1
|
Westas M, Mourad G, Andersson G, Lundgren J, Johansson P. The effects of internet-based cognitive behaviour therapy for depression in cardiovascular disease on symptoms of anxiety: a secondary analysis of a randomized trial. Eur J Cardiovasc Nurs 2024; 23:382-390. [PMID: 37740442 DOI: 10.1093/eurjcn/zvad097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
AIMS The aims of this study were to evaluate: (i) the short- and long-term effects of the internet-based cognitive behaviour (iCBT) programme on symptoms of distress and fear disorder in cardiovascular disease (CVD) patients, and (ii) the association between changes in depression and changes in symptoms of distress and fear disorder from baseline to 12-month follow-up. METHODS AND RESULTS Secondary analysis of data collected in a randomized controlled study evaluating the effects on depression of an iCBT programme compared to an online discussion forum (ODF) in CVD patients (n = 144). Data were collected at baseline, at post-intervention (9 weeks), and at 6- and 12-month follow-ups.The results showed that symptoms of distress disorder were statistically significantly more reduced in the iCBT group than in the ODF group. For symptoms of the fear disorder, no differences were found except for avoidance, which showed a statistically significant reduction in the iCBT group. The long-term analysis in the iCBT group showed that CAQ total score and fear decreased from baseline to 6- and 12-month follow-ups, respectively. Avoidance and attention both decreased statistically significantly from baseline to post-intervention, but not between post-intervention and 12-month follow-up. CONCLUSION The results suggest that the iCBT programme targeted depression in CVD patients successfully reduced symptoms of distress disorder and to a lesser extent symptoms of fear disorder. Change in depression was more strongly associated with a change in distress than a change in fear disorder. REGISTRATION ClinicalTrials.gov: NCT02778074.
Collapse
Affiliation(s)
- Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, 601 74 Norrköping, Linköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, 601 74 Norrköping, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, 601 74 Norrköping, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences and Department of Internal Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Seo EJ, Son YJ. The Prevalence of Cognitive Frailty and Its Association with Sleep duration and Depression Among Older Adults with Heart Failure. Clin Gerontol 2024; 47:416-425. [PMID: 36117469 DOI: 10.1080/07317115.2022.2125858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The prevalence of cognitive frailty and its associated factors in older population with heart failure have not been extensively studied. We investigated the prevalence of cognitive frailty and its association with sleep duration and depression among older adults with heart failure. METHODS This secondary analysis used a cross-sectional sample with 168 older adults with heart failure from an academic tertiary care hospital in South Korea. RESULTS Cognitive frailty was found in 58 (34.5%) older adults with heart failure. Our main finding revealed that longer sleep durations of ≥ 8 h (adjusted odds ratio (OR) = 2.62, 95% confidence interval (CI) = 1.04-6.59) and depression (adjusted OR = 2.84, 95% CI = 1.22-6.61) predicted an increased risk of cognitive frailty. CONCLUSIONS Early detection on changes in sleep patterns and depression can play a crucial role in reducing the risk of cognitive frailty in patients with heart failure. Longitudinal studies are needed to explore that sleep patterns and depression are both linked to greater risk of developing cognitive frailty among older adults with heart failure. CLINICAL IMPLICATIONS Development of a validated instrument for cognitive frailty screening may be beneficial for older adults with heart failure to prevent adverse outcomes.
Collapse
Affiliation(s)
- Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, Republic of Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Thapa A, Kang J, Chung ML, Wu JR, Latimer A, Lennie TA, Lin CY, Thompson JH, Cha G, Moser DK. Perceived Control, Functional Status, Depressive Symptoms, and Anxiety: Mediating and Moderating Influences on Health-Related Quality of Life in Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00187. [PMID: 38687114 DOI: 10.1097/jcn.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability to design effective interventions. PURPOSE Our aim was to evaluate a moderated mediation model, in which the association between perceived control and HRQoL was hypothesized to be mediated by DS and anxiety in the presence of a moderator, functional status. METHODS Patients (N = 426) with heart failure completed the Control Attitudes Scale-Revised to measure perceived control, Duke Activity Status Index for functional status, Patient Health Questionnaire-9 for DS, Brief Symptom Inventory for anxiety, and Minnesota Living with Heart Failure Questionnaire for HRQoL. We performed a moderated parallel mediation analysis. RESULTS Higher levels of perceived control were associated with better HRQoL through lower levels of anxiety and DS in the presence of functional status (index of moderated mediation for DS, b = 0.029; 95% confidence interval, 0.016-0.045; for anxiety: b = 0.009, 95% confidence interval, 0.002-0.018). The effect of perceived control on psychological symptoms was stronger at low and moderate functional statuses; however, this effect diminished with increasing functional status. CONCLUSION Functional status moderated the indirect effects of perceived control on HRQoL through DS and anxiety in patients with heart failure. Efforts to improve HRQoL by targeting perceived control may be more effective when considering DS and anxiety in patients with low to moderate levels of functional status.
Collapse
|
4
|
Müller-Tasch T, Löwe B, Frankenstein L, Frey N, Haass M, Friederich HC. Somatic symptom profile in patients with chronic heart failure with and without depressive comorbidity. Front Psychiatry 2024; 15:1356497. [PMID: 38566960 PMCID: PMC10985237 DOI: 10.3389/fpsyt.2024.1356497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patients with chronic heart failure (CHF) frequently suffer from depressive comorbidity. CHF and depressive comorbidity can cause somatic symptoms. The correct attribution of somatic symptoms is important. Thus, we aimed to assess potential differences in somatic symptom severity between CHF patients with and without depressive comorbidity. Methods We evaluated depressive comorbidity using the Patient Health Questionnaire-9 (PHQ-9), somatic symptom severity with the Patient Health Questionnaire-15 (PHQ-15), and sociodemographic and medical variables in 308 CHF outpatients. To compare somatic symptom severity between CHF patients with and without depressive comorbidity, we conducted item-level analyses of covariance. Results Of the 308 participating patients, 93 (30.3%) met the PHQ-9 criteria for depressive comorbidity. These patients did not differ from those without depressive comorbidity with regard to age, sex, left ventricular function, and multimorbidity. Patients with depressive comorbidity scored significantly higher on ten out of thirteen PHQ-15 items than patients without depressive comorbidity. The largest effect sizes (0.71-0.80) were shown for symptoms of headache, chest pain, shortness of breath, and palpitations, and the latter three were potentially attributable to heart failure. Conclusions Among patients with CHF, somatic symptoms are more pronounced in those with depressive comorbidity than those without depressive comorbidity. This finding is especially true for cardiac symptoms independent of CHF severity. The potential interpretation of somatic symptoms as correlates of depressive comorbidity must be recognized in clinical practice.
