1
|
Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up. Life (Basel) 2021; 11:life11121438. [PMID: 34947969 PMCID: PMC8706706 DOI: 10.3390/life11121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.
Collapse
|
2
|
Spaderna H, Hoffman JM, Hellwig S, Brandenburg VM. Fear of Physical Activity, Anxiety, and Depression. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract. Background: Physical activity (PA) is recommended by heart failure treatment guidelines. Adherence to exercise prescriptions is low and not much is known about everyday PA in this patient group. Aims: This study describes objectively assessed everyday PA/sedentary behavior in men and women with chronic heart failure and examines associations of potential barriers for engaging in PA, namely fear of physical activity (FoPA), general anxiety, and depression, with indicators of PA and sedentary behavior. Method: In 61 outpatients with heart failure (67.5 ± 10.7 years of age) the impact of FoPA, trait anxiety, and depression on 6-day accelerometer measures was evaluated using linear regression models. Results: Sedentary behavior was prevalent in men and women alike, with lying down and sitting/standing as predominant activity classes during daytime. Men had higher PA energy expenditure (726 vs. 585 kcal/d, Cohen’s effect size d = 0.74) and walked up/down more often (0.21% vs. 0.12% of total PA, d = 0.56) than women. FoPA did not differ between sexes. FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates (β-values between −0.26 and −0.44, p-values < 0.024). Limitations: The self-selected sample included few women. Medical data were assessed via self-reports. Conclusion: FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates. These preliminary findings highlight FoPA as a barrier to everyday PA in patients with heart failure.
Collapse
Affiliation(s)
- Heike Spaderna
- Division of Health Psychology, Department of Nursing Science, Trier University, Germany
| | - Jeremia M. Hoffman
- Division of Health Psychology, Department of Nursing Science, Trier University, Germany
| | - Susan Hellwig
- Division of Method Teaching and Psychological Diagnostics, University of Wuppertal, Germany
| | - Vincent M. Brandenburg
- Department of Cardiology, Nephrology, and Internal Intensive Care Medicine, Rhein-Maas Klinikum, Germany
| |
Collapse
|
3
|
Exercise for Solid Organ Transplant Candidates and Recipients: A Joint Position Statement of the Canadian Society of Transplantation and CAN-RESTORE. Transplantation 2019; 103:e220-e238. [DOI: 10.1097/tp.0000000000002806] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
4
|
Snipelisky D, Smidt J, Gallup S, Myrick J, Bauer B, Burton MC. Canine-Assisted Therapy in Hospitalized Patients Awaiting Heart Transplantation. South Med J 2019; 112:344-348. [PMID: 31158890 DOI: 10.14423/smj.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Patients awaiting heart transplantation can be listed for prolonged periods of time and, as a result, the prevalence of anxiety and depression is high. Our study evaluates the feasibility of canine-assisted therapy (CAT) in this population. METHODS A prospective, multicenter study was performed on all status 1a patients admitted during a 12-month period to await transplantation. Patients were asked to complete the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire-9 at baseline, week 2, and week 6, and the Perceived Stress Scale at baseline and week 4. At the conclusion of the study, patients completed a questionnaire assessing the overall efficacy of CAT. RESULTS Baseline measures demonstrated high levels of anxiety, depression, and stress. The complete Generalized Anxiety Disorder 7-item scale (average score 10.9 vs 8; P = 0.14) and the Patient Health Questionnaire-9 (average score 12.3 vs 9.5; P = 0.057) scores decreased from baseline to week 6 and the Perceived Stress Scale (average score 29.8 vs 27; P = 0.16) decreased from baseline to week 4 with trends toward significance. All of the patients perceived CAT as improving the overall quality of hospitalization, would recommend CAT to other patients, and would elect for CAT during subsequent admissions. No infectious concerns were reported. CONCLUSIONS Anxiety, stress, and depression are prevalent among 1a heart transplantation candidates, and CAT is a welcomed adjunct to the usual medical care in this population.
