Depression and Anxiety in Heart Failure: A Review

Recent advances in biomimetic nanodelivery systems for the treatment of depression

Depression and cognitive disorders remain major challenges in healthcare, with conventional treatments often facing limitations such as slow onset, side effects, and poor drug delivery to the brain. Biomimetic nanodelivery systems, including nanozymes, cell membrane-based systems, and exosomes, have emerged as promising solutions to these issues. These systems leverage natural biological processes to enhance drug targeting, improve bioavailability, and regulate complex biological pathways. Nanoenzymes, with their catalytic properties, offer antioxidant and anti-inflammatory benefits, while cell membranes and exosomes provide efficient targeting and immune evasion. However, challenges remain, including the immaturity of large-scale production techniques, stability concerns, and incomplete understanding of their mechanisms of action. Moreover, the long-term safety, pharmacokinetics, and toxicity of these systems require further investigation. Despite these obstacles, the potential of biomimetic nanodelivery systems to revolutionize depression treatment is significant. Future research should focus on optimizing their preparation, improving drug targeting and release, and ensuring clinical safety. Multidisciplinary collaboration will be essential for advancing these systems from the laboratory to clinical practice, offering new therapeutic avenues for depression and other neurological disorders.

Dose-Response Relationship Between Perceived Control and Depression in Patients With Chronic Heart Failure: A Multicenter and Cross-sectional Study

BACKGROUND

Little is known regarding the relationship between perceived control and depression in patients with chronic heart failure (CHF), particularly in terms of their dose-response relationship.

OBJECTIVE

The aim of this study was to explore this relationship based on linear and nonlinear hypotheses and potential subgroup differences in patients with CHF.

METHODS

A total of 308 patients with CHF were included in the study. Data on perceived control, depression, and relevant covariates, such as gender, age, New York Heart Association classification, and comorbidity burden, were collected. Logistic regression, Spearman correlation, and restricted cubic spline analysis were used for data analysis.

RESULTS

Compared with the patients in the first quartiles of perceived control scores (0-16), those in the other 3 quartiles had a lower risk of depression (odds ratios of 0.29, 0.21, and 0.20, respectively; P < .05). Furthermore, a negative correlation between perceived control and depression ( r = -0.317, P < .01) was observed. The restricted cubic spline analysis revealed an "L-shaped" curve relationship between perceived control and the presence of depression ( P for nonlinear < .01). Compared with patients with a perceived control within the 5th percentile (10 scores), as the perceived control increased, the risk of depression rapidly decreased from "1" until it reached a threshold (20 scores) and stabilized. This trend remained consistent across the subgroups grouped by gender, age, New York Heart Association classification, and comorbidity burden.

CONCLUSIONS

Interventions targeting perceived control may hold valuable implications for reducing the risk of depression in patients with CHF, particularly those who have not yet reached the threshold.

Observational protocol on neuropsychological disorders in cardiovascular disease for holistic prevention and treatment

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. In view of the close correlation between the functions of the body, which cannot be examined in a piecemeal manner but as an integrated system, a holistic approach allows for a comprehensive assessment of the patient. Our study aims to (i) examine the connection between CVD and cognitive deficits; (ii) examine the presence of anxiety and depression; (iii) evaluate the presence of dysphagia, pneumophonic coordination disorders, respiratory and sleep disorders; (iv) analyze the impact of CVD on the caregiver; and (v) evaluate the effectiveness of psychoeducational intervention. At least 218 patients will participate in the survey. At T0, they will undergo neuropsychological, psychological and associated clinical condition assessment through standardized tests. In addition, at least one psychoeducation meeting will be held. After 6 months (T1), the same tests will be repeated, and the effectiveness of psychoeducation will be evaluated. Assessment of associated disorders will provide a comprehensive view of the patient. In addition, it will be observed how psychoeducational intervention can make changes on general well-being. Comprehensive, multi-step observation allows for identification of risk factors, tailoring of treatment, and prevention of future complications.Clinical Trial Registration: registered on Clinicaltrials.gov (ID: NCT06413823).

Effects of Social Isolation and Loneliness on Heart Failure Self-care: A Cross-sectional Analysis

BACKGROUND

Patients with heart failure (HF) who engage in effective HF self-care have better quality of life, and lower risks of all-cause and HF-related hospital readmission and mortality. It is unclear whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care.

OBJECTIVE

The aim was to explore the relationship between social isolation, loneliness, and HF self-care.

METHODS

This was a cross-sectional secondary analysis (n = 49) of the GEtting iNTo Light Exercise for HF randomized controlled trial, a 6-month home-based live group gentle exercise intervention for patients with HF. Measures included the following: 6-item Lubben Social Network Scale for social isolation, Patient-Reported Outcomes Measurement Information System Social Isolation survey for loneliness, Self-Care of Heart Failure Index, and Patient-Reported Outcomes Measurement Information System Depression survey. Multiple linear regression modeling was used to examine the relationships of 4 HF self-care processes to social isolation and loneliness, adjusting for depression and grouping (control group or intervention group).

RESULTS

Scores indicating less social isolation predicted higher self-care maintenance ( B = 0.937, P = .015), monitoring ( B = 0.799, P = .041), and management ( B = 1.812, P < .001). Loneliness did not predict HF self-care.

CONCLUSIONS

To our knowledge, this is the first study to predict HF self-care using distinct measures for social isolation and loneliness. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care. Prospective studies are needed to investigate causal relationships between social isolation and HF-self-care engagement to determine the effect on outcomes such as hospital readmission and mortality.

The implications of integrating positive psychological frameworks into clinical practice in cardiac surgery

There is a growing recognition of the significance of the mental and emotional readiness of patients prior to undergoing heart surgery. Self Determination Theory, a part of Positive Psychology delves into the realms of happiness, drive, and satisfaction in life. This theory highlights the importance of autonomy, competence, and relatedness as fundamental basic psychological needs necessary for attaining life satisfaction, motivation, and psychological well-being. To examine these aspects in this study, it is assessed the levels of basic psychological needs, motivation levels, and levels of psychological energy of patients undergoing heart surgery. Basic Psychological Needs Scale, Motivation Scale, and Psychological Energy Scale are used for data collection. Through an analysis involving independent samples t-tests on 55 patients, the research findings revealed these psychological outcomes associated with heart surgery. Following heart surgery, participants showed decreases in their levels of psychological needs satisfaction, motivation, and psychological energy.

Refining a hybrid music therapy intervention for chronic obstructive pulmonary disease and heart failure: a single arm pilot study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose significant challenges to patients and the health systems that care for them. Music therapy has the potential to address these challenges, but its impact on readmission rates and quality of life remains largely underexplored. This study evaluated the feasibility, fidelity, and acceptability of a hybrid music therapy intervention as a precursor to a randomized controlled trial (RCT).

METHODS

Using a single-arm, mixed-methods approach, inpatients aged 30 - 89 with COPD or HF and access to home videoconferencing technology, a mobile device with a data plan, and a reliable support person were recruited during their hospitalizations. Patients with significant hearing/visual impairments, severe psychological comorbidities, terminal medical conditions, stage IV HF, or end-stage COPD were excluded. The intervention included 2 inpatient in-person sessions and 2 virtual sessions following discharge. Feasibility was assessed by rates of recruitment, retention, session attendance, and measure completion. Fidelity was evaluated by adherence to the session protocol, while acceptability was assessed through semi-structured interviews with randomly selected participants.

RESULTS

Of 113 patients approached, 20 (17.7%) were enrolled, and 85% were retained. Median participant age was 61.5 years, with 80% having HF and participants having high rates of anxiety (50%) and depression (35%). Overall session attendance was 57.5%, with higher rates for in-person (75%) compared to virtual sessions (40%). Adherence to the intervention protocol was > 80% across all monitored sessions. Challenges with the trial included difficulty reaching participants following discharge, frequent virtual session rescheduling, and participants' challenges using technology. Semi-structured interviews supported the acceptability of the intervention with three emerging themes (1) the therapeutic relationship facilitated a positive intervention experience, (2) need for strategies to improve post-discharge engagement in the intervention, and (3) impacts on mental health.

CONCLUSIONS

Findings support the feasibility of hybrid music therapy among patients with COPD or HF. However, challenges in post-discharge communication and virtual session attendance were noted. These issues will be addressed in a subsequent feasibility RCT through implementing secure text-based communication in addition to phone communication to reach participants post-discharge, refined eligibility criteria (e.g., excluding patients on dialysis), and in-person technology instruction.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06214325. Registered on January 9, 2024.