Collapse
Affiliation(s)
- Thomas Müller-Tasch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum am Weissenhof, Weinsberg, Germany
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Markus Haass
- Department of Cardiology, Theresien Hospital Mannheim, Mannheim, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
5
|
Kitagaki K, Aoki T, Miura H, Shimada Y, Konishi H, Tsukamoto Y, Noguchi T. Depressive symptoms, right ventricular function, and muscular strength are associated with peak oxygen uptake in patients with implantable left ventricular assist devices. Artif Organs 2024; 48:166-174. [PMID: 37921338 DOI: 10.1111/aor.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation is among the most effective treatment options for patients with severe heart failure. Although previous studies have examined the factors related to peak oxygen uptake (peak VO2 ), they were limited by the few patients involved and their focus on medical and physical functions. Therefore, this study comprehensively examined the factors associated with peak VO2 , which is an important prognostic factor in patients with implantable LVADs. METHODS Eighty-nine patients who underwent initial LVAD implantation and were eligible for cardiopulmonary exercise testing (CPX) between May 2014 and September 2021 were included. The patients' mean age was 48 ± 12 years, and 70% were males. Based on previous studies, the cut-off was set at 12 and 14 mL/kg/min for patients taking β-blocker and those not taking β-blockers, respectively. Furthermore, factors associated with peak VO2 were examined using multivariate logistic regression analysis. RESULTS The mean time from surgery to CPX administration was 73 ± 40 days. The high group had a higher cardiac index, right ventricular stroke work index (RVSWI), and isometric knee extensor muscular strength and lower Patient Health Questionnaire-9 (PHQ-9) and B-type natriuretic peptide values than the low group. Multivariate logistic regression analysis showed that RVSWI and KEMS were positively correlated, whereas PHQ-9 was negatively associated with peak VO2 . CONCLUSION Right ventricular function, depressive symptoms, and lower limb muscular strength were associated with exercise capacity in patients with implantable LVADs.
Collapse
Affiliation(s)
- Kazufumi Kitagaki
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daito, Japan
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yukihiro Shimada
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Harumi Konishi
- Department of Nursing, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasumasa Tsukamoto
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
6
|
Heo S, Kang J, Shin MS, Lim YH, Kim SH, Kim S, An M, Kim J. Physical Symptoms, Depressive Symptoms, and Quality of Life in Patients With Heart Failure: Cluster Analysis. J Cardiovasc Nurs 2024; 39:31-37. [PMID: 37787730 DOI: 10.1097/jcn.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Physical and psychological symptoms are prevalent in patients with heart failure (HF) and are associated with poor quality of life (QOL) and high hospitalization rates. Thus, it is critical to identify symptom clusters to better manage patients with high-risk symptom cluster(s) and to reduce adverse effects. OBJECTIVE The aims of this study were to identify clusters of physical HF symptoms (ie, dyspnea during daytime, dyspnea when lying down, fatigue, chest pain, edema, sleeping difficulty, and dizziness) and depressive symptoms and to examine their association with QOL in patients with HF. METHODS In this secondary analysis of a cross-sectional study, data on physical HF symptoms (Symptom Status Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and general QOL (European Quality of Scale-Visual Analog Scale) were collected. We identified clusters based on the physical HF symptoms and depressive symptoms using 2-step and k -means cluster analysis methods. RESULTS Chest pain was removed from the model because of the low importance value. Two clusters were revealed (cluster 1, severe symptom cluster, vs cluster 2, less severe symptom cluster) based on the 7 symptoms. In cluster 1, all of the 7 symptoms were more severe, and QOL was poorer than those in cluster 2 (all P s < .001). All the mean and median scores of the 7 symptoms in cluster 1 were higher than those in cluster 2. CONCLUSIONS Patients with HF were clearly divided into 2 clusters based on physical HF symptoms and depressive symptoms, which were associated with QOL. Clinicians should assess these symptoms to improve patient outcomes.
Collapse
|
7
|
Roy R, Mayer MM, Dzekem BS, Laiteerapong N. Screening for Emotional Distress in Patients with Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1165-1174. [PMID: 37610597 DOI: 10.1007/s11886-023-01936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research. RECENT FINDINGS Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.
Collapse
Affiliation(s)
- Rukmini Roy
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Michael M Mayer
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Bonaventure S Dzekem
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
| |
Collapse
|
8
|
Odero SA, Mwangi P, Odhiambo R, Mumbua Nzioka B, Shumba C, Ndirangu-Mugo E, Abubakar A. Psychometric evaluation of PHQ-9 and GAD-7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey. Front Psychiatry 2023; 14:1123839. [PMID: 37324823 PMCID: PMC10264862 DOI: 10.3389/fpsyt.2023.1123839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya. Methods Between June and November 2021, a national survey on mental well-being and resilience among nurses/midwives and CHVs was conducted via telephone interviews. The survey had a total sample size of 1907 nurses/midwives and 2027 CHVs. Cronbach's alpha and MacDonalds' omega were used to evaluate the scale's internal consistency. Confirmatory Factor Analysis (CFA) was used to test the one-factor structure of the scales. Multi-group CFA was applied to evaluate the generalizability of the scales across the Swahili and English versions, and among male and female health workers. The Spearman correlation was used to assess the tools' divergent and convergent validity. Results The internal consistency of PHQ-9 and GAD-7 was good, with alpha and omega values above 0.7 across study samples. CFA results indicated a one-factor structure of the PHQ-9 and GAD-7 for both nurses/midwives and CHVs. Multi-group CFA showed that both scales were unidimensional across both language and sex. The PHQ-9 and GAD-7 were significantly negatively correlated with resilience and work engagement, supporting divergent validity. The PHQ-9 and GAD-7 were also significantly positively correlated with resilience and work engagement, supporting divergent validity. Conclusion The PHQ-9 and GAD-7 are unidimensional, reliable, and valid tools for screening depression and anxiety among nurses/midwives and CHVs. The tools can be administered in a similar population or study setting using either Swahili or English.
Collapse
Affiliation(s)
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
9
|
Basile C, Parlati ALM, Paolillo S, Marzano F, Nardi E, Chirico A, Buonocore D, Colella A, Fontanarosa S, Cotticelli C, Marchesi A, Rodolico D, Dellegrottaglie S, Gargiulo P, Prastaro M, Perrone-Filardi P, Montisci R. Depression in Heart Failure with Reduced Ejection Fraction, an Undervalued Comorbidity: An Up-To-Date Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:948. [PMID: 37241180 PMCID: PMC10224073 DOI: 10.3390/medicina59050948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Introduction: Depression is a common and severe comorbidity among individuals with heart failure (HF). Up to a third of all HF patients are depressed, and an even higher proportion have symptoms of depression. Aim: In this review, we evaluate the relationship between HF and depression, explain the pathophysiology and epidemiology of both diseases and their relationship, and highlight novel diagnostic and therapeutic options for HF patients with depression. Materials and Methods: This narrative review involved keyword searches of PubMed and Web of Science. Review search terms included ["Depression" OR "Depres*" OR "major depr*"] AND ["Heart Failure" OR "HF" OR "HFrEF" OR "HFmrEF" OR "HFpEF" OR "HFimpEF"] in all fields. Studies included in the review met the following criteria: (A) published in a peer-reviewed journal; (B) described the impact of depression on HF and vice versa; and (C) were opinion papers, guidelines, case studies, descriptive studies, randomized control trials, prospective studies, retrospective studies, narrative reviews, and systematic reviews. Results: Depression is an emergent HF risk factor and strongly relates with worse clinical outcomes. HF and depression share multiple pathways, including platelet dis-reactivity, neuroendocrine malfunction, inappropriate inflammation, tachi-arrhythmias, and frailty in the social and community setting. Existing HF guidelines urge evaluation of depression in all HF patients, and numerous screening tools are available. Depression is ultimately diagnosed based on DSM-5 criteria. There are both non-pharmaceutical and pharmaceutical treatments for depression. Regarding depressed symptoms, non-pharmaceutical treatments, such as cognitive-behavioral therapy and physical exercise, have shown therapeutic results, under medical supervision and with an effort level adapted to the patient's physical resources, together with optimal HF treatment. In randomized clinical studies, selective serotonin reuptake inhibitors, the backbone of antidepressant treatment, did not demonstrate advantage over the placebo in patients with HF. New antidepressant medications are currently being studied and could provide a chance to enhance management, treatment, and control of depression in patients with HF. Conclusions: Despite the substantial link between depression and HF, their combination is underdiagnosed and undertreated. Considering the hopeful yet unclear findings of antidepressant trials, further research is required to identify people who may benefit from antidepressant medication. The goal of future research should be a complete approach to the care of these patients, who are anticipated to become a significant medical burden in the future.