Collapse
Affiliation(s)
- David Snipelisky
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| | - Jessica Smidt
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| | - Shawn Gallup
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| | - Jane Myrick
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| | - Brent Bauer
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| | - M Caroline Burton
- From the Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Integrative Medicine and Health Research, Department of Medicine, Complementary and Integrative Medicine, and the Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, and the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
5
|
Association Between Depressive Symptoms and Exercise Capacity in Patients With Heart Disease: A META-ANALYSIS. J Cardiopulm Rehabil Prev 2018; 37:239-249. [PMID: 27428818 DOI: 10.1097/hcr.0000000000000193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Depression and reduced exercise capacity are risk factors for poor prognosis in patients with heart disease, but the relationship between the 2 is unclear. We assessed the relationship between depressive symptoms and exercise capacity in patients with heart disease. METHODS PubMed, Cochrane Library, Google Scholar, and ProQuest databases were browsed for English-language studies published from January 2000 to September 2013. Studies including adult patients with coronary artery disease, heart failure, congenital heart disease, and implantable cardioverter defibrillator, reporting correlation between a depression scale and exercise capacity ((Equation is included in full-text article.)O2peak, peak watts, estimated metabolic equivalents, and incremental shuttle walk test distance), as well as studies from which such a correlation could be calculated and provided by the authors, were included. Correlation coefficients (CCs) were converted to Fischer z values, and the analysis was performed using a random-effects model. Then, summary effects and 95% CIs were converted back to CCs. RESULTS Fifty-nine studies (25 733 participants) were included. Depressive symptoms were inversely correlated to exercise capacity (CC = -0.15; 95% CI, -0.17 to -0.12). Heterogeneity was significant (I = 64%; P < .001). There was no evidence of publication bias (Fail-safe N = 4681; Egger test: P = .06; Kendall test: P = .29). CONCLUSIONS Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.
Collapse
|
6
|
EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2014.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
7
|
Leisure time physical activity and health-related behaviours after liver transplantation: a prospective, single-centre study. GASTROENTEROLOGY REVIEW 2015; 10:100-4. [PMID: 26557941 PMCID: PMC4631278 DOI: 10.5114/pg.2015.49002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/11/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Leisure time physical activity is of proven significance in surveys of fitness levels in various patient groups. Low physical functioning may affect recovery after liver transplantation (LTx). AIM To assess patients' leisure time activity and health-related habits after transplantation. MATERIAL AND METHODS One hundred and seven patients after LTx were included. They were divided into groups depending on aetiology of liver problem and the period after LTx. Minnesota Leisure Time Physical Activity Questionnaire (MILTPAQ) and Health Behaviour Inventory (HBI) were applied. RESULTS Neither the primary indication for the procedure nor the period after surgery had a significant relationship with physical activity assessed with MILTPAQ; however, activity was lower in females than males (1804.3 ±1848.9 vs. 2619.9 ±2067; p = 0.03). Age at survey/surgery was inversely associated with higher activity (p = 0.02 and p = 0.03, respectively). Health Behaviour Inventory analysis showed a correlation between all four of its domains and age at transplantation/survey (p < 0.001 for both). There was a negative correlation between positive mental attitude and body mass index (BMI). CONCLUSIONS The primary indications for grafting and, surprisingly, the period after surgery did not seem to be related to the patients' physical activity in leisure time. Younger and leaner patients appeared to understand the standards of healthy behaviour better and implement them in their daily activities. As higher BMI are associated with a negative mental attitude in patients after LTx, a particular emphasis should be placed on proper counselling in this subgroup of patients.
Collapse
|
8
|
Impact of identification and treatment of depression in heart transplant patients. Cardiovasc Psychiatry Neurol 2014; 2014:747293. [PMID: 25295180 PMCID: PMC4177779 DOI: 10.1155/2014/747293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/23/2014] [Accepted: 08/29/2014] [Indexed: 01/30/2023] Open
Abstract
Background. The effects of clinical depression after orthotopic heart transplantation (OHT) are relatively unknown. The purpose of this study was to evaluate the impact of depression on outcomes after OHT. Methods. We performed a single center retrospective review of 102 consecutive patients who underwent OHT at Northwestern Memorial Hospital from June 2005 to October 2009. The diagnosis of depression was obtained from attending physician documentation. The primary endpoints were all-cause mortality (ACM), hospitalizations, and rejection. Results. Of 102 OHT patients, 26 (26%) had depression. Depressed patients were similar in age to nondepressed patients (57.6 years versus 56.9, P = 0.79). There was no statistical difference in survival between groups at 5 years after OHT (P = 0.94). All-cause hospitalizations were higher in depressed versus nondepressed patients (4.3 versus 2.6 hospitalizations P = 0.05). There were no significant differences in hospitalizations between the two groups for the following complications: cardiac (heart failure, edema, arrhythmias, and acute rejection) and infections. There was no significant difference in episodes of 2R and 3R rejection. Conclusion. Early identification and treatment of depression in OHT patients result in outcomes similar to nondepressed patients.