Factors Influencing Medication Adherence in Heart Failure Patients-A Survey Among Cardiac Healthcare Providers

Adhering to medication regimens is key behavior to alleviate symptoms and slow disease progression in heart failure (HF). This study explores cardiac healthcare providers' perceptions and experiences of factors influencing medication adherence (MA) in HF patients, with findings contributing to developing a HF-specific MA assessment scale. Using a cross-sectional, mixed methods design, we conducted an online survey with both closed and open-ended questions distributed to cardiac healthcare providers, working at the National University Hospital in Iceland. The survey consisted of 103 questions divided into 18 themes. Analysis included descriptive statistics of the participants' responses to closed responses with simplified scoring. Free-text responses were grouped into thematic categories and then into subthemes. Of 104 healthcare providers invited, 73 (70%) participated. Key factors identified as most beneficial for supporting MA included supportive patient-provider relationships (97%), selecting suitable drug formulation (96%), healthcare support at home (95%), and multi-dose dispensing from pharmacies (93%). The youngest and oldest HF patients were believed to be at the highest risk of medication non-adherence, particularly among males. Other patients estimated at increased risk included those with alcohol and/or substance abuse (89%), those with limited knowledge of medication effects (89%), those perceiving medication as useless (88%), and those with cognitive impairment (86%). Most participants (73%) agreed that healthcare providers should assess and document MA in clinical care. These findings provide a comprehensive overview of factors that cardiac healthcare providers believe influence non-adherence in HF patients, contributing to the development of a HF-specific MA scale.

Heart Failure Symptoms Improve With More Intense Physical Activity

BACKGROUND

Little is known about how changes in physical activity (PA) over time may influence symptoms in people with heart failure (HF).

METHODS

A secondary analysis was conducted with data from an RCT of an exercise intervention in patients with ICDs (implantable cardioverter defibrillator) and a HF diagnosis (n = 96). Data were collected at baseline and 2 months of PA intervention. Physical activity (PA Steps = mean steps/day; PA Intensity = mean steps/min for most intense 30 minutes/day) were measured over 5 days at each timepoint. Physical symptoms were measured using the Patient Concerns Assessment, the SF-36 Vitality, and Bodily Pain subscales for fatigue and pain. Psychological symptoms were assessed using the Patient Health Questionnaire-9, and the State-Trait Anxiety Index. Associations between PA and physical and psychological symptoms were analyzed with multivariate regression.

RESULTS

Patients (n = 96) were predominately male (83%) and Caucasian (79%), aged 55.8 ± 12.3 years, BMI of 29.7 ± 5.1, with heart failure with reduced ejection fraction (HFrEF; 30.9 ± 9.9%). An increase in PA Steps was associated with improvement in anxiety (β = -1.178, p = .048). An increase in PA Intensity was associated with significant reductions in depression (β = -0.127, p = .021), anxiety (β = -0.234, p = .037), and fatigue (β = 0.528, p = .022). Decreases in PA Steps and PA Intensity were not associated with changes in any symptoms.

CONCLUSION

For HF patients with an ICD, more intense PA over 2 months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with changes in symptoms. Interventions promoting increasing the intensity of PA over time may be an effective approach to reduce some HF symptoms.

Supporting Physical and Mental Health in Rural Veterans Living With Heart Failure: Protocol for a Nurse-Led Telephone Intervention Study

BACKGROUND

Heart failure (HF) remains a disease of notable disparity for rural veterans, despite recent advancements in clinical treatment. Managing HF in the home is stressful and complex for rural veterans who experience unique barriers to optimal physical and mental health, necessitating adequate support and problem-solving skills.

OBJECTIVE

This study aims to (1) adapt, to the rural sociocultural context, a culturally sensitive, tailored, telephone support and problem-solving intervention (CARE-HF [Supporting Physical and Mental Health in Rural Veterans With Heart Failure]) using findings from preliminary qualitative research and (2) evaluate the effects of CARE-HF on problem-solving and physical and mental health outcomes among rural veterans with HF.

METHODS

This study involves a repeated-measures, single-group design. The intervention content was adapted and tailored to the rural sociocultural context using preliminary qualitative data and guided by the Theories of Social Problem-Solving and Stress, Appraisal, and Coping. Veterans are recruited from Veterans Administration home-based cardiac rehabilitation clinics, cardiology clinics that serve veterans, veterans-based community resource centers, and social media campaigns. Veterans with HF (N=100) receive the CARE-HF intervention. This nurse-led intervention comprises 8 telephone sessions that use a five-step, problem-solving process to manage common HF problems in the home: (1) identifying the problem and viewing it in a positive manner, (2) goal setting, (3) generating potential strategies for problem management, (4) choosing and implementing strategies to manage the problem, and (5) evaluating strategy effectiveness. Veterans receive initial problem-solving training during the first session, with follow-up sessions focusing on problem-solving skill reinforcement and assisting veterans in applying these principles to manage self-identified, HF-related problems experienced in the home. Data are collected at baseline and 3, 6, 12, and 18 months from baseline on problem-solving and outcomes of interest (ie, HF self-care; HF symptoms; health care utilization; depressive symptoms; anxiety; HF-specific, health-related quality of life; stress; resilience; and coping). Demographic data will be analyzed using descriptive statistics and multilevel growth curve modeling with restricted maximum likelihood estimation to compare a series of models using Akaike information criteria and Bayesian information criteria fit indices while controlling for covariates.

RESULTS

Recruitment started in April 2023. As of December 2024, we have enrolled 56 veterans. Recruitment is anticipated to end in June 2025, with data collection continuing until all enrolled veterans have completed the 18-month follow-up period.

CONCLUSIONS

Adapting and testing a culturally sensitive, tailored, telephone intervention to aid support and problem-solving in the home has the potential to provide individualized care to rural veterans where they reside, thereby reducing travel burden while also increasing access to evidence-based care programs. If effective, telephone support and problem-solving interventions could be a low-cost, accessible method to improve physical and mental health in rural veterans with HF.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05839067; https://clinicaltrials.gov/study/NCT05839067.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63498.

Burden of psychological symptoms and disorders among individuals with hepatitis B: a systematic review, meta-analysis and meta-regression

Introduction

Hepatitis B is a highly contagious viral infection that has long been a significant global health concern. Given its adverse effects on the course of the disease, evaluating psychiatric outcomes is important. Despite indications of an increased risk of psychological outcomes among those with hepatitis B, the extent of this association remains unclear.

Methods

This PRISMA-adherent systematic review (PROSPERO: CRD42024564246) searched PubMed, Embase, Cochrane, and PsycINFO for all studies evaluating the prevalence and risk of anxiety and depressive symptoms in individuals with hepatitis B. Random effects meta-analyses and meta-regression were used for primary analysis.

Results

A total of 31 studies were included. We identified a high prevalence of depressive symptoms (Proportion=19%, 95% CI: 11-31) and anxiety (Proportion=30%, 95% CI: 18-45) among individuals with hepatitis B. There was also a significantly increased risk of depressive symptoms (RR=1.45, 95% CI: 1.00-2.09, P=0.049) and anxiety (RR=1.40, 95% CI: 1.11-1.78) in individuals with hepatitis B compared to controls. Subgroup analyses indicated that older age and chronic hepatitis B infection were associated with a higher prevalence of anxiety and depressive symptoms. The systematic review found that being single, unemployed, having a lower income, a lower education level, high comorbidities, and a family history of mental illness were significant risk factors for poorer psychological outcomes.

Conclusion

Our study highlights an increased vulnerability to anxiety and depressive symptoms among individuals with hepatitis B. We emphasize the urgent need for early detection and additional support for this at-risk group.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024564246.

Heart and brain interactions in heart failure: pathophysiological mechanisms and clinical perspectives

Heart failure (HF) is a complex and debilitating syndrome that affects millions of people worldwide. In addition to the syndrome-related functional limitations, such as exercise intolerance and dyspnea, patients frequently suffer from various comorbidities. Neuropsychiatric conditions, including autonomic dysfunction, cognitive impairment, and depression, are important albeit underrecognized comorbidities in HF. Autonomic dysfunction, which is expressed as sympathetic predominance and decreased parasympathetic tone, is a key contributor to HF progression. Depression and cognitive impairment are highly prevalent in HF patients, affecting adherence to medical treatment and increasing morbidity and mortality risk. Stress cardiomyopathy, a usually reversible form of left ventricular dysfunction triggered by emotional or physical stress, is another clinical manifestation of the interplay between the heart and the brain. Early recognition and management of these comorbidities in HF patients are crucial for improving outcomes. This narrative review provides an overview of the pathophysiological mechanisms linking HF and brain disorders and discusses clinical perspectives of heart-brain interactions in the context of HF.