Collapse
Affiliation(s)
- Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Alfonsina Chirico
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Davide Buonocore
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Angela Colella
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Sara Fontanarosa
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Ciro Cotticelli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Anna Marchesi
- Department of Psychiatry, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00128 Rome, Italy
| | | | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
10
|
Thompson JH, Moser D, Lee CS. Psychometric Testing of the Control Attitudes Scale-Revised for Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2023; 38:120-127. [PMID: 35324510 PMCID: PMC9508290 DOI: 10.1097/jcn.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perceived control, an indicator of the patient's ability to cope and thrive with a chronic illness, is a common target of nursing interventions. As of 2019, more than 25 000 patients had been implanted with a left ventricular assist device (LVAD) as a treatment of advanced heart failure. Patients with an LVAD experience significant life changes that affect anxiety, depression, health-related quality of life, and, presumably, perceived control. To adequately intervene and improve perceived control, a reliable and valid measure is needed. OBJECTIVES The objectives of this analysis were to (1) assess item discrimination and anticipated range of scores of the Control Attitudes Scale-Revised (CAS-R), (2) assess the internal consistency and validity of the CAS-R, and (3) examine perceived control in a sample of patients with an LVAD. METHODS Two cohorts of patients with an LVAD (n = 113) were combined to evaluate the psychometric qualities of the CAS-R. Correlations among patient-reported outcomes and perceived control were used to evaluate validity. Cronbach α was used to test internal consistency. Item response theory was used to measure item discrimination and anticipated scores. Descriptive statistics describe perceived control in the sample. RESULTS Overall, the CAS-R demonstrated good internal consistency and convergent validity with other patient-reported outcomes. Using the item response theory, we saw that the CAS-R was a good predictor of lower-moderate scorers but was not good at differentiating high performers. There were several items that were poor discriminators and could be altered or discarded to create a more predictive instrument. CONCLUSIONS The CAS-R is a valid and reliable instrument to measure perceived control in patients who have LVAD implants; however, more work could be done to improve item-level information.
Collapse
|
11
|
Factors Related to Patients' Self-care and Self-care Confidence in Korean Patients With Heart Failure and Their Caregivers: A Cross-sectional, Correlational Study. J Cardiovasc Nurs 2023; 38:140-149. [PMID: 35507026 DOI: 10.1097/jcn.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure. OBJECTIVE The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure. METHODS In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression. RESULTS Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence. CONCLUSION Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care.
Collapse
|
12
|
Manolis TA, Manolis AA, Melita H, Manolis AS. Neuropsychiatric disorders in patients with heart failure: not to be ignored. Heart Fail Rev 2022:10.1007/s10741-022-10290-2. [DOI: 10.1007/s10741-022-10290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
|
13
|
Goyal P, Zainul O, Marshall D, Kitzman DW. Geriatric Domains in Patients with Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:517-532. [PMID: 36210135 PMCID: PMC10282897 DOI: 10.1016/j.ccl.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because heart failure with preserved ejection fraction (HFpEF) is closely linked to aging processes and disproportionately affects older adults, consideration of geriatric domains is paramount to ensure high-quality care to older adults with HFpEF. Multimorbidity, polypharmacy, cognitive impairment, depressive symptoms, frailty, falls, and social isolation each have important implications on quality of life and clinical events including hospitalization and mortality. There are multiple strategies to screen for these conditions. This narrative review underscores the importance of screening for multiple geriatric conditions, integrating these conditions into decision making, and addressing these conditions when caring for older adults with HFpEF.
Collapse
Affiliation(s)
- Parag Goyal
- Department of Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10023, USA.
| | - Omar Zainul
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10023, USA
| | - Dylan Marshall
- Department of Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10023, USA
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Disease and Geriatrics, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| |
Collapse
|
14
|
Nguyen TT, Nguyen TX, Nguyen TTH, Nguyen TN, Nguyen HTT, Nguyen HTT, Nguyen AT, Pham T, Vu HTT. Symptom Burden among Hospitalised Older Patients with Heart Failure in Hanoi, Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13593. [PMID: 36294170 PMCID: PMC9602984 DOI: 10.3390/ijerph192013593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to assess the symptom burden among older patients hospitalised for heart failure. This hospital-based, cross-sectional study was conducted at the National Geriatric Hospital, Hanoi, Vietnam, from June 2019 to August 2020. Face-to-face interviews were performed to gather the following information: socio-demographic characteristics, heart failure classification, and clinical characteristics (comorbidities, polypharmacy, pro-B-type natriuretic peptide, left ventricular ejection fraction (LVEF), symptom burden, and depression). Symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS), and depression was measured using the Patient Health Questionnaire. A total of 314 patients participated in the study. The mean participant age was 72.67 (SD = 9.42) years. The most frequently reported symptoms on the ESAS were shortness of breath (95.5%), fatigue (94.8%), and anxiety (81.2%). In univariate analyses, depression was significantly associated with heart failure class (p < 0.05). Multivariate linear regression revealed that major depression was significantly associated with total symptom burden score (Beta: 11.74; 95% CI: 9.24-14.23) and LVEF (Beta: -0.09; 95% CI: -0.17-(-0.007)). Patients hospitalised for heart failure experienced a high burden of symptoms. Further studies addressing adverse outcomes and expanding to community-dwelling older people are essential. Palliative care approaches that target symptom reduction should be considered in patients with heart failure.
Collapse
Affiliation(s)
- Thanh Thi Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| |
Collapse
|
15
|
Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
Collapse
Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
| |
Collapse
|
16
|
Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
Collapse
Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
17
|
Feder KM, Rahr HB, Lautrup MD, Egebæk HK, Christensen R, Ingwersen KG. Effectiveness of an expert assessment and individualised treatment compared with a minimal home-based exercise program in women with late-term shoulder impairments after primary breast cancer surgery: study protocol for a randomised controlled trial. Trials 2022; 23:701. [PMID: 35987857 PMCID: PMC9392220 DOI: 10.1186/s13063-022-06659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In breast cancer patients, late-term upper limb sequelae, such as shoulder pain and impaired shoulder function, remain common after primary breast cancer surgery. The aim of this trial is to evaluate whether an expert assessment of shoulder impairments, followed by an individualised treatment plan, is superior to a minimal physiotherapeutic rehabilitation program in reducing shoulder symptoms, among women with late-term shoulder impairments after primary breast cancer.
Methods/design
The study is designed as a stratified, parallel-group, assessor-blinded, randomised, controlled trial conducted in Denmark; 130 participants with late-term shoulder impairments 3–7 years after primary surgery for breast cancer will be recruited. Participants will be randomised (allocation 1:1) to either an expert assessment of shoulder impairments followed by an individualised treatment plan or to follow a minimal physiotherapeutic rehabilitation program delivered in a pamphlet. The primary outcome will be a change in shoulder pain and function from baseline to 12 weeks after initiating the treatment, as measured by the patient-reported outcome Shoulder Pain and Disability Index (SPADI) questionnaire.
Discussion
There has been an insufficient focus in research and clinical practice on late-term shoulder impairment in women following surgery for breast cancer. This trial will focus on interventions towards late-term shoulder impairments and is expected to provide evidence-based knowledge to physiotherapists and women about the management of shoulder pain and impaired shoulder function.
Trial registration
ClinicalTrials.gov NCT05277909. Registered on 11 March 2022.