Collapse
|
9
|
Tajfard M, Ghayour-Mobarhan M, Rahimi HR, Mouhebati M, Esmaeily H, Ferns GAA, Latiff LA, Tajfiroozeh F, Mokhber N, Nazeminezhad R, Falsoleyman H, Taghipour A, Aziz AFA, Manaf RA, Saghiri Z, Hanachi P. Anxiety, Depression and Coronary Artery Disease among Patients Undergoing Angiography in Ghaem Hospital, Mashhad, Iran. Health (London) 2014. [DOI: 10.4236/health.2014.611137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Osada N, Omiya K, Shimizu H. Association between mental health and physical activity in patients with chronic heart failure. Disabil Rehabil 2013; 36:250-4. [PMID: 23614372 DOI: 10.3109/09638288.2013.785604] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. METHODS We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n = 148) and poor-MH (<68 points) group (n = 95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. RESULTS PA correlated positively with MH in all patients (steps: r = 0.46, p < 0.001; EE: r = 0.43, p < 0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1 ± 280.7 versus 7174.1 ± 221.5 steps, p < 0.001; 133.9 ± 10.8 versus 215.9 ± 8.4 kcal, p < 0.001). Cut-off values of 5590.8 steps and 141.1 kcal were determined as PA target values associated with improved MH. CONCLUSIONS Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.
Collapse
Affiliation(s)
- Kazuhiro P Izawa
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital , Kanagawa , Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Alosco ML, Spitznagel MB, van Dulmen M, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Depressive symptomatology, exercise adherence, and fitness are associated with reduced cognitive performance in heart failure. J Aging Health 2013; 25:459-77. [PMID: 23378527 PMCID: PMC5022365 DOI: 10.1177/0898264312474039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression is common in heart failure (HF) and associated with reduced cognitive function. The current study used structrual equation modeling to examine whether depression adversely impacts cognitive function in HF through its adverse affects on exercise adherence and cardiovascular fitness. METHOD 158 HF patients completed neuropsychological testing, physical fitness test, Beck depression inventory-II (BDI-II), and measures assessing exercise adherence and physical exertion. RESULTS The model demonstrated excellent model fit and increased scores on the BDI-II negatively affected exercise adherence and cardiovascular fitness. There was a strong inverse association between cardiovascular fitness and cognitive function. Sobel test showed a significant indirect pathway between the BDI-II and cognitive function through cardiovascular fitness. DISCUSSION This study suggests depression in HF may adversely impact cognitive function through reduced cardiovascular fitness. Prospective studies are needed to determine whether treatment of depression can lead to better lifestyle behaviors and ultimately improve neurocognitive outcomes in HF.
Collapse
|
12
|
Spaderna H, Zahn D, Pretsch J, Connor SL, Zittermann A, Schulze Schleithoff S, Bramstedt KA, Smits JM, Weidner G. Dietary Habits are Related to Outcomes in Patients With Advanced Heart Failure Awaiting Heart Transplantation. J Card Fail 2013; 19:240-50. [DOI: 10.1016/j.cardfail.2013.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 02/16/2013] [Accepted: 02/27/2013] [Indexed: 01/07/2023]
|
13
|
Everyday Physical Activity in Ambulatory Heart Transplant Candidates: the Role of Expected Health Benefits, Social Support, and Potential Barriers. Int J Behav Med 2013; 21:248-57. [DOI: 10.1007/s12529-013-9304-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Smits JM, Niesing J, Breidenbach T, Collett D. The making of a pan-European organ transplant registry. Transpl Int 2013; 26:307-14. [PMID: 23279132 DOI: 10.1111/tri.12041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/07/2012] [Accepted: 11/18/2012] [Indexed: 11/28/2022]
Abstract
A European patient registry to track the outcomes of organ transplant recipients does not exist. As knowledge gleaned from large registries has already led to the creation of standards of care that gained widespread support from patients and healthcare providers, the European Union initiated a project that would enable the creation of a European Registry linking currently existing national databases. This report contains a description of all functional, technical, and legal prerequisites, which upon fulfillment should allow for the seamless sharing of national longitudinal data across temporal, geographical, and subspecialty boundaries. To create a platform that can effortlessly link multiple databases and maintain the integrity of the existing national databases crucial elements were described during the project. These elements are: (i) use of a common dictionary, (ii) use of a common database and refined data uploading technology, (iii) use of standard methodology to allow uniform protocol driven and meaningful long-term follow-up analyses, (iv) use of a quality assurance mechanism to guarantee completeness and accuracy of the data collected, and (v) establishment of a solid legal framework that allows for safe data exchange.