Impact of Anxiety During Hospitalization on the Clinical Outcome of Patients With Osteoporotic Thoracolumbar Vertebral Fracture

STUDY DESIGN

Multicenter prospective cohort study.

OBJECTIVES

Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whether anxiety has an impact on the short-term functional outcome of patients with an OVCF. Furthermore, a direct impact of the fracture on the patient's anxiety during hospitalization should be recognized.

METHODS

All inpatients with an OVCF of the thoracolumbar spine from 2017 to 2020 were included. Trauma mechanism, analgetic medication, anti-osteoporotic therapy, timed-up-and-go test (TuG), mobility, Barthel index, Oswestry-Disability Index (ODI) and EQ5D-5L were documented.For statistical analysis, the U test, chi-square independence test, Spearman correlation, General Linear Model for repeated measures, Bonferroni analysis and Wilcoxon test were used. The item anxiety/depression of the EQ5D-5L was analyzed to describe the patients' anxiousness.

RESULTS

Data from 518 patients from 17 different hospitals were evaluated. Fracture severity showed a significant correlation (r = .087, P = .0496) with anxiety. During the hospital stay, pain medication (P < .001), anti-osteoporotic medication (P < .001), and initiation of surgical therapy (P < .001) were associated with less anxiety. The anxiety of a patient at discharge was negatively related to the functional outcomes at the individual follow-up: TuG (P < .001), Barthel index (P < .001), ODI (P < .001) and EQ5D-5L (P < .001).

CONCLUSIONS

Higher anxiety is associated with lower functional outcome after OVCF. The item anxiety/depression of the EQ5D-5L provides an easily accessible, quick and simple tool that can be used to screen for poor outcomes and may also offer the opportunity for a specific anxiety intervention.

Beyond Guideline-Directed Medical Therapy: Nonpharmacologic Management for Patients With Heart Failure

Heart failure (HF) is a leading cause of cardiovascular morbidity, mortality, and health care expenditure. Guideline-directed medical therapy and device-based therapy in HF are well established. However, the role of nonpharmacologic modalities to improve HF care remains underappreciated, is underused, and requires multimodal approaches to care. Diet, exercise and cardiac rehabilitation, sleep-disordered breathing, mood disorders, and substance use disorders are potential targets to reduce morbidity and improve function of patients with HF. Addressing these factors may improve symptoms and quality of life, reduce hospitalizations, and improve mortality in heart failure. This state-of-the-art review discusses dietary interventions, exercise programs, and the management of sleep-disordered breathing, mood disorders, and substance use in individuals with heart failure. The authors review the latest data and provide optimal lifestyle recommendations and recommended prescriptions for nonpharmacologic therapies.

Quality of life is an independent predictor of mortality in patients with heart failure: a prospective cohort study from the Colombian heart failure registry (RECOLFACA)

AIMS

Patients with heart failure (HF) commonly have poor quality of life (QoL), secondary to the persistence and severity of HF symptoms. We aimed to evaluate the prognostic value of QoL measures on all-cause mortality in patients with HF from the Colombian registry of heart failure (RECOLFACA).

METHODS AND RESULTS

We analysed data from patients registered in RECOLFACA during 2017-19. QoL was measured using the EuroQol-5D questionnaire (EQ-5D). From the questionnaire, two independent predictors of mortality were obtained, the visual analogue scale (VAS) and the utility score (US). The primary outcome was all-cause mortality, and secondary variables evaluated were demographic factors, comorbidities, NYHA classification, medications used, and laboratory test results. To analyse survival among patients, the Kaplan-Meier method and the hierarchical Cox proportional hazards regression model were used. This study included 2514 patients from RECOLFACA. Most patients were male (57.6%), and the mean age was 67.8 years. The mean value and standard deviation (SD) of the VAS score was 78.8 ± 20.1 points, while the mean and SD of the US score was 0.81 ± 0.20. As the Kaplan-Meier curve illustrated, patients in the lower quartiles of both VAS and US scores had a significantly higher probability of mortality (log-rank test: P < 0.001 for both scores).

CONCLUSION

QoL, as calculated by the EQ-5D questionnaire, served as an independent predictor of mortality in patients from RECOLFACA. Further studies may be needed to evaluate whether the provision of optimizing therapies and follow-up care based on patients' perceived QoL reduces short- and long-term mortality rates in this population.

Adapting and Implementing a Blended Collaborative Care Intervention for Older Adults with Multimorbidity: Quantitative and Qualitative Results from the ESCAPE Pilot Study

Multimorbidity poses significant challenges for patients and healthcare systems, often exacerbated by fragmented care and insufficient collaboration across providers. Blended Collaborative Care (BCC) is a promising strategy to address care complexity by partnering care managers (CMs) with primary care providers (PCPs) and specialists. This study aimed to adapt and pilot a BCC intervention for patients aged 65+ with heart failure and physical-mental multimorbidity. Our objectives were to assess the feasibility of the study procedures, patient recruitment, participant satisfaction and acceptability, and to identify necessary adjustments for improving intervention delivery. We evaluated goal attainment and intervention fidelity through standardised electronic documentation by CMs, and patient acceptance and satisfaction through semi-structured interviews. A monocentric, one-arm pilot study involved nine patients with a mean of 6.7 contacts with their CM over three months. Patients' health goals primarily focused on lifestyle changes and psychosocial support. The intervention was generally well-accepted, with no reported negative consequences. Difficulties in establishing working alliances with PCPs were a barrier to effective implementation. The analysis indicated the need for minor procedural adjustments. Next steps include launching the ESCAPE trial, a large randomised-controlled trial across different European healthcare systems and developing strategies to facilitate PCP involvement.

The associations of cardiovascular health and all-cause mortality among individuals with depression

The association between the recently updated cardiovascular health (CVH) assessment algorithm, the Life's Essential 8 (LE8), and all-cause mortality among adults with depression remains unknown. From the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018, a cohort of 2,935 individuals diagnosed with depression was identified. Their CVH was evaluated through the LE8 score system. The investigation of mortality status utilized connections with the National Death Index up to December 31, 2019. To assess the impact of CVH on mortality risk, Kaplan-Meier survival analysis and Cox proportional hazards models, adjusting for variables related to demographics and socioeconomic status, were applied. Among 2,935 participants, those with higher CVH levels had significantly lower all-cause mortality compared to those with lower CVH levels. Cox regression analyses demonstrated that each 1-point increase in CVH score was associated with a lower risk of all-cause mortality [HR = 0.97, 95%CI:0.96-0.98]. The inverse association between CVH and mortality persisted across different demographic and socioeconomic subgroups. Higher CVH levels were associated with a significantly lower risk of all-cause mortality in individuals with depression. These findings underscore the importance of comprehensive CVH management as part of healthcare strategies for people with depression, suggesting that improving CVH may contribute to longer life expectancy in this vulnerable population.

Deciphering the Psychological Characteristics of Takotsubo Cardiomyopathy and Acute Myocardial Infarction

Background/Objectives: Takotsubo syndrome (TTS) shares many clinical features with acute myocardial infarction (AMI); however, its underlying pathophysiology remains elusive due to specific characteristics (i.e., reversibility, presence of stressors, and low mortality rate). Emerging evidence suggests that TTS often emerges following significant somatic, emotional, or psychological stressors. Several studies have investigated the biological factors that may contribute to the onset of TTS, including the release of stress hormones. However, the psychological characteristics associated with TTS, which may be useful for differentiating TTS from other cardiovascular conditions, remain poorly explored. This study aims to overcome these limitations by evaluating whether certain psychological features may allow this specific clinical condition to be differentiated from other cardiovascular conditions. Methods: This study compared three groups of individuals: patients with TTS (N = 56), patients with AMI (N = 52), and individuals without a history of cardiovascular disease (N = 56). Patients were examined three months after the acute phases. The objective was to identify and examine multiple psychological factors involved in TTS, including state and trait anxiety, symptoms of depression, psychological symptoms, distress, perceived social support, and health locus of control. Results: The results indicate that patients with TTS exhibited higher levels of somatization, trait anxiety, obsessive-compulsiveness, and overall psychological distress than patients with AMI and control groups. These findings were associated with an internal health locus of control and low-risk lifestyles. Conclusions: This psychological exploration of TTS reveals a multifaceted relationship between the mind and the heart, challenging traditional notions of cardiovascular pathophysiology and suggesting the importance of considering the cardio-psychological health of patients in both preventive and intervention programs.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BACKGROUND

The behavioral disorder is characterized by a profound abnormality in an individual's cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.

