, Carpenter JS, Elomba CD, Alwine JS, Yue M, Chen CX, Tisdale JE. Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric 2021; 25:128-140. [PMID: 34346265 DOI: 10.1080/13697137.2021.1948006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This systematic review provides an overview of the effects of menopausal symptom treatment options on palpitations, defined as feelings of missed or exaggerated heart beats, reported by perimenopausal and postmenopausal women. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in PubMed, CINAHL and PsycINFO to identify articles meeting pre-specified inclusion criteria. Of 670 unique articles identified, 37 were included in the review. Treatments included drug therapies and non-drug therapies. Palpitations were studied as an outcome in 89% of articles and as an adverse effect in 11%. Articles provided mostly level II/III evidence due to their design and/or small sample sizes. Based on available evidence, no therapies can be fully recommended for clinical practice. Only some hormonal agents (e.g. estradiol) can be recommended with caution based on some positive evidence for reducing palpitation prevalence or severity. However, other drug therapies (e.g. moxonidine, atenolol), dietary supplementary treatments (e.g. isoflavones, Rheum rhaponticum, sage), cognitive-behavioral intervention and auricular acupressure cannot be recommended given the existing evidence. Additional well-designed randomized controlled treatment trials focusing on palpitations during the menopause transition as an inclusion criteria and outcome are needed to advance the field.
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Affiliation(s)
- Y Sheng
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - J S Carpenter
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - C D Elomba
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - J S Alwine
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - M Yue
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - C X Chen
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - J E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, IN, USA.,School of Medicine, Indiana University, Indianapolis, IN, USA
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Reame NK. Anxiety and hot flashes as predictors of mid-life palpitations: getting to the heart of the matter in the time of COVID-19. Menopause 2021; 28:731-734. [PMID: 34165445 PMCID: PMC8240496 DOI: 10.1097/gme.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
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Sheng Y, Carpenter JS, Elomba CD, Alwine JS, Yue M, Pike CA, Chen CX, Tisdale JE. Review of menopausal palpitations measures. Womens Midlife Health 2021; 7:5. [PMID: 34059122 PMCID: PMC8167994 DOI: 10.1186/s40695-021-00063-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Indiana University, Indianapolis, IN, 46202, USA
| | - Janet S Carpenter
- School of Nursing, Indiana University, Indianapolis, IN, 46202, USA.
| | - Charles D Elomba
- School of Nursing, Indiana University, Indianapolis, IN, 46202, USA
| | | | - Min Yue
- College of Pharmacy, Purdue University, West Lafayette, IN, 47907, USA
| | - Caitlin A Pike
- University Library, Indiana University, Indianapolis, IN, 46202, USA
| | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, IN, 46202, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, IN, 47907, USA.,School of Medicine, Indiana University, Indianapolis, IN, 46202, USA
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