Collapse
Affiliation(s)
- Jacqueline M Smits
- Eurotransplant International Foundation, 2301 CH Leiden, The Netherlands.
| | | | | | | |
Collapse
|
15
|
Health behaviors contribute to quality of life in patients with advanced heart failure independent of psychological and medical patient characteristics. Qual Life Res 2012; 22:1603-11. [PMID: 23161327 DOI: 10.1007/s11136-012-0312-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the contribution of health behaviors to quality of life (QoL) in heart transplant candidates. We examined physical activity, dietary habits, psychological, and medical patient characteristics as correlates of QoL among patients enrolled in the multisite Waiting for a New Heart Study. METHOD QoL (Minnesota Living with Heart Failure Questionnaire), demographic variables, psychological variables (e.g., depression, coping styles), and health behaviors (physical activity, dietary habits) were assessed in 318 patients (82% male, 53 ± 11 years) at the time of wait-listing and analyzed in 312 patients (excluding six underweight patients). Eurotransplant provided BMI and medical variables to compute the Heart Failure Survival Score (HFSS). Hierarchical multiple regression models were used to assess the independent contribution of health behaviors to QoL. RESULTS The HFSS was unrelated to QoL. As expected, psychological characteristics (depression, anxiety, vigilant coping style) contributed to impaired QoL, accounting for 22.9, 35.9, and 12.9% of the variance in total, emotional, and physical QoL, respectively. Physical inactivity further impaired QoL (total: 4.1%, p < 0.001; physical: 7.4%, p < 0.001). Dietary habits typically considered as unhealthy (i.e., infrequent consumption of fruits/vegetables/legumes; frequent intake of foods high in saturated fats) were related to enhanced physical QoL, but only among the overweight and obese patients. CONCLUSION Lifestyle interventions to modify negative emotions and to increase physical activity could help to improve QoL in heart transplant candidates, regardless of their disease severity. The role of eating habits in QoL among obese and overweight patients needs further exploration.
Collapse
|
16
|
Alosco ML, Spitznagel MB, Miller L, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, Waechter D, Hughes J, Rosneck J, Gunstad J. Depression is associated with reduced physical activity in persons with heart failure. Health Psychol 2012; 31:754-62. [PMID: 22924448 DOI: 10.1037/a0028711] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Reduced physical activity is common in persons with heart failure (HF). However, studies of correlates and modifiers of physical activity in this population rarely employ objective measures. Motivational and mood related factors that may exacerbate inactivity in HF patients are also rarely investigated. In this study, we examined the relationship between physical activity as assessed by accelerometry, and depression in older adults with HF. METHODS At baseline, older adults with HF (N = 96; 69.81 ± 8.79) wore an accelerometer for seven days, and completed a brief fitness assessment, neuropsychological testing, and psychosocial measures including the Beck Depression Inventory-II (BDI-II). Medical and demographic history was obtained through record review and self-report. RESULTS Accelerometer measures showed that HF patients averaged 587 minutes of sedentary time and just 0.31 minutes of vigorous activity per day. Lower daily step count was associated with poorer quality of life and reduced cognitive function. A multiple linear regression adjusting for important demographic and medical variables found that greater number of depressive symptoms on the BDI-II independently predicted lower physical activity levels. CONCLUSION Consistent with past work, the current study found that low physical activity is common in older adults with HF. Depression is an independent predictor of physical activity in older adults with HF and reduced physical activity is associated with numerous adverse psychosocial outcomes. Future studies need to determine whether treatment of depression can boost physical activity and thus improve health outcomes in this population.