METHODS

This cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6-17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.

RESULTS

The study included 166 children with a median age of 15 years [Interquartile range (IQR):13-17 years]. One-fourth of children, 24.7% (95% CI: 18.34-31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09-0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11-0.79, P 0.016) had lower odds for behavioral problems.

CONCLUSION

One-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

Reducing sedentary behavior improves depressive symptoms among patients with heart failure enrolled in a home-based mobile health app cardiac rehabilitation

BACKGROUND

Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.

OBJECTIVE

Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.

METHODS

A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.

RESULTS

Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.

CONCLUSION

The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.

CLINICAL RELEVANCE

The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.

Clinical and Psychological Factors Associated with Frailty in Patients with Heart Failure

Background/Objectives: Heart failure (HF) is a significant public health issue with high morbidity and mortality rates. This study aims to investigate the interrelationships between frailty, cognitive impairment, and depression in older adults with HF, specifically focusing on how the physical and neuropsychiatric dimensions of frailty contribute to cognitive decline. Methods: This study included 250 patients aged 60 years or older, diagnosed with HF and hospitalized for acute decompensated HF. The patients were assessed using standardized protocols for frailty, cognitive function, and depression. The frailty was evaluated using Fried's phenotype criteria, cognitive function with MMSE and MoCA, and depression and anxiety with HADS and PHQ-9. Statistical analyses included univariable and multivariable linear regression to identify the predictors of frailty. Results: Of the 250 patients, 151 (60.4%) were identified as frail. The frail patients were older (mean age 73.58 ± 6.80 years) compared to the non-frail patients (mean age 70.39 ± 6.16 years, p = 0.0002). Significant differences were observed in the NYHA class, length of the hospital stay, and prevalence of diabetes mellitus. The frail patients had worse cognitive (MMSE: 27.39 ± 2.12 vs. 28.13 ± 1.72, p = 0.004; MoCA: 24.68 ± 3.65 vs. 25.64 ± 3.98, p = 0.050) and psychological outcomes (higher prevalence of marked depression based on HADS categories: 8.61% vs. 1.01%, p = 0.021; and PHQ-9 categories: severe depression: 2.65% vs. 1.01%, p < 0.001). Conclusions: Age, C-reactive protein (CRP) levels, and anxiety were identified as independent predictors of frailty in the patients with heart failure. Depression, cognitive dysfunction, and the length of the hospital stay showed significant differences between the frail and non-frail patients in the group comparisons but were not independent predictors.

Top Ten Tips Palliative Care Clinicians Should Know About the Psychiatric Manifestations of Nonpsychiatric Serious Illness and Treatments

Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature. This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. Building upon the first article, which focused on 10 common physical manifestations of psychiatric illness among patients receiving PC, these two articles advocate for an integrated approach to PC that prioritizes mental and emotional wellbeing across the continuum of serious illness.

Recognition of psychological comorbidity and psychotherapeutic treatment status of ventricular assist device patients

BACKGROUND

Due to its high impact on quality of life and mental health, close monitoring and often psychotherapy is recommended for patients with a ventricular assist device (VAD). This study investigates the psychological comorbidity and the corresponding psychotherapeutic treatment situation of VAD patients. Special attention is also given to the professional perspective VAD team (assistant and senior cardiologists and specialized nurses).

METHODS

We conducted a cross-sectional observational study. Data from 50 VAD patients (mean age = 53.52, standard deviation = 13.82 years, 84.0% male) and their VAD team were analyzed. The presence of a psychological disorder was evaluated by structured clinical interviews for DSM-IV (SCID-I-Interviews). Patients answered a questionnaire regarding their current psychotherapeutic treatment status and their attitude towards psychotherapy. The VAD team answered a questionnaire about the patients' needs for psychotherapy and indicated whether they addressed this topic with the patient. Data were analyzed descriptively, by analysis of variance and t-test.

RESULTS

A total of 58% of VAD patients suffered from at least one significant psychological disorder, 79.3% of those were not in psychotherapy. The VAD team could not identify the patients who suffered from a psychological disorder (F = 1.90; p = 0.18). They perceived more need for psychotherapy than they addressed with their patients (T = 3.39; p < 0.001).

CONCLUSIONS

While there is a high psychological morbidity among VAD patients, only few receive psychotherapy. Psychological comorbidity is not easily detected by the VAD team. Standardized psychosocial care could be implemented by regular psychological assessments and further information of patients and their VAD teams.

Symptoms and negative emotions in patients with advanced thyroid cancer: a prospective cross-sectional study

BACKGROUND

There is no relevant research on the symptoms and emotions of patients with advanced thyroid cancer in mainland China.

AIM

To investigate the symptoms and negative emotions of patients with advanced thyroid cancer and to analyze the correlation between the two preliminarily.

METHODS

Using a convenience sampling method, 180 patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at West China Hospital of Sichuan University from January 2023 to December 2023 were selected as the research subjects. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY) and Hospital Anxiety and Depression Scale (HADS). The correlation between symptom severity and negative emotions was determined by Spearman correlation analysis.

RESULTS

Disturbed sleep was the symptom with the highest incidence (74.4%) and the greatest severity (3.0 points), while mood distress was the symptom with the highest incidence (63.3%) and the greatest severity (2.0 points). 71 patients (39.4%) had anxiety, and 62 patients (34.4%) had depression. All symptoms and symptom interference were positively correlated with anxiety and depression (P < 0.05).

CONCLUSION

Patients with advanced thyroid cancer have multiple symptoms that seriously affect their daily lives and emotions. Medical staff should conduct targeted observation and preventive treatment to reduce the burden of symptoms and improve the negative emotions of patients.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study

Background: Depression is a known factor in poor cardiovascular outcomes but is often underassessed in cardiac units. This study evaluates the impact of depression on cardiovascular outcomes in patients undergoing cardiac interventions. Methods: The study included 133 patients who underwent uncomplicated procedures for degenerative aortic valve stenosis (n = 40), acute coronary syndrome (n = 29), or chronic coronary artery disease (n = 64). Depression was assessed using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D). The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE). Patients were followed up for 12 months. Cox proportional hazards analysis was used to identify MACCE risk factors. Results: Depression was more frequently screened by HAM-D than BDI (42.9% vs. 30.8%, p < 0.001). During follow-up, 26 (19.5%) MACCEs occurred. In univariate analysis, risk factors included BDI score ≥ 11, HAM-D score ≥ 8, diabetes on insulin, anticoagulant use, atrial fibrillation, and serum creatinine level ≥ 130 µmol/L. Depression in the BDI increased the risk of the MACCE 3.6-fold (95%CI: 1.64-8.0, p = 0.001), whereas in the HAM-D, it increased the risk 4.9-fold (95%CI: 1.97-12.24, p < 0.001). Multivariate analysis showed HAM-D score ≥ 8 as the strongest predictor of MACCE (HR: 3.08, 95%CI: 1.18-8.08). Conclusions: Depression is a common finding in cardiovascular patients, and it is a strong risk factor for one-year cardiovascular mortality and adverse event risk. Therefore, we believe that common guidelines should be elaborated between relevant psychiatry and cardiology scientific societies.

Network analysis of anxiety and depressive symptoms among patients with heart failure

BACKGROUND

Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF.

METHODS

This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R.

RESULTS

In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family).

CONCLUSIONS

This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression.

Prevalence and risk of hospitalization for depression in patients with heart failure

BACKGROUND

Patients with heart failure could have a high prevalence of depression which may increase the risk of hospitalization. So this study is to estimate the prevalence of depression among patients attending heart failure clinics, and determine whether depression increases the risk of hospitalization in patients with heart failure.

METHODS

In this analytical cross-sectional study, we interviewed patients with heart failure and identified those with depression; the Patient Health Questionnaire-9 was used to estimate the prevalence of depression and assess clinical outcomes, including the risk of hospitalization.

RESULTS

A total of 200 patients with a mean age of 64,44±13,865 years were analyzed. The prevalence of depression among them was 36.5%. and it affected by factors like employment, education, and medical status, as Patients on diuretics were found to be greater at 41.1% than non-users at 19% (p=0,008). The majority of the patients with both heart failure and depression were hospitalized twice or more during the last year 54.8% (p=0,001).

CONCLUSION

The prevalence of depression among patients with heart failure is high, which increases the risk of hospitalization.

