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Gali K, Weidner G, Smits JMA, Beyersmann J, Spaderna H. 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; 11:1438. [PMID: 34947969 PMCID: PMC8706706 DOI: 10.3390/life11121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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.
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Affiliation(s)
- Kathleen Gali
- Hamburg Center for Health Economics, University of Hamburg, 20354 Hamburg, Germany;
- University Cancer Center Hamburg (UCCH), University Medical Center-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Gerdi Weidner
- Department of Biology, Romberg Tiburon Campus, San Francisco State University, Tiburon, CA 94920, USA
| | | | - Jan Beyersmann
- Institute of Statistics, Ulm University, 89081 Ulm, Germany;
| | - Heike Spaderna
- Department of Nursing Science, Section Health Psychology, Trier University, 54286 Trier, Germany
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Hoffmann JM, Hellwig S, Brandenburg VM, Spaderna H. Measuring Fear of Physical Activity in Patients with Heart Failure. Int J Behav Med 2017; 25:294-303. [DOI: 10.1007/s12529-017-9704-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Spaderna H, Zittermann A, Reichenspurner H, Ziegler C, Smits J, Weidner G. Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation. J Am Heart Assoc 2017; 6:JAHA.117.007016. [PMID: 29187384 PMCID: PMC5779021 DOI: 10.1161/jaha.117.007016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients. Methods and Results Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively). Conclusions Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.
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Affiliation(s)
- Heike Spaderna
- Division of Health Psychology, Department of Nursing Science, Trier University, Trier, Germany
| | - Armin Zittermann
- Department for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Hermann Reichenspurner
- University Heart Center at the University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Corinna Ziegler
- School of Education, Bergische Universitaet Wuppertal, Germany
| | - Jacqueline Smits
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Gerdi Weidner
- Department of Biology, San Francisco State University, San Francisco, CA
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Stress-related and basic determinants of hair cortisol in humans: A meta-analysis. Psychoneuroendocrinology 2017; 77:261-274. [PMID: 28135674 DOI: 10.1016/j.psyneuen.2016.12.017] [Citation(s) in RCA: 534] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/25/2016] [Accepted: 12/21/2016] [Indexed: 01/02/2023]
Abstract
The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.
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Murks C, Juricek C. Balloon Pumps Inserted via the Subclavian Artery: Bridging the Way to Heart Transplant. AACN Adv Crit Care 2016; 27:301-315. [PMID: 27959314 DOI: 10.4037/aacnacc2016355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Intra-aortic balloon pumps have traditionally been inserted via the femoral artery, limiting patients' activity and exposing patients to complications of immobility. For patients awaiting cardiac transplant, these complications may threaten a successful outcome, or at the least, complicate recuperation after transplant. A novel approach to insertion of balloon pumps via the subclavian artery is presented here, including routine nursing care, complications and related nursing actions, and experience with and advantages of this method. A team approach to care of these patients, including rehabilitation and exercise protocols, is recommended.
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Affiliation(s)
- Catherine Murks
- Catherine Murks is Nurse Practitioner, Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5841 S. Maryland, MC 2016, Chicago, IL 60637 . Colleen Juricek is Ventricular Assist Device Coordinator, Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Colleen Juricek
- Catherine Murks is Nurse Practitioner, Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5841 S. Maryland, MC 2016, Chicago, IL 60637 . Colleen Juricek is Ventricular Assist Device Coordinator, Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois
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Gali K, Spaderna H, Smits JMA, Bramstedt KA, Weidner G. Smoking Status at Time of Listing for a Heart Transplant Predicts Mortality on the Waiting List. Prog Transplant 2016; 26:117-21. [DOI: 10.1177/1526924816640687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We examined the association of smoking status at time of listing with waitlist mortality among heart transplant (HTx) candidates. Participants and Design: Data were analyzed from 316 participants (aged 53 ± 11; 18% female) of the Waiting for a New Heart Study, a prospective observational study of patients newly listed for HTx at 17 hospitals. Results: During the study period (April 2005 to March 2010), 14% of those who never smoked died, 18% among former smokers died, and almost half (42%) died among those who reported smoking at time of wait listing. Multivariate Cox regression models controlling for age, sex, and disease severity revealed smoking at time of listing was associated with significantly higher risk of mortality compared to never smoking (hazard ratio [HR] = 3.43; P = .03). The relationship between smoking and mortality risk appeared to follow a dose-dependent pattern: adjusted HRs were 1.80 for those who quit ≤1 year ago, 1.25 for those who quit >1 to 10 years ago, and 0.90 for those quit >10 years ago, compared to never smokers. Smoking at time of listing may increase risk of mortality during the waiting period, indicating the need for improved strategies to achieve smoking cessation as early as possible in the course of HTx.