Collapse
|
18
|
Li J, Jiang C, Liu R, Lai Y, Li L, Zhao X, Wang X, Li L, Du X, Ma C, Dong J. Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure. Front Cardiovasc Med 2022; 9:858751. [PMID: 35983186 PMCID: PMC9378836 DOI: 10.3389/fcvm.2022.858751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDepression is a prevalent comorbidity in patients with heart failure (HF). However, data regarding the prognostic significance of depression during the early post-discharge period in patients hospitalized with acute HF, regardless of left ventricular ejection fraction (LVEF), were scarce.Methods and resultsThe Heart Failure Registry of Patient Outcomes (HERO) study is a prospective, multicenter study of patients hospitalized with acute HF in China. At the first follow-up after discharge (median 4.0, interquartile range [IQR]: 2.4–6.1 weeks), depressive symptoms over the past 2 weeks were assessed using the Patient Health Questionnaire-9 (PHQ-9). Of 3,889 patients, 480 (12.3%) patients had depression (PHQ-9 score ≥ 10). A total of 3,456 patients (11.4% with depression) were included in the prospective analysis. After a median follow-up of 47.1 weeks (IQR: 43.9, 49.3) from the first follow-up, 508 (14.7%) patients died, and 1,479 (42.8%) patients experienced a composite event (death or HF rehospitalization). Cox proportional hazards models were used to assess the association of post-discharge depression with adverse events. After adjustment, post-discharge depression was associated with an increased risk of all-cause mortality (hazard ratio [HR] 2.38 [95% confidence interval (CI): 1.93–2.94]; p < 0.001) and the composite event (HR 1.78 [95% CI: 1.55–2.05]; p < 0.001). A per scale point increase in PHQ-9 score (ranging from 0 to 27 points) was associated with a 7.6% increase in all-cause mortality (HR 1.08 [95% CI: 1.06–1.09]; p < 0.001). In the subgroup analysis, the association between depression and the composite event was significantly stronger in relatively younger patients (< 75 vs. ≥ 75 years; p for interaction = 0.011), and the association between depression and all-cause mortality was significantly stronger in patients with preserved ejection fraction than in those with reduced ejection fraction (p for interaction = 0.036).ConclusionPost-discharge depression in patients recently hospitalized with acute HF is associated with an increased risk of adverse events, regardless of LVEF. Screening for depressive symptoms during the early post-discharge period may help to better identify high-risk patients and tailor patient management. Further studies are needed to determine how regular depression screening can help improve patient management and clinical outcomes.
Collapse
Affiliation(s)
- Junlei Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Rong Liu
- Heart Health Research Center (HHRC), Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Li Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofang Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
| | - Changsheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
- *Correspondence: Jianzeng Dong,
| |
Collapse
|
19
|
Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rubin EH, Rich MW. Sequential Interventions for Major Depression and Heart Failure Self-Care: A Randomized Clinical Trial. Circ Heart Fail 2022; 15:e009422. [PMID: 35973032 PMCID: PMC9389592 DOI: 10.1161/circheartfailure.121.009422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major depression and inadequate self-care are common in patients with heart failure (HF). Little is known about how to intervene when both problems are present. This study examined the efficacy of a sequential approach to treating these problems. METHODS Stepped Care for Depression in HF was a single-site, single-blind, randomized controlled trial of cognitive behavior therapy (CBT) versus usual care (UC) for major depression in patients with HF. The intensive phase of the CBT intervention lasted between 8 and 16 weeks, depending upon the rate of improvement in depression. All participants received a tailored HF self-care intervention that began 8 weeks after randomization. The intensive phase of the self-care intervention ended at 16 weeks post-randomization. The coprimary outcome measures were the Beck Depression Inventory (version 2) and the Maintenance scale of the Self-Care of HF Index (v6.2) at week 16. RESULTS One hundred thirty-nine patients with HF and major depression were enrolled; 70 were randomized to UC and 69 to CBT. At week 16, the patients in the CBT arm scored 4.0 points ([95% CI, -7.3 to -0.8]; P=0.02) lower on the Beck Depression Inventory, version 2 than those in the usual care arm. Mean scores on the Self-Care of HF Index Maintenance scale were not significantly different between the groups ([95% CI, -6.5 to 1.5]; P=0.22). CONCLUSIONS CBT is more effective than usual care for major depression in patients with HF. However, initiating CBT before starting a tailored HF self-care intervention does not increase the benefit of the self-care intervention. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02997865.
Collapse
Affiliation(s)
- Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Judith A. Skala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Robert M. Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Brian C. Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Eugene H. Rubin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W. Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
20
|
Lua I, Freitas KS, Teixeira JRB, Reichenheim ME, Almeida MMGD, Araújo TMD. Measurement of depression in the Brazilian population: validation of the Patient Health Questionnaire (PHQ-8). CAD SAUDE PUBLICA 2022; 38:e00176421. [PMID: 35766627 DOI: 10.1590/0102-311xen176421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
We aimed to evaluate the psychometric properties of the Brazilian version of the Patient Health Questionnaire (PHQ-8). A study with a sample of 4,170 individuals (≥ 15 years old) from the urban area. Conglomerate sampling was adopted in two stages (census sectors and streets), with weighting of estimates by sample weights. A structured questionnaire with sociodemographic data, the PHQ - the modules for depression, generalized anxiety disorder and panic disorder - and the Self-Reporting Questionnaire (SRQ-20) were used. In the evaluation of the PHQ-8, we verified the construct validity by analyzing the dimensional structure, convergent validity and internal consistency. We found a linear disorder without losses to maintain the four response categories. The factor analysis found unidimensionality of the depression construct, with strong factor loads, low residual variances, low residual correlation between items, good fit of the model, internal consistency and satisfactory convergent factorial validity (high loads and correlations with other tests/scales of similar constructs). The PHQ-8 has a one-dimensional structure with evidence of good validity and reliability, being suitable for use in the Brazilian population.
Collapse
Affiliation(s)
- Iracema Lua
- Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Resilience, defined as a dynamic process of positively responding to adversity, could protect against depressive symptoms in cardiac disease. No systematic review has been conducted on the relationship between these variables in this population. OBJECTIVE The aim of this review was to explore the association between psychological resilience and depressive symptoms in adults with cardiac disease. METHODS Seven databases (PubMed, EMBASE, CINAHL, PsycInfo, Web of Science, SCOPUS, and Cochrane) were searched from inception to December 2019 using the search terms "cardiac disease," "depressive symptoms," "depression," and "resilience." Inclusion criteria dictated that studies reported original research on the association between resilience and depressive symptoms in adults with a cardiac disease broadly defined. Quality ratings were performed by 2 independent raters. RESULTS We identified 13 studies for final review. Study sample sizes ranged from 30 to 1022 participants, average age ranged from 52 to 72 years, and all studies had majority male participants (64%-100%). Resilience and depressive symptoms were inversely related in 10 of 13 studies. The 3 studies with poor-quality sampling techniques or significant loss to follow-up found no relationship. CONCLUSIONS Resilience seems to protect against depression in adults with cardiac disease. Gaps in the literature include poor understanding of the direction of causality. Methods of promoting resilience need to be identified and studied.