Analysis of Depression in Aged, Hospitalized Patients with Chronic Heart Failure

Objective

The objective is to investigate the situation and risk factors of depression in aged, hospitalized patients with chronic heart failure (CHF).

Methods

A total of 196 aged CHF patients admitted to Xuanwu Hospital from May 2022 to March 2024 were consecutively selected. Information such as demographics, comorbidities, old-age hospitalization assessment results, and admission test results was collected. Differences were found between the patients admitted with CHF and depression and those without depression. Independent predictors of depression in aged, hospitalized patients with CHF were identified using logistic regression analyses. The sensitivity and specificity of age, frailty score, and New York Heart Association (NYHA) classification to evaluate the occurrence of depression were examined by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

Results

Increased age [OR (Odds Ratio) = 1.132, (95% CI [Confidence Interval], 1.050-1.221), P = .001], higher frailty score [OR = 8.324, (95% CI, 4.233-16.368), P < .001], and higher NYHA classification [OR = 3.806, (95% CI, 1.864-7.773), P < .001] were independent predictors of depression in aged CHF hospitalized patients. The best indicators for the occurrence of depressive symptoms were age of 75 years, a score of 2 for frailty, and an NYHA classification of III. The AUCs for age, frailty score, and NYHA classification were 0.764, 0.876, and 0.707, respectively.

Conclusion

Clinical assessment of depression is necessary for aged, hospitalized CHF patients. Patients over 75 years old, with a frailty score of at least 2, and an NYHA classification of III or IV are more prone to depression, which requires attention.

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.

A Self-Administered Eating Behavior Scale for Patients With Heart Failure Living at Home: Protocol for a Mixed Methods Scale Development Study

BACKGROUND

The prevalence of heart failure (HF) is increasing worldwide, with the associated mortality rates rising consistently. Preventing HF progression requires adherence to restricted sodium intake alongside sufficient and balanced nutritional consumption. For patients at home, preparing nutritionally balanced meals is essential, either self-assisted or with the aid of close individuals. Patients with HF frequently experience decreased exercise tolerance, depression, anxiety, and social isolation, which interfere with eating behaviors, leading to inadequate dietary habits. However, measures focusing on the determinants of eating behavior among patients with HF are currently lacking.

OBJECTIVE

This study aims to develop a self-administered scale to assess the eating behaviors of patients with HF living at home (Self-Administered Eating Behaviors Scale for Heart Failure [SEBS-HF]).

METHODS

This study encompasses 3 phases. Phase 1 involves identifying factors influencing eating behaviors in patients with HF. First, a literature review will be conducted using PubMed and CINAHL databases. The specified literature will be analyzed qualitatively and inductively. Additionally, verbatim transcripts obtained from semistructured interviews of patients with HF and medical experts will be qualitatively analyzed. Based on the Phase 1 results, a preliminary scale will be constructed. In Phase 2, cognitive interviews will be conducted with patients with HF and experts; the preliminary scale will be used to qualitatively evaluate its content validity. After validation, the scale will be used in Phase 3 to conduct a cross-sectional study involving patients with HF. In Phase 3, data will be collected from clinical records and self-administered questionnaires or scales. After conducting a preliminary survey, the main survey will be conducted. The reliability and validity of the scale will be assessed using statistical methods.

RESULTS

The first phase of this study commenced in September 2023, and by May 2, 2024, a total of 7 patients with HF and 6 expert professionals were enrolled as study participants. The draft creation of the scale will be completed in 2024, and the content validity evaluation of the draft scale is expected to be finished by early 2025. The third phase will begin its investigation in mid-2025 and is expected to be completed by late 2025, after which the SEBS-HF will be published.

CONCLUSIONS

The development and use of this scale will enable a more comprehensive evaluation of the factors influencing eating behaviors in patients with HF. Thus, medical and welfare professionals should provide appropriate support tailored to the specific needs of patients with HF.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60719.

Relationships between heart failure, depression, and anxiety: A Mendelian randomization study

Growing evidence suggests that heart failure (HF) is associated with an increased risk of depressive disorders and anxiety. However, the existing studies were observational and may have confounded and not reflected true causal relationships. This study collected genetic instruments about HF, depression, and anxiety from publicly available genetic summary data. Two-sample Mendelian randomization (MR) analysis was performed, with inverse-variance weighted designated as the primary approach for determining causal effects. Secondary analyses included MR-Egger regression and the weighted media method. Additionally, we conducted MR pleiotropy residual sum and outlier to address horizontal pleiotropy. Cochran Q test, MR-Egger intercept test, and leave-one-out analysis were used to assess the robustness of the findings. The significance is determined by a P-value below .05. Gene prediction result revealed that HF did not exhibit a significant association with elevated incidence of depression by inverse-variance weighted method no matter HF from the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.93-1.18, P = .424 for major depressive disorder, MDD; OR = 1.01, 95% CI = 0.94-1.09, P = .782 for major depression) or the FinnGen Consortium (OR = 1.03, 95% CI = 0.92-1.15, P = .644 for MDD; OR = 1.00, 95% CI = 0.94-1.07, P = .962 for major depression). In contrast, the results of HF on anxiety exhibited inconsistency (OR = 1.60, 95% CI = 1.10-2.31, P = .013 for Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium; OR = 1.42, 95% CI = 0.91-2.21, P = .123 for FinnGen Consortium); however, a combined effect analysis indicated support causal relationship between HF and the risk of anxiety (OR = 1.52, 95% CI = 1.07-2.00, P < .001). Our findings did not reveal evidence to confirm a causal association between HF and depression. However, our results provide support for a causal effect of HF on the risk of anxiety.

A Study on the Current Situation and Related Factors of Personal Mastery in Patients with Chronic Heart Failure: A Cross-Sectional Study

Purpose

To explore the status quo and influencing factors of personal mastery in Chinese patients with chronic heart failure, based on the analysis of patient characteristics.

Methods

The sample of the study comprised 249 chronic heart failure patients who visited a university hospital in China. We collected the data using general demographic Information, personal mastery scale, the Simple Coping Style Questionnaire and Minnesota Living With Heart Failure Quality of Life Questionnaire (MLHFQ). SPSS26.0 was used to describe the survey results statistically, and univariate analysis, Pearson correlation analysis and multiple linear regression were used to analyze the influencing factors of personal sense of control.

Results

Chronic heart failure patients' total personal mastery scores were (20.63±4.486), which is in the medium level. Multiple linear regression analysis shows that Age group (β=-1.627, p=0.036), NYHA functional classification (β=-1.563, P<0.001), Positive coping style (β= 0.088, P=0.004) and MLHFQ (β= -0.121 P<0.001) significantly influenced patients' personal mastery (P<0.001).

Conclusion

Our study suggests that the personal mastery of patients with chronic heart failure is at a moderate level in China. Additionally, age group, NYHA functional classification, Positive coping style and MLHFQ emerged as significant influencing factors. Clinical staff should dynamically observe the changes in the level of personal mastery of patients with chronic heart failure, pay more attention to the elderly and patients with poor heart function according to the influencing factors, and encourage active responses to improve the level of personal mastery of patients with heart failure.

Depressive symptomatology, NT-proBNP levels and health status in patients with heart failure: a prospective observational study

Background

Depressive symptoms frequently occur in patients with heart failure (HF). However, research on the relationship between these symptoms and N-terminal pro-brain natriuretic peptide (NT-proBNP), a key biomarker for HF severity and treatment, is scarce and yields inconsistent results.

Aims

This study investigates the relationship among depressive symptomatology, NT-proBNP and health status in a cohort of patients with HF. Additionally, it assesses the impact of depressive symptoms on their clinical outcomes.

Methods

A cohort of 151 patients with HF was followed for 1 year. The Hospital Anxiety and Depression Scale-Depression (HADS-D) Score was used to assess anxiety and depressive symptoms, and NT-proBNP levels were measured. Health status was evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Results

Patients with HADS-D scores>5 points showed significantly higher NT-proBNP levels and lower KCCQ scores at baseline. Over the year, changes in HADS-D scores correlated positively with changes in NT-proBNP levels and negatively with changes in KCCQ scores. A baseline HADS-D score>5 points was significantly associated with an increased risk of the composite outcome of all-cause mortality and HF hospitalisation, even after adjusting for baseline characteristics (adjusted hazard ratio (HR): 2.17; 95% CI 1.05 to 4.48; p=0.036).

Conclusions

HADS-D scores are significantly correlated with NT-proBNP levels and health status in patients with HF. A baseline HADS-D score>5 points is significantly associated with an elevated risk for the composite outcome of all-cause mortality and hospitalisation due to HF.