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Affiliation(s)
- Kathleen Gali
- Department of Public Health, University of California, Merced, CA, USA
| | - Heike Spaderna
- Department of Health Psychology, Trier University, Trier, Germany
| | | | | | - Gerdi Weidner
- Department of Biology, San Francisco State University, San Francisco, CA, USA
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Stalder T, Tietze A, Steudte S, Alexander N, Dettenborn L, Kirschbaum C. Elevated hair cortisol levels in chronically stressed dementia caregivers. Psychoneuroendocrinology 2014; 47:26-30. [PMID: 25001953 DOI: 10.1016/j.psyneuen.2014.04.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/04/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
Abstract
Hair cortisol concentrations (HCC) are assumed to reflect integrated long-term cortisol levels and have been proposed as a promising endocrine marker of chronic psychological stress. The current study examined HCC in relation to caregiving burden, a well-established naturalistic model of chronic stress in humans. HCC and relevant psychosocial data were examined in 20 caregivers of relatives with dementia and 20 non-caregiver controls matched for age and sex. Results revealed elevated HCC in dementia caregivers compared to non-caregiver controls (F(1,38)=4.4, p=.04, ηp2=.10). Further, within caregivers, a trend for a positive association of HCC with self-reported caregiving burden (r=.43, p=.058) and a positive association with depressiveness (r=.48, p=.045) were observed. No other associations between HCC and subjective measures were seen. These findings concur with the notion that HCC sensitively capture endocrine aberrations in stress-exposed groups.
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Affiliation(s)
- Tobias Stalder
- Technische Universität Dresden, Department of Psychology, Dresden, Germany.
| | - Antje Tietze
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | - Susann Steudte
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | - Nina Alexander
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | - Lucia Dettenborn
- Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Germany
| | - Clemens Kirschbaum
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
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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]
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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]
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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.
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Cortisol in hair, body mass index and stress-related measures. Biol Psychol 2012; 90:218-23. [DOI: 10.1016/j.biopsycho.2012.03.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/06/2012] [Accepted: 03/19/2012] [Indexed: 11/20/2022]
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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
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Sustainability in medicine: a case for the prevention of chronic non-communicable diseases. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10669-011-9344-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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]
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Spaderna H, Zahn D, Schulze Schleithoff S, Stadlbauer T, Rupprecht L, Smits JMA, Krohne HW, Münzel T, Weidner G. Depression and disease severity as correlates of everyday physical activity in heart transplant candidates. Transpl Int 2010; 23:813-22. [DOI: 10.1111/j.1432-2277.2010.01056.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spaderna H, Mendell NR, Zahn D, Wang Y, Kahn J, Smits JMA, Weidner G. Social isolation and depression predict 12-month outcomes in the "waiting for a new heart study". J Heart Lung Transplant 2009; 29:247-54. [PMID: 19804987 DOI: 10.1016/j.healun.2009.07.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identification of modifiable psychosocial characteristics related to survival of heart transplant (HTx) candidates is needed to prevent clinical deterioration and improve prognosis. METHODS A multi-site, prospective study was conducted with 318 HTx candidates (18% female, 82% male; 53 +/- 11 years of age) newly listed at 17 hospitals in Germany and Austria. Baseline demographic and psychosocial characteristics were assessed by questionnaires. Indicators of disease severity (Heart Failure Survival Score, creatinine, cardiac index) and 12-month outcomes (death, high-urgency HTx, elective HTx, de-listing due to deterioration or improvement) were provided by Eurotransplant. RESULTS By 12 months, 33 patients died, 83 received an urgent HTx, 30 underwent an elective HTx, and 9 were de-listed due to clinical deterioration and 17 due to improvement. All measures of disease severity predicted outcomes. Controlling for disease severity, the number of social contacts contributed significantly to outcomes, favoring those who improved. Comparing socially isolated patients (<4 social contacts/month) who also had depression scores in the clinical range (high psychosocial risk group; n = 37) to those with >10 social contacts/month without depression (low psychosocial risk group; n = 47) revealed significant differences in the distribution of outcome frequencies (chi-square = 11.2, df = 4, p < 0.04). The high psychosocial risk group was more likely to have died/deteriorated and less likely to have improved than the low psychosocial risk group. CONCLUSIONS Regardless of disease severity, socially isolated HTx candidates who are also depressed may be at increased risk for clinical deterioration and mortality, indicating a need for psychosocial intervention.
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Affiliation(s)
- Heike Spaderna
- Psychological Institute, Johannes Gutenberg University, Mainz, Germany.
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