Collapse
|
22
|
Van Tassell B, Mihalick V, Thomas G, Marawan A, Talasaz AH, Lu J, Kang L, Ladd A, Damonte JI, Dixon DL, Markley R, Turlington J, Federmann E, Del Buono MG, Biondi-Zoccai G, Canada JM, Arena R, Abbate A. Rationale and design of interleukin-1 blockade in recently decompensated heart failure (REDHART2): a randomized, double blind, placebo controlled, single center, phase 2 study. J Transl Med 2022; 20:270. [PMID: 35706006 PMCID: PMC9198622 DOI: 10.1186/s12967-022-03466-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) is a global leading cause of mortality despite implementation of guideline directed therapy which warrants a need for novel treatment strategies. Proof-of-concept clinical trials of anakinra, a recombinant human Interleukin-1 (IL-1) receptor antagonist, have shown promising results in patients with HF. Method We designed a single center, randomized, placebo controlled, double-blind phase II randomized clinical trial. One hundred and two adult patients hospitalized within 2 weeks of discharge due to acute decompensated HF with reduced ejection fraction (HFrEF) and systemic inflammation (high sensitivity of C-reactive protein > 2 mg/L) will be randomized in 2:1 ratio to receive anakinra or placebo for 24 weeks. The primary objective is to determine the effect of anakinra on peak oxygen consumption (VO2) measured at cardiopulmonary exercise testing (CPX) after 24 weeks of treatment, with placebo-corrected changes in peak VO2 at CPX after 24 weeks (or longest available follow up). Secondary exploratory endpoints will assess the effects of anakinra on additional CPX parameters, structural and functional echocardiographic data, noninvasive hemodynamic, quality of life questionnaires, biomarkers, and HF outcomes. Discussion The current trial will assess the effects of IL-1 blockade with anakinra for 24 weeks on cardiorespiratory fitness in patients with recent hospitalization due to acute decompensated HFrEF. Trial registration: The trial was registered prospectively with ClinicalTrials.gov on Jan 8, 2019, identifier NCT03797001.
Collapse
Affiliation(s)
- Benjamin Van Tassell
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA. .,Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA.
| | - Virginia Mihalick
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Georgia Thomas
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Amr Marawan
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Azita H Talasaz
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Lu
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Amy Ladd
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Juan Ignacio Damonte
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Dave L Dixon
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA.,Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Roshanak Markley
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Jeremy Turlington
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Emily Federmann
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Marco Giuseppe Del Buono
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Justin M Canada
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, USA
| | - Antonio Abbate
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA
| |
Collapse
|
23
|
Chernoff RA, Messineo G, Kim S, Pizano D, Korouri S, Danovitch I, IsHak WW. Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis. Psychosom Med 2022; 84:560-580. [PMID: 35354163 DOI: 10.1097/psy.0000000000001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure. METHODS Studies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted. RESULTS Twenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: -0.41; 95% confidence interval [CI] = -0.66 to -0.17; p = .001) and anxiety (combined DSMC: -0.33; 95% CI = -0.51 to -0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = -0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect). CONCLUSIONS CBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.
Collapse
Affiliation(s)
- Robert Alan Chernoff
- From the Department of Psychiatry and Behavioral Neurosciences (Chernoff, Messineo, Pizano, Korouri, Danovitch, IsHak), and Biostatistics Core (Kim), Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | | | | |
Collapse
|
24
|
Wilhelm EAB, Davis LL, Sharpe L, Waters S. Assess and address: Screening and management of depression in patients with chronic heart failure. J Am Assoc Nurse Pract 2022; 34:769-779. [PMID: 35383649 DOI: 10.1097/jxx.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF. LOCAL PROBLEM Depression screening was not being systematically implemented in an outpatient cardiology clinic. METHODS To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms. INTERVENTION A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan. RESULTS Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan. CONCLUSIONS We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.
Collapse
Affiliation(s)
| | - Leslie L Davis
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
| | - Leslie Sharpe
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
| | - Sarah Waters
- Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
25
|
Heo S, Lennie TA, Moser DK, Dunbar SB, Pressler SJ, Kim J. Testing of a health-related quality of life model in patients with heart failure: A cross-sectional, correlational study. Geriatr Nurs 2022; 44:105-111. [PMID: 35104725 PMCID: PMC8995344 DOI: 10.1016/j.gerinurse.2022.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/18/2023]
Abstract
Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.
Collapse
Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia, 30341, USA.
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, 760 Rose Street, Lexington, Kentucky, 40536, USA
| | - Debra K. Moser
- College of Nursing, University of Kentucky, 760 Rose Street, Lexington, Kentucky, 40536, USA
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322
| | - Susan J. Pressler
- School of Nursing, Indiana University, 600 Barnhill Dr, Indianapolis, IN 46202
| | - JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon, 21936, South Korea
| |
Collapse
|
26
|
Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure. J Cardiovasc Nurs 2021; 35:116-125. [PMID: 31985701 DOI: 10.1097/jcn.0000000000000642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined. OBJECTIVE The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL. METHODS We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose. RESULTS Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL. CONCLUSION Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.
Collapse
|
27
|
Denfeld QE, Habecker BA, Camacho SA, Roberts Davis M, Gupta N, Hiatt SO, Medysky ME, Purnell JQ, Winters-Stone K, Lee CS. Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure. Circ Heart Fail 2021; 14:e008076. [PMID: 34428925 DOI: 10.1161/circheartfailure.120.008076] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. METHODS We prospectively enrolled adults with class I-IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. RESULTS The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81-11.84], P=0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non-physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non-physically frail men. CONCLUSIONS Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.
Collapse
Affiliation(s)
- Quin E Denfeld
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland.,Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Beth A Habecker
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland.,Department of Chemical Physiology and Biochemistry (B.A.H.), Oregon Health and Science University, Portland
| | - S Albert Camacho
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Mary Roberts Davis
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Nandita Gupta
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Shirin O Hiatt
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Mary E Medysky
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Jonathan Q Purnell
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Kerri Winters-Stone
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland.,Knight Cancer Institute (K.W.-S.), Oregon Health and Science University, Portland
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA (C.S.L.)
| |
Collapse
|
28
|
Brown S, Mearns J, Muirhead E, Rodgers S, Walker N. Supported exercise programme for adults with Congenital Heart Disease (SEACHange). INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
29
|
Denfeld QE, Faulkner KM, Davis MR, Habecker BA, Chien CV, Gelow JM, Mudd JO, Hiatt SO, Grady KL, Lee CS. Exploring gender differences in trajectories of clinical markers and symptoms after left ventricular assist device implantation. Eur J Cardiovasc Nurs 2021; 20:648-656. [PMID: 34080624 DOI: 10.1093/eurjcn/zvab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/14/2020] [Accepted: 03/23/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite well-known gender differences in heart failure, it is unknown if clinical markers and symptoms differ between women and men after left ventricular assist device (LVAD) implantation. Our aim was to examine gender differences in trajectories of clinical markers (echocardiographic markers and plasma biomarkers) and symptoms from pre- to post-LVAD implantation. METHODS AND RESULTS This was a secondary analysis of data collected from a study of patients from pre- to 1, 3, and 6 months post-LVAD implantation. Data were collected on left ventricular internal end-diastolic diameter (LVIDd) and ejection fraction (LVEF), plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppressor of tumorigenicity (sST2). Physical and depressive symptoms were measured using the Heart Failure Somatic Perception Scale and Patient Health Questionnaire-9, respectively. Latent growth curve modelling was used to compare trajectories between women and men. The average age of the sample (n = 98) was 53.3 ± 13.8 years, and most were male (80.6%) and had non-ischaemic aetiology (65.3%). Pre-implantation, women had significantly narrower LVIDd (P < 0.001) and worse physical symptoms (P = 0.041) compared with men. Between pre- and 6 months post-implantation, women had an increase in plasma sST2 followed by a decrease, whereas men had an overall decrease (slope: P = 0.014; quadratic: P = 0.011). Between 1 and 6 months post-implantation, women had a significantly greater increase in LVEF (P = 0.045) but lesser decline in plasmoa NT-proBNP compared with men (P = 0.025). CONCLUSION Trajectories of clinical markers differed somewhat between women and men, but trajectories of symptoms were similar, indicating some physiologic but not symptomatic gender differences in response to LVAD.