The Relation between Parameters of Physical Performance and Depression in Consecutive Hospitalized Geriatric Patients with Heart Failure

BACKGROUND

In the geriatric population, the risk of cardiometabolic diseases is strongly influenced by comorbidities. The aim of the study was to estimate the prevalence of depression among hospitalized patients with heart failure (HF) and to assess the relation between physical performance and depression in this population.

METHODS

We included consecutive hospitalized patients with HF aged >65 years. The depression symptoms were evaluated using the Geriatric Depression Scale (GDS), the physical performance was assessed using the grip strength measurements, the Back Scratch Test, the Timed Up and Go Test (TUGT), the Five Times Sit to Stand Test (5 × SST), and the 6 min walk test.

RESULTS

We included 206 patients (134 females and 72 males, median age 82 years (77-86) years). Altogether, 33% of participants had signs of depression. The association was found between depression severity and economic status (p = 0.001), stressful events (p = 0.005), self-reported general health status (p = 0.001), and heart failure severity assessed by the New York Heart Association class (NYHA), p = 0.003. The Back Scratch Test, the TUGT, and the 5xSST were associated with depression severity in a univariable regression analysis (β coefficient 0.04 [95% CI 0.00-0.08], 0.20 [95% CI 0.12-0.27], 0.18 [95% CI 0.07-0.27], respectively); however, when adjusted for co-factors, the TUGT and the 5xSST (0.17 [95% CI 0.08-0.26] and 0.14 [95% CI 0.02-0.26], respectively) were significantly related to the GDS score. Grip strength and the 6 min walk test were not related to the GDS score in the univariable nor multivariable analysis. These findings were confirmed in the logistic analyses.

CONCLUSIONS

Our study indicated a high incidence of depression among elderly hospitalized patients with heart failure. Depression severity in older patients with HF is related to physical performance decline as assessed by the Timed Up and Go Test and the Five Times Sit to Stand Test. Grip strength and the 6 min walk test are not related to the GDS score in this population.

Circulating brain-derived neurotrophic factor levels and heart failure: A systematic review and meta-analysis

AIMS

Biomarkers are paramount for managing heart failure (HF) patients as prognostic and therapeutic efficacy index tools. Systemic levels of brain-derived neurotrophic factor (BDNF) can add to the HF biomarker scenario, allowing for potentiated efficacy in diagnosis, prognostic stratification, and prediction of patient response to a given therapeutic intervention because BDNF is one of the primary rulers of myocardial function. Yet, whether BDNF is a reliable clinical biomarker awaits clinical validation. Hence, we aimed to answer this relevant question via a systematic review and meta-analysis of existing studies.

METHODS AND RESULTS

International databases, including PubMed, Scopus, Embase, and the Web of Science, were comprehensively searched for studies assessing BDNF levels in patients with HF versus non-HF controls or as a prognostic factor for HF complications. Data were extracted and analysed by random-effect meta-analysis. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were computed to pool the results of studies. We included 11 studies in the final review, among which six underwent meta-analysis. These studies analysed 1420 HF patients, with a mean age of 65.4 ± 11.2 years. Meta-analysis revealed that patients with HF had significantly lower circulating BDNF levels than healthy controls (SMD -2.47, 95% CI -4.39 to -0.54, P-value = 0.01). Moreover, patients with higher New York Heart Association functional classification had lower levels of BDNF. Adverse clinical outcomes such as all-cause mortality and HF rehospitalization were also associated with lower levels of BDNF in individual studies.

CONCLUSIONS

BDNF levels are decreased in patients with HF. Most importantly, we observed an association between lower BDNF levels and poor prognosis in patients with HF. Our study supports BDNF as an easy-to-dose diagnostic and prognostic biomarker to be implemented in clinical practice for HF. Further studies are warranted to address this ability specifically.

Depressive Symptoms and Left Ventricular Diastolic Dysfunction Among Men and Women with HIV

Background and Aim

The prevalence of depressive symptoms and major depressive disorder is high among adults living with HIV. Depressive symptoms are associated with increased cardiovascular disease risk. This study examined the association between depressive symptoms and echocardiographic indices of left ventricular diastolic dysfunction (LVDD) among men and women living with and without HIV.

Methods

Cross-sectional analysis included individuals in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) who participated in transthoracic echocardiogram substudies and completed measures of depressive symptoms at the same visit as, or up to 6 months prior to, the transthoracic echocardiogram visit. Participants had helper T cells (CD4) >350 cells/mm3 and HIV RNA viral load <499 copies/mL. The presence of LVDD was defined according to the Characterizing Heart Function on Antiretroviral Therapy (CHART) criteria. Secondary outcomes were continuous values of each component of the CHART criteria: left ventricular ejection fraction >50%, septal e' velocity, lateral e' velocity, left atrial volume index, left ventricular mass index, and relative wall thickness. Logistic and linear regression were used to adjust for sociodemographic, behavioural, cardiometabolic, and HIV-related factors.

Results

Among 874 men (51% with HIV) and 1,191 women (76% with HIV), in whom the overall prevalence of LVDD was 22.5% and depressive symptoms 30.8%, depressive symptoms were not significantly associated with LVDD. The associations between individual LVDD components and depression were in the small to medium range, though generally not significant.

Conclusion

Findings warrant further research regarding the association between LVDD and depressive symptoms in the era of combination antiretroviral therapy.

The Association between Aortic Valve Stenosis and a Subsequent Diagnosis of Depression in Germany

Background/Objectives: Aortic valve stenosis (AS) represents one of the most common valve diseases in the western world. It often leads to severe symptoms that can lead to a restriction of everyday life and thus to psychological stress. Therefore, we aimed to investigate the association between AS and depression in outpatients in Germany. Methods: The IQVIATM Disease Analyzer database was used to identify 14,681 individuals with non-rheumatic AS (ICD-10: I35.0 or I35.2). They were propensity score matched (1:1) based on age, sex, average yearly consultation frequency during the follow-up, and co-diagnoses to 14,681 patients without AS. Cox regression models were used to analyze the association between aortic stenosis and depression. Results: Within the follow-up period of up to 10 years, depression was diagnosed in 20.6% of AS patients compared to 20.0% in the matched cohort (p = 0.351). In the regression analysis, we were not able to discover an association between AS and a subsequent diagnosis of depression (HR: 1.03; 95% CI: 0.96-1.11). This effect was consistent among different age and sex groups. Conclusions: In the broad population of patients treated outside of hospital settings in Germany, AS was not associated with a higher incidence of depression.

Temporal evolution of anxiety and depression in chronic heart failure and its association with clinical outcome

BACKGROUND

Although anxiety and depression have been associated with adverse outcomes in chronic heart failure (HF), data on temporal evolution of these symptoms are scarce. We aimed to investigate the association between repeatedly measured depression and anxiety symptoms and clinical outcome in chronic HF patients.

METHODS

In this prospective observational study, outpatients with chronic HF were included and followed-up for a maximum of 2.5 years. The hospital anxiety and depression scale (HADS) questionnaire was conducted every six months. The primary endpoint was a composite of HF hospitalization, cardiovascular death, heart transplantation and left ventricular assist device (LVAD) implantation. Cox and joint models were used to investigate the association between the HADS score and the endpoint.

RESULTS

A total of 362 patients filled out a median (25th-75th percentile) of 3 [2-4] questionnaires each. Mean ± SD age was 63 ± 13 years, 72% were men. Anxiety scores remained relatively stable leading up to the endpoint, while depression scores increased. Higher baseline depression scores were significantly associated with the endpoint (hazard ratio [HR] 1.68 and 95% confidence interval [CI] 1.19-2.36 per log(score+1), p = 0.003), while higher baseline anxiety scores did not reach statistical significance (HR [95% CI] 1.34 [0.99-1.83], p = 0.061). When repeatedly measured, both higher anxiety (HR [95% CI] 1.57[1.07-2.30], p = 0.022) and depression (HR [95% CI] 2.04 [1.39-3.06], p < 0.001) scores were significantly associated with the endpoint.

CONCLUSION

Serial measurements of depression and anxiety symptoms identify chronic HF patients with increased risk of adverse clinical outcomes. Screening for both disorders should be considered in clinical practice.

Social Vulnerability and Sickle Cell Disease Mortality in the US

Importance

Social determinants of health (SDOH) influence health outcomes, including those of sickle cell disease (SCD), despite advancements in treatments like disease-modifying therapies.

Objective

To investigate the association of SDOH with SCD mortality rates from 2016 to 2020.