Collapse
Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
LI PHILIPKAMTAO, CHU KWOKHONG, CHOW KAIMING, LAU MIUFONG, LEUNG CHIBON, KWAN BONNIECHINGHA, TONG YUENFAN, SZETO CHEUKCHUN, NG MAGGIEMIUMAN. Cross sectional survey on the concerns and anxiety of patients waiting for organ transplants. Nephrology (Carlton) 2012; 17:514-8. [DOI: 10.1111/j.1440-1797.2012.01615.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Madan A, White-Williams C, Borckardt JJ, Burker EJ, Milsom VA, Pelic CM, Thurstin AH. Beyond rose colored glasses: the adaptive role of depressive and anxious symptoms among individuals with heart failure who were evaluated for transplantation. Clin Transplant 2012; 26:E223-31. [PMID: 22428989 DOI: 10.1111/j.1399-0012.2012.01613.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2012] [Indexed: 11/28/2022]
Abstract
The prospect of and the evaluative period for transplantation can be stressful for individuals with heart failure (HF). Little is known about the impact of psychosocial factors on service utilization and health outcomes. The current study examined the impact of depression, dysthymia, and anxiety on two-yr hospitalization and mortality among 96 individuals with HF who were evaluated for transplantation. Results revealed that only a small percentage of individuals endorsed sufficient symptomatology to meet criteria for a psychiatric, Axis I disorder (3.1% = anxiety; 2.1% = depression; 1.0% = dysthymia) although a significant proportion of the sample was prescribed an antidepressant or an anxiolytic (37%). Multivariable regression analysis was conducted to examine the association between significant independent demographic, medical, and psychiatric predictors and total duration of hospitalizations; logistic regression analysis was used to examine the relation between predictors and mortality. An increase in anxious symptoms was associated with a decrease in total number of days hospitalized during the two-yr period following the initial evaluation. Similarly, as depressive symptoms increased, risk of two-yr mortality decreased. Future research should assess communication between the patient and providers to further elucidate the potential relationship between psychiatric symptoms, service utilization/hospitalization, and mortality in this patient population.
Collapse
Affiliation(s)
- A Madan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Spaderna H, Weidner G, Koch KC, Kaczmarek I, Wagner FM, Smits JM. Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study. J Heart Lung Transplant 2012; 31:16-26. [DOI: 10.1016/j.healun.2011.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/16/2011] [Accepted: 07/28/2011] [Indexed: 11/28/2022] Open
|
20
|
Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' sex and emotional support as predictors of death and clinical deterioration in the waiting for a new heart study: results from the 1-year follow-up. Prog Transplant 2011. [PMID: 21736238 DOI: 10.7182/prtr.21.2.j779w1q6k61k0jk4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. OBJECTIVE To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. DESIGN, SETTING, AND PARTICIPANTS The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs. low support]) were assessed at the time of wait-listing. Main Outcomes-Time until death/delisting due to deteriorated tealth, considering competing outcomes (e.g., transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. RESULTS By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs. 8.6%) and being a past or current smoker (80.4% vs. 56.9%). More women than men had low vocational level (93.1% vs. 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04-5.12; P = .04); low emotional support further tended to increase the risk for this outcome (P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04-4.82; P = .04). CONCLUSION Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
Collapse
Affiliation(s)
- Gerdi Weidner
- Department of Biology, Romberg Tiburon Center, San Francisco State University, 3150 Paradise Drive, Tiburon, CA 94920, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' Sex and Emotional Support as Predictors of Death and Clinical Deterioration in the Waiting for a New Heart Study: Results from the 1-Year Follow-up. Prog Transplant 2011; 21:106-14. [DOI: 10.1177/152692481102100204] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Context Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. Objective To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. Design, Setting, and Participants The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs low support]) were assessed at the time of wait-listing. Main Outcomes Time until death/delisting due to deteriorated health, considering competing outcomes (eg, transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. Results—By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs 8.6%) and being a past or current smoker (80.4% vs 56.9%). More women than men had low vocational level (93.1% vs 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04–5.12; P = .04); low emotional support further tended to increase the risk for this outcome ( P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04–4.82; P = .04). Conclusion Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
Collapse
Affiliation(s)
- Gerdi Weidner
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Daniela Zahn
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Nancy R. Mendell
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Jacqueline M. A. Smits
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Mario C. Deng
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Armin Zittermann
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Heike Spaderna
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | | |
Collapse
|
22
|
Zahn D, Weidner G, Beyersmann J, Smits JMA, Deng MC, Kaczmarek I, Meyer S, Reichenspurner H, Mehlhorn U, Wagner FM, Spaderna H. Composite risk scores and depression as predictors of competing waiting-list outcomes: the Waiting for a New Heart Study. Transpl Int 2010; 23:1223-32. [DOI: 10.1111/j.1432-2277.2010.01133.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|