Collapse
Affiliation(s)
- Quin E Denfeld
- School of Nursing, Oregon Health & Science University, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239-2941, USA
| | - Kenneth M Faulkner
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Mary Roberts Davis
- School of Nursing, Oregon Health & Science University, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239-2941, USA
| | - Beth A Habecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, OR, USA
| | - Christopher V Chien
- Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jill M Gelow
- Providence Heart & Vascular Institute, Portland, OR, USA
| | - James O Mudd
- Providence Sacred Heart Medical Center, Spokane, WA, USA
| | - Shirin O Hiatt
- School of Nursing, Oregon Health & Science University, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239-2941, USA
| | - Kathleen L Grady
- Department of Surgery, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| |
Collapse
|
30
|
Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | |
Collapse
|
31
|
Kim J, Shin MS, Jang AY, Kim S, Heo S, Cha E, An M. Advance Directives and Factors Associated with the Completion in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041780. [PMID: 33673089 PMCID: PMC7918223 DOI: 10.3390/ijerph18041780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/16/2022]
Abstract
Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.
Collapse
Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, Korea;
| | - Mi-Seung Shin
- Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea;
- Correspondence: (M.-S.S.); (M.A.); Tel.: +82-32-460-3663 (M.-S.S.); +82-62-530-4944 (M.A.)
| | - Albert Youngwoo Jang
- Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea;
| | - Shinmi Kim
- Department of Nursing, Changwon National University, 20 Changwondaehakro, Euichanggu, Kyungsangnamdo, Changwon 51140, Korea;
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA;
| | - EunSeok Cha
- College of Nursing, Chungnam National University, 266 MunWharo, Junggu, Daejeon 35015, Korea;
| | - Minjeong An
- College of Nursing, Interdisciplinary Program of Arts & Design Technology, Chonnam National University, 160 Baekseoro, Donggu, Gwangju 61469, Korea
- Correspondence: (M.-S.S.); (M.A.); Tel.: +82-32-460-3663 (M.-S.S.); +82-62-530-4944 (M.A.)
| |
Collapse
|
32
|
OUP accepted manuscript. Eur J Cardiovasc Nurs 2021; 21:559-567. [DOI: 10.1093/eurjcn/zvab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022]
|
33
|
Chandra A, Alcala MA, Claggett B, Desai AS, Fang JC, Heitner JF, Liu J, Pitt B, Solomon SD, Pfeffer MA, Lewis EF. Associations Between Depressive Symptoms and HFpEF-Related Outcomes. JACC-HEART FAILURE 2020; 8:1009-1020. [DOI: 10.1016/j.jchf.2020.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022]
|
34
|
Ghaheri A, Omani-Samani R, Sepidarkish M, Hosseini M, Maroufizadeh S. The Four-item Patient Health Questionnaire for Anxiety and Depression: A Validation Study in Infertile Patients. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:234-239. [PMID: 33098392 PMCID: PMC7604697 DOI: 10.22074/ijfs.2020.44412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 05/20/2020] [Indexed: 12/02/2022]
Abstract
Background The most common mental disorders in infertile patients are depression and anxiety. The four-item
Patient Health Questionnaire-4 (PHQ-4) is a widely used tool that consists of the PHQ-2 depression and Generalized
Anxiety Disorder-2 (GAD-2) scales. Given that PHQ-4 has not been validated in infertile patients, this study aimed to
examine its reliability and validity in this population. Materials and Methods Participants in this cross-sectional study consisted of 539 infertile patients from a referral
fertility centre in Tehran, Iran. The PHQ-4, Hospital Anxiety and Depression Scale (HADS), World Health Organi-
sation-Five Well-Being Index (WHO-5), Penn State Worry Questionnaire (PSWQ) and demographic/infertility ques-
tionnaires were administered to all participants. Factor structure and internal consistency of PHQ-4 were evaluated
via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. The convergent validity of this scale was
examined by its relationship with HADS, WHO-5 and PSWQ. Results CFA results provided support for a two-factor model of PHQ-4. Internal consistency of the PHQ-4 and its subscales
both were elevated with Cronbach’s alpha coefficients of 0.767 (PHQ-4), 0.780 (PHQ-2) and 0.814 (GAD-2). Inter-item
correlations were between 0.386 and 0.639, and corrected item-total correlations were between 0.576 and 0.687. PHQ-4,
PHQ-2 and GAD-2 showed positive correlations with measures of HADS-anxiety, HADS-depression, and PSWQ and neg-
ative correlations with WHO-5, which confirmed convergent validity. Among demographic/fertility variables, we observed
that gender, infertility duration, and failure in previous treatment were correlated with PHQ-4 and its subscales scores. Conclusion The PHQ-4 is a reliable and valid ultra-brief screening instrument for measuring both anxiety and depres-
sive symptoms in infertile patients.
Collapse
Affiliation(s)
- Azadeh Ghaheri
- Department of Diabetes, Obesity and Metabolism, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Electronic Address:
| |
Collapse
|
35
|
The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure. Heart Lung 2020; 49:737-744. [PMID: 32977035 DOI: 10.1016/j.hrtlng.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/10/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health. OBJECTIVES The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver. METHODS A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2). RESULTS Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life. CONCLUSIONS The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.
Collapse
|
36
|
Chen AMH, Yehle KS, Plake KS, Rathman LD, Heinle JW, Frase RT, Anderson JG, Bentley J. The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model. Heart Lung 2020; 49:702-708. [PMID: 32861889 DOI: 10.1016/j.hrtlng.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.
Collapse
Affiliation(s)
- Aleda M H Chen
- Assistant Dean and Associate Professor, Cedarville University School of Pharmacy, 251N. Main St., Cedarville, OH 45314, USA.
| | - Karen S Yehle
- Professor Emerita, Purdue University, School of Nursing, 502N. University Street, West Lafayette, IN, 47907, USA.
| | - Kimberly S Plake
- Associate Head of Professional Education, Associate Professor, Director, Purdue University Academic and Ambulatory Care Fellowship Program, Faculty Associate, Center for Aging and the Life Course, 575 Stadium Mall Dr., West Lafayette, IN, 47907, USA.
| | - Lisa D Rathman
- Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health/PENN Medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA.
| | - J Wes Heinle
- At time of project: Research Assistant, The Heart Group of Lancaster General Health/PENN medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA
| | - Robert T Frase
- Graduate Student, Purdue University, Department of Sociology, 700W. State Street, West Lafayette, IN 47907, USA.
| | - James G Anderson
- Purdue University, Department of Medical Sociology and Health Communication, 700W. State Street, West Lafayette, IN 47907, USA.
| | - John Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Faser Hall 225, University, MS, 38677, USA.