Design, Setting, and Participants

This cross-sectional study combined county-level data from the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) with SCD mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1, 2016, to December 31, 2020. US counties were divided into 4 quartile (Q) models according to their SVI scores. Deaths from SCD in the US among patients of all ages were included. Data analysis occurred from March to April 2024.

Exposure

SVI score.

Main Outcomes and Measures

Age-adjusted mortality rates (AAMRs) per 1 000 000 individuals were measured. Rate ratios (RRs) were obtained by comparing county-specific AAMRs of SVI-Q4 with SVI-Q1.

Results

From 2016 to 2020, among a total population of 1 633 737 771 individuals, there were 2635 deaths from SCD (1289 male [49.1%] and 1336 female [50.9%]). There were 1480 deaths in Q4, 687 deaths in Q3, 344 deaths in Q2, and 114 deaths in Q1. Higher SVI was associated with 2.11 excess deaths per 1 000 000 individuals (RR, 4.90; 95% CI, 4.81-5.00). Similar trends were seen for both males (RR, 4.56; 95% CI, 4.44-4.69) and females (RR, 5.85; 95% CI, 5.68-6.03). Middle-aged patients with SCD had the highest mortality rate in Q4, with 3.45 excess deaths per 1 000 000 individuals (RR, 4.97; 95% CI, 4.85-5.09). Higher SVI was associated with 2.29 excess deaths per 1 000 000 individuals in African American individuals with SCD (RR, 1.24; 95% CI, 1.22-1.27]). In White individuals with SCD, higher SVI was associated with 0.12 excess deaths per 1 000 000 individuals (RR not available due to unreliable data in Q1). When stratifying by census region, the highest level of SCD-related mortality was in the Northeast, with higher SVI associated with 3.16 excess deaths per 1 000 000 individuals (RR, 8.02; 95% CI, 7.66-8.40).

Conclusions

In this cross-sectional study of the association of SVI with SCD mortality rates, higher SVI was associated with higher SCD mortality across US counties. These findings underscore the importance of addressing social determinants of health to improve mortality outcomes among patients with SCD.

Depressive Symptoms and Sleep Quality Mediate the Relationship Between Race and Quality of Life Among Patients With Heart Failure: A Serial Multiple Mediator Model

BACKGROUND

Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL.

OBJECTIVE

The aim of this study was to determine whether depressive symptoms and sleep quality are mediators of the relationship between race and QoL among patients with HF.

METHODS

This was a cross-sectional study. We included 271 outpatients with HF. Self-reported race (White/Black), depressive symptoms (Patient Health Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Kansas City Cardiomyopathy Questionnaire) were collected at baseline. A serial multiple mediator analysis was conducted using the PROCESS macro for SPSS.

RESULTS

Ninety-six patients (35.4%) were Black. Black participants reported higher levels of depressive symptoms and poorer sleep quality than White participants. Race was not directly associated with QoL but indirectly associated with QoL through depressive symptoms and poorer sleep quality. Because of higher levels of depressive symptoms and poorer sleep quality, Black participants reported poorer QoL than White participants.

CONCLUSIONS

Depressive symptoms and sleep quality together mediated the relationship between race and QoL. These findings suggest that screening for depressive symptoms and sleep quality could identify patients at risk for poor QoL, especially in Black patients.

Quality of Life of Patients with Heart Failure Due to Myocardial Ischemia

Background

Heart failure caused by myocardial ischemia is a common cause encountered in clinical practice. A significant problem in heart failure is its progressive, unfavorable course and the associated increased frequency of repeated hospitalizations, as well as a significant deterioration in the functioning of patients, leading to their inability to function independently and a significant decline in the quality of life. This study aimed to assess the quality of life of patients with heart failure due to myocardial ischemia, considering the left ventricular ejection fraction, the number of "diseased" coronary arteries, co-occurring diseases, and cardiovascular risk factors.

Methods

A total of 204 patients with decompensated heart failure due to chronic myocardial ischemia were included in this study and examined twice: A: on the first day of hospitalization; A': from 4 to 8 weeks. For the individual assessment of the quality of life, the WHOQOL-BREF (The World Health Organization Quality of Life - BREF) questionnaire was used.

Results

In the group of patients with heart failure in the decompensation stage a statistically significant positive relationship was observed between the number of comorbidities and the social domain (R(A) = 0.197; p(A) = 0.005), the number of diseased coronary arteries and the mental (R(A) = 0.184; p(A) = 0.184) and environmental (R(A) = 0.149; p(A) = 0.034) domains, left ventricular ejection fraction (LVEF%) and quality of life (R(A) = 0.235; p = 0.001) and satisfaction with health (R(A) = 0.235; p = 0.001) and somatic domain (R(A) = 0.194; p = 0.005). A similar result was observed among patients in the long-term follow-up. A statistically significant negative correlation was demonstrated in the mentioned group between the LVEF% value and the social domain (R(A) = -0.235; p = 0.001), as well as in the long-term follow-up (R(A') = -0.191, p = 0.026). The level of self-assessment of quality of life and satisfaction with health was statistically significantly higher among patients with heart failure in the long-term follow-up (3.20 ± 0.62) than in patients in the decompensation stage (1.98 ± 0.69).

Conclusions

The quality of life of the examined patients with heart failure caused by chronic myocardial ischemia was poor, although it improved to average in the long-term follow-up. It was determined by left ventricular ejection fraction, the number of "diseased" coronary arteries, comorbidities, and risk factors.

Effects of Tactile Massage in Improving Older Residents' Psychological Health in Long-Term Care Facilities: A Randomised Controlled Trial

BACKGROUND

Loneliness, anxiety and depressive symptoms are common among older residents in long-term care facilities (LTCFs), which can negatively impact their quality of life and increase mortality rates. Addressing these psychological health issues is an important task for nursing staff. There is a need for easy and accessible interventions to improve older residents' negative emotions. Tactile massage (TM) is a form of touch therapy that induces oxytocin, which can help individuals feel relaxed, experience pleasure and reduce anxiety. TM can also provide a sense of security and care for individuals.

OBJECTIVE

This study aimed to evaluate the effects of TM in improving older residents' psychological health in LTCFs.

DESIGN

In this study, we applied a two-arm randomised controlled trial research design.

METHODS

We used convenience sampling to enrol 55 older residents in three long-term care facilities who were randomly assigned to an intervention group and a comparison group. The intervention group received TM by research assistants on both hands for 15 min per time, twice a week for 4 weeks and the comparison group received regular care. Data were collected before and after the intervention. Generalised estimating equations (GEEs) were used to evaluate the effectiveness of the intervention.

RESULTS

There were no significant differences in loneliness, anxiety, depressive symptoms, happiness, ear temperature, heart rate or diastolic blood pressure between the two groups after the intervention. However, the intervention group had significant improvements in comfort (B = 0.86, p < 0.001), relaxation (B = 1.00, p < 0.001), respiratory rate (B = -0.16, p = 0.021) and systolic blood pressure (B = - 4.17, p = 0.002) compared to the control group.

CONCLUSIONS

TM can help older residents who live in LTCFs feel relaxed and comfortable.

IMPLICATIONS FOR PRACTICE

TM can be easily implemented as it requires no tools. We recommend that nursing staff and healthcare professionals incorporate TM as part of their care routines. They also can encourage family members to perform TM on residents during their visits to enhance residents' comfort and relaxation.

REPORTING METHOD

The Consolidated Standards of Reporting Trials (CONSORT) checklist was used for this paper.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05052138).

Heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and has a prevalence that is expected to rise with the growing ageing population. HFpEF is associated with significant morbidity and mortality. Specific HFpEF risk factors include age, diabetes, hypertension, obesity and atrial fibrillation. Haemodynamic contributions to HFpEF include changes in left ventricular structure, diastolic and systolic dysfunction, left atrial myopathy, pulmonary hypertension, right ventricular dysfunction, chronotropic incompetence, and vascular dysfunction. Inflammation, fibrosis, impaired nitric oxide signalling, sarcomere dysfunction, and mitochondrial and metabolic defects contribute to the cellular and molecular changes observed in HFpEF. HFpEF impacts multiple organ systems beyond the heart, including the skeletal muscle, peripheral vasculature, lungs, kidneys and brain. The diagnosis of HFpEF can be made in individuals with signs and symptoms of heart failure with abnormality in natriuretic peptide levels or evidence of cardiopulmonary congestion, facilitated by the use of HFpEF risk scores and additional imaging and testing with the exclusion of HFpEF mimics. Management includes initiation of guideline-directed medical therapy and management of comorbidities. Given the significant impact of HFpEF on quality of life, future research efforts should include a particular focus on how patients can live better with this disease.