| |
Collapse
|
37
|
Auld JP, Thompson EA, Dougherty CM. Social cognitive intervention following an initial implantable cardioverter defibrillator: Better treatment response for secondary versus primary prevention. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:974-982. [PMID: 32364618 DOI: 10.1111/pace.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The patient + partner (P+P) is a patient/partner-focused social cognitive intervention with demonstrated efficacy to improve outcomes following an initial implantable cardioverter defibrillator (ICD). Little is known about how the patient response may differ by ICD implant indication. The aim of this study was to examine the response to intervention for patients with an initial ICD by reasons for primary versus secondary ICD indication. METHOD A longitudinal secondary analysis of data from a randomized clinical trial testing the P+P intervention examined patient health outcomes over 12 months, stratified by the indication for the ICD: primary prevention without cardiac resynchronization therapy (CRT) (1o No CRT, n = 100), primary prevention with CRT (1o CRT, n = 78), secondary prevention after cardiac arrest (2° Cardiac Arrest, n = 66), and secondary prevention for other arrhythmias (2o Other, n = 57). Outcomes included physical and mental health status (Short-Form-36 Physical Component Summary and Mental Component Summary), physical symptoms (Patient Concerns Assessment), depression (Patient-Health-Questionniare-9), and anxiety (State-Trait Anxiety Inventory). RESULTS Participants (n = 301) were on average 64 years old, primarily male (73.7%) and Caucasian (91%) with reduced ejection fraction (34%). There were no baseline differences between ICD groups for all outcomes (P > .05). Patients in the 2° Cardiac Arrest group showed greater improvement from baseline to 3 months in physical and mental health outcomes. The 2° Cardiac Arrest group had better physical (F = 11.48, P = .004) and mental health (F = 4.34, P = .038) and less severe physical (z = 2.24, P = 0.013) and depressive symptoms (z = 2.71, P = .003) at 12 months compared to the 1o No CRT group. CONCLUSION The P+P intervention was more effective for promoting physical and psychological health outcomes for individuals receiving an ICD for 2o prevention after cardiac arrest.
Collapse
Affiliation(s)
- Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Elaine A Thompson
- School of Nursing, Psychosocial and Community Health, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| |
Collapse
|
38
|
Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Fail 2020; 7:2193-2207. [PMID: 32757363 PMCID: PMC7524132 DOI: 10.1002/ehf2.12875] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic heart failure (CHF) is a chronic, progressive disease that has detrimental consequences on a patient's quality of life (QoL). In part due to requirements for market access and licensing, the assessment of current and future treatments focuses on reducing mortality and hospitalizations. Few drugs are available principally for their symptomatic effect despite the fact that most patients' symptoms persist or worsen over time and an acceptance that the survival gains of modern therapies are mitigated by poorly controlled symptoms. Additional contributors to the failure to focus on symptoms could be the result of under‐reporting of symptoms by patients and carers and a reliance on insensitive symptomatic categories in which patients frequently remain despite additional therapies. Hence, formal symptom assessment tools, such as questionnaires, can be useful prompts to encourage more fidelity and reproducibility in the assessment of symptoms. This scoping review explores for the first time the assessment options and management of common symptoms in CHF with a focus on patient‐reported outcome tools. The integration of patient‐reported outcomes for symptom assessment into the routine of a CHF clinic could improve the monitoring of disease progression and QoL, especially following changes in treatment or intervention with a targeted symptom approach expected to improve QoL and patient outcomes.
Collapse
Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Elisha R Gallivan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Melanie McGinlay
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Anet G Toms
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| |
Collapse
|
39
|
Exercise Training in Patients With Heart Failure With Preserved Ejection Fraction: A Community Hospital Pilot Study. J Cardiovasc Nurs 2020; 36:124-130. [PMID: 32740221 DOI: 10.1097/jcn.0000000000000737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) experience poor exercise tolerance and quality of life. Little is known about the feasibility or effects of HFpEF exercise training (ET) in a community hospital setting. OBJECTIVE The aim of this study was to examine the feasibility and pilot data of a community-based HFpEF ET intervention. METHODS This was a single-group (n = 16), pretest-posttest, 9-week ET intervention. The Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, cardiopulmonary exercise test (peak VO2), and 6-minute walk test were used for evaluation. RESULTS Participants (n = 16) attended 88% of prescribed ET sessions and 94% completed all pretest-posttest assessments. Significant improvements in Minnesota Living With Heart Failure Questionnaire (P = .01), Patient Health Questionnaire-9 (P ≤ .01), exercise test time (P = .01) and 6-minute walk test (P = .001), but not in peak VO2 (P = .16), were found. CONCLUSIONS The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.
Collapse
|
40
|
Al-Hammouri MM, Rababah JA, Hall LA, Moser DK, Dawood Z, Jawhar W, Alawawdeh A. Self-care behavior: a new insight of the role of impulsivity into decision making process in persons with heart failure. BMC Cardiovasc Disord 2020; 20:349. [PMID: 32718351 PMCID: PMC7385854 DOI: 10.1186/s12872-020-01617-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background Self-care behavior has been reported to be below optimum in persons with heart failure, while the underlying decision making is not well understood. The Hot/Cool System model is a psychological model that may have potential applications in decision making process in persons with heart failure. The aim of this study was to examine the decision making process in self-care behavior in persons with heart failure in the light of the Hot/Cool System model. Methods We used the Hoot/Cool System Model to guide this study. Participants with heart failure from in-patients setting (N = 107) were recruited. Data were collected using self-report questionnaires. Moderated mediation analysis was used to study complex relationships among study variables. Results The current study showed that impulsivity and perceived stress were negatively associated with self-care behavior. The results also showed that self-care confidence and impulsivity significantly predict self-care maintenance. The moderated mediation analysis revealed that self-care confidence mediated the relationship between impulsivity and self-care maintenance at lower levels of perceived stress, but not at higher levels of perceived stress. Conclusion Our findings revealed that persons with heart failure tend to make impulsive choices that may negatively affect disease progression under higher levels of perceived stress. This study provides foundational knowledge regarding the decision making process in persons with heart failure.
Collapse
Affiliation(s)
- Mohammed Munther Al-Hammouri
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
| | - Jehad A Rababah
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, USA
| | - Debra K Moser
- School of Nursing, University of Kentucky, Lexington, USA
| | - Zainab Dawood
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Ayat Alawawdeh
- Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
41
|
Carlozzi NE, Goodnight S, Kratz AL, Stout JC, McCormack MK, Paulsen JS, Boileau NR, Cella D, Ready RE. Validation of Neuro-QoL and PROMIS Mental Health Patient Reported Outcome Measures in Persons with Huntington Disease. J Huntingtons Dis 2020; 8:467-482. [PMID: 31424415 DOI: 10.3233/jhd-190364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) for mental health are important for persons with Huntington disease (HD) who commonly experience symptoms of depression, anxiety, irritability, anger, aggression, and apathy. Given this, there is a need for reliable and valid patient-reported outcomes measures of mental health for use as patient-centered outcomes in clinical trials. OBJECTIVE Thus, the purpose of this study was to establish the psychometric properties (i.e., reliability and validity) of six Neuro-QoL and PROMIS mental health measures to support their clinical utility in persons with HD. METHODS 294 individuals with premanifest (n = 102) or manifest HD (n = 131 early HD; n = 61 late HD) completed Neuro-QoL/PROMIS measures of Emotional and Behavioral Dyscontrol, Positive Affect and Well-Being, Stigma, Anger, Anxiety, and Depression, legacy measures of self-reported mental health, and clinician-rated assessments of functioning. RESULTS Convergent validity and discriminant validity for the Neuro-QoL and PROMIS measures of Emotional and Behavioral Dyscontrol, Positive Affect and Well-Being, Stigma, Anger, Anxiety, and Depression, were supported in persons with HD. Neuro-QoL measures of Anxiety and Depression also demonstrated moderate sensitivity and specificity (i.e., they were able to distinguish between individuals with and without clinically significant anxiety and depression). CONCLUSIONS Findings provide psychometric support for the clinical utility of the Neuro-QoL/PROMIS measures of mental health measures in persons with HD. As such, these measures should be considered for the standardized assessment of health-related quality of life in persons with HD.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Stout
- Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael K McCormack
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA.,Department of Pathology, Rowan-School of Medicine, Stratford, NJ, USA
| | - Jane S Paulsen
- Departments of Psychiatry, Neurology, and Psychology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - David Cella
- Departments of Medical Social Sciences and Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
42
|
Sbolli M, Fiuzat M, Cani D, O'Connor CM. Depression and heart failure: the lonely comorbidity. Eur J Heart Fail 2020; 22:2007-2017. [DOI: 10.1002/ejhf.1865] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marco Sbolli
- University of Brescia Brescia Italy
- Inova Heart and Vascular Institute Fairfax VA USA
| | | | - Dario Cani
- University of Brescia Brescia Italy
- Inova Heart and Vascular Institute Fairfax VA USA
| | | |
Collapse
|
43
|
Abstract
BACKGROUND Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF. OBJECTIVE The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status. METHODS A total of 115 patients with HF were included. Data on symptom status (Memorial Symptom Assessment Scale-HF), perceived control (Control Attitudes Scale-Revised), and self-care (Self-Care of Heart Failure Index) were collected. Other covariates included were age, gender, New York Heart Association class, comorbidity burden, and depressive symptoms. Multiple regression analyses were performed to analyze the data. RESULTS Lower perceived control predicted worse symptom status after controlling for covariates (P = .009). Other covariates predictive of worse symptom status were younger age, New York Heart Association class III/IV, and higher levels of depressive symptoms. Higher levels of perceived control were associated with better self-care (P = .044). Better self-care was associated with better symptom status (P = .038). CONCLUSIONS Lower levels of perceived control were independently associated with worse symptom status in patients with HF. Intervention strategies targeting perceived control should be tested to determine whether they could improve symptom status.