A systematic review about the importance of neuropsychological features in heart failure: is at heart the only failure?

Heart failure can lead to cognitive impairment that is estimated to be present in over a quarter of patients. It is important to intervene at a cognitive level to promote brain plasticity through cognitive training programs. Interventions transformed by technology offer the promise of improved cognitive health for heart failure patients. This review was conducted on studies evaluating the role of cognitive rehabilitation in patients with heart failure. We examined clinical trials involving patients with heart failure. Our search was performed on Pubmed, Web of Science and Cochrane library databases. Of the initial 256 studies, 10 studies met the inclusion criteria. Cognitive rehabilitation training has important implications for the treatment and prevention of cognitive decline in heart failure patients with significant recovery for delayed recall memory and a significant time effect for total recall memory and delayed, psychomotor speed and IADL performance. It is important to include the assessment of cognitive functioning in the routine clinical examinations of patients with heart failure, discover the relationship between cognitive function and heart failure, and target cognitive rehabilitation programs that promote brain plasticity.

Transition from asymptomatic to symptomatic systolic chronic heart failure: rationale and design of TransitionCHF

AIMS

Chronic systolic heart failure (CHF) is a major health burden. A relevant number of patients shows asymptomatic left ventricular dysfunction (ALVSD) before symptomatic CHF or becomes asymptomatic after initiating heart failure therapy. Clinical course, prognosis, and response to pharmacological and device-based treatment are largely unknown in these two distinct groups of patients. Current pharmacological and interventional therapies do neither properly address the underlying pathophysiology nor prevent malignant loss of function. New therapeutic paradigms are needed to stop the progression from asymptomatic to symptomatic heart failure. Key questions are what causes progression of clinically asymptomatic New York Heart Association (NYHA) I heart failure to overt heart failure (>NYHA I) in some but not all patients and the underlying reasons for this transition. This requires the identification of disease mechanisms and biomarkers that predict outcome in well-defined cohorts for innovative preclinical and clinical trials.

METHODS AND RESULTS

TransitionCHF is a prospective, multicentre, longitudinal pathophysiological evaluation cohort study in patients with asymptomatic systolic dysfunction NYHA I and left ventricular ejection fraction ≤40%. The cohort comprises both incidental findings and patients who had become asymptomatic after a previous symptomatic event. TransitionCHF has recruited 1000 patients with ALVSD caused by various aetiologies in 20 university heart failure clinics across Germany. Both patients with and without comorbidities at study entry will be recruited. Patients will be systematically investigated and followed up annually over the course of the study. The primary composite endpoint is time to hospitalization for heart failure and cardiovascular death. The secondary endpoints assess time to all-cause mortality, to cardiovascular mortality, to heart failure mortality, to all-cause hospitalization, to heart failure hospitalization, and to recurrent heart failure hospitalizations, as well as time to assist device implantation/transplantation. Additional investigations focusing on biomarkers, comorbidities, gender aspects, nutrition, and functional parameters including quality of life will be performed.

CONCLUSIONS

TransitionCHF will provide a more thorough pathophysiological understanding of the progression of asymptomatic systolic dysfunction into symptomatic heart failure that will help develop therapies tailored to prevent progressive heart failure.

[ORPHYS - Treatment Manual for a Short-Term Psychodynamic Psychotherapy in Patients with Serious Physical Illness]

The diagnosis of a life-threatening illness may lead to a breakdown of psychological processing patterns and a reactualization of existential conflicts. The sudden loss of continuity, physical integrity and social roles can overwhelm patients' ability to cope psychologically. Psychosocial and medical care is likely compromised if patients suffer from affective disorders or symptoms of existential distress. Psychodynamic treatments may strengthen the experience of closeness and connectedness in order to cope with losses and enable farewell processes. ORPHYS describes a short-term psychodynamic psychotherapy (12-24 sessions) that aims to address the existential distress of seriously physically ill patients by taking into account relational conflicts at the end of life. The combination of supportive and expressive treatment techniques that focus on patients' subjective experience and illness situation may enable patients to integrate painful affective states and to explore their relationship and coping patterns. ORPHYS can thus facilitate a shared mourning process, in which the intense desire for connectedness at the end of life and the reality of dying can be reconciled.

Patient-centered care for mental health in patients with heart failure in the intensive care unit: A systematic review

AIM

To assess basic data for developing appropriate interventions by examining the effects of patient-centered care (PCC) on the mental health of patients with heart failure in the intensive care unit (ICU).

BACKGROUND

Patients with heart failure are frequently admitted to ICUs, and ICU stays are associated with prolonged mental health problems.

METHODS

We conducted a systematic review using the CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and gray literature databases. Inclusion criteria were studies with participants aged ≥18 years with heart failure in the ICU who received a PCC intervention, and studies that described the outcomes for mental health problems. Data were extracted from five selected studies published after 2020 and analyzed.

RESULTS

PCC is classified into three areas: comprehensive nursing, multidisciplinary disease management, and targeted motivational interviewing with conventional nursing. The two specific areas of focus for PCC regarding mental health were integrated mental healthcare and specific psychological nursing. Specific psychological nursing comprised relationship building, therapeutic communication, relaxation and motivational techniques, active therapeutic cooperation, psychological status evaluation, music therapy, and environmental management.

CONCLUSIONS

This review provides a distinctive understanding of multidisciplinary and multicomponent PCC interventions for patients with heart failure in the ICU as an effective approach for improving their mental health. Future PCC intervention strategies aimed at patients with heart failure in the ICU should consider their preferences and family participation.

A quasi-experimental study to assess the effect of Benson's relaxation on anxiety and depression among patients with heart failure in Jordan

BACKGROUND

Despite advancements in treatment, heart failure (HF) remains a leading cause of death. Anxiety and depression (A&D) are highly prevalent among patients with HF, negatively impacting their mortality, and morbidity. The Benson relaxation technique (BRT) is a non-pharmacological approach that is easy to learn, use, and apply for reducing A&D. This study aimed to investigate the effectiveness of the BRT in reducing A&D among patients with HF in Jordan.

METHODS

This quasi-experimental pre and post-design study involved a consecutive sample of 204 participants with a confirmed diagnosis of HF. Data were collected from four hospitals in Jordan.

RESULTS

A total of 204 patients participated in this study, with 138 males and 66 females. The mean A&D scores for the sample at baseline were 11.09±2.60 and 10.80±2.30, respectively. In the intervention group, there was a statistically significant difference between pre-intervention anxiety and post-intervention anxiety levels (P<0.001), as well as between pre-intervention depression and post-intervention depression levels (P<0.001). In contrast, the control group showed no statistically significant differences between pre-intervention and post-intervention A&D levels (P=0.83 and P=0.34) respectively.

CONCLUSIONS

BRT can be used as an adjunctive intervention for patients with HF to reduce A&D. Healthcare professionals should consider incorporating BRT into treatment plans, while nursing departments can lead its implementation.

Financial burden and physical and emotional quality of life in COPD, heart failure, and kidney failure

Patients with chronic and serious illnesses experience significant quality of life concerns. More research is needed to understand the impact of financial burden on patients with COPD, heart failure, and kidney failure. Patients with COPD, heart failure, or kidney failure completed a cross-sectional online survey using validated measures of financial burden (general financial strain as well as financial toxicity attributable to treatment), physical quality of life (symptom burden and perceived health), and emotional quality of life (anxiety, depression, and suicidal ideation). ANCOVA was used to examine whether financial strain and financial toxicity were associated with physical and emotional quality of life, while accounting for key covariates. Among 225 participants with COPD (n = 137), heart failure (n = 48), or kidney failure (n = 40), 62.2% reported general financial strain, with 34.7% experiencing financial toxicity attributable to treatments. Additionally, 68.9% rated their health as fair or poor, experiencing significant symptom burden including fatigue, dyspnea, and chest pain. Participants also reported clinically relevant levels of anxiety (55.1%), depression (52.0%), and suicidal ideation (21.8%). In the total sample, financial strain was associated with worse physical and emotional quality of life on all measures (all Ps < .001). Financial toxicity attributable to treatment was not associated with quality of life in the total sample or subsamples. Patients with COPD, heart failure, and kidney failure face significant financial, physical, and emotional burdens. Financial strain appears to undermine physical and emotional quality of life. Our study highlights the demand for interventions aimed at mitigating financial strain and toxicity experienced by individuals with chronic illnesses.