Collapse
|
44
|
Suarez L, Dunlay SM, Schettle SD, Stulak JM, Staab JP. Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices. Gen Hosp Psychiatry 2020; 64:93-98. [PMID: 32008725 DOI: 10.1016/j.genhosppsych.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. METHODS We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. RESULTS Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. CONCLUSION Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
Collapse
Affiliation(s)
- Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America; Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| |
Collapse
|
45
|
Ely AV, Alio C, Bygrave D, Burke M, Walker E. Relationship Between Psychological Distress and Cognitive Function Differs as a Function of Obesity Status in Inpatient Heart Failure. Front Psychol 2020; 11:162. [PMID: 32116957 PMCID: PMC7033423 DOI: 10.3389/fpsyg.2020.00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/21/2020] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a chronic medical condition rapidly growing in prevalence. Evidence links HF to cognitive decline, obesity, and psychological distress. The current study examined the association between cognitive function and ejection fraction (EF%), anxiety, depression, and obesity in inpatient HF. Patients completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7), Patient Health Questionnaire 9-Item Scale (PHQ-9), and Mini-Cog while hospitalized for HF. Additional demographic and medical information was gathered via chart review. All models controlled for age. Of 117 patients assessed (49% male), 55% (n = 64) were obese. ANCOVA analyses were conducted comparing those with obesity and without on cognitive function: model A included EF%, model B included depression, and model C included anxiety. All three models were significantly related to cognitive function. There was a significant interaction effect of EF% and obesity and of anxiety and obesity to predict Mini-Cog scores. Post hoc partial correlational analyses revealed that anxiety was negatively associated with Mini-Cog scores among only patients without obesity. Depression was not significantly related to cognitive function in either group. However, patients with obesity demonstrated higher depression and anxiety than patients without. Results suggest that at lower EF%, and with higher anxiety, patients without obesity may be at greater risk of cognitive dysfunction than those with obesity. Cognitive dysfunction among HF patients with obesity may be independent of psychological distress. These findings may reflect the “obesity paradox” observed among HF patients, in that patients with obesity may have a different biopsychosocial presentation, which may lead to unexpected clinical outcomes. Further research is necessary to articulate the relationship of obesity and cognitive function in HF.
Collapse
Affiliation(s)
- Alice V Ely
- Department of Psychiatry, Christiana Care, Newark, DE, United States.,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Courtney Alio
- Department of Psychiatry, Christiana Care, Newark, DE, United States
| | - Desiree Bygrave
- Department of Psychiatry, Christiana Care, Newark, DE, United States.,School of Nursing, University of Delaware, Newark, DE, United States
| | - Marykate Burke
- Department of Psychiatry, Christiana Care, Newark, DE, United States
| | - Earl Walker
- Department of Psychiatry, Christiana Care, Newark, DE, United States
| |
Collapse
|
46
|
Vaughan EM, Johnston CA, Moreno JP, Cheskin LJ, Dutton GR, Gee M, Gaussoin SA, Knowler WC, Rejeski WJ, Wadden TA, Yanovski SZ, Foreyt JP. Symptom prevalence differences of depression as measured by BDI and PHQ scales in the Look AHEAD study. Obes Sci Pract 2020; 6:28-38. [PMID: 32128240 PMCID: PMC7042097 DOI: 10.1002/osp4.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI-1A) and Patient Health Questionnaire (PHQ-9). METHODS Investigators conducted a cross-sectional secondary analysis of data collected as part of the follow-up observational phase of the Look AHEAD study. Rates of agreement between the BDI-1A and PHQ-9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease). RESULTS A high level of agreement (κ = 0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI-1A and PHQ-9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI-1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health-related quality of life, and minority racial/ethnic classification. CONCLUSIONS Either the BDI-1A or PHQ-9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.
Collapse
Affiliation(s)
| | - Craig A. Johnston
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexas
| | - Jennette P. Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics‐NutritionBaylor College of MedicineHoustonTexas
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, College of Health and Human ServicesGeorge Mason UniversityFairfaxVirginia
- Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Gareth R. Dutton
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Molly Gee
- Department of MedicineBaylor College of MedicineHoustonTexas
| | - Sarah A. Gaussoin
- Department of Biostatistical Sciences and Data Science, Division of Public Health ServicesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of HealthPhoenixArizona
| | - W. Jack Rejeski
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - Thomas A. Wadden
- Department of PsychiatryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvania
| | - Susan Z. Yanovski
- Division of Digestive Diseases and NutritionNational Institute of Diabetes and Digestive and Kidney DiseasesBethesdaMaryland
| | - John P. Foreyt
- Department of MedicineBaylor College of MedicineHoustonTexas
| | | |
Collapse
|
47
|
Kang J, Moser DK, Biddle MJ, Lennie TA, Smyth SS, Vsevolozhskaya OA. Inflammatory properties of diet mediate the effect of depressive symptoms on Framingham risk score in men and women: Results from the National Health and Nutrition Examination Survey (2007-2014). Nutr Res 2020; 74:78-86. [PMID: 31958655 DOI: 10.1016/j.nutres.2019.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/17/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022]
Abstract
Depression is common in patients with cardiovascular disease (CVD) and associated with inflammation. Inflammation contributes to the development of CVD and can be modulated by diet. However, the role of inflammatory properties of diet in the relationship between depressive symptoms and CVD risk is not well understood. We hypothesized that the inflammatory properties of diet mediate the relationship between depressive symptoms and CVD risk in men and women. Cross-sectional data collected by the National Health and Nutrition Examination Survey (2007-2014) were used for the study. Depressive symptoms scores, inflammatory properties of diet, and CVD risk were measured by the Patient Health Questionnaire-9 (PHQ-9), the Dietary Inflammatory Index (DII), and the Framingham risk score (FRS), respectively. Generalized linear models were used for the mediation analysis. There were significant differences in the proportions of men and women in the depressed group (PHQ-9 ≥ 10; 5.24 ± 0.65% vs 9.36 ± 0.87%, P < .001) and high CVD risk group (FRS >20%; 16.47 ± 0.79% vs 6.03 ± 0.32%, P < .001). The DII partially mediated the relationship between depressive symptoms and CVD risk in men (indirect effect: 0.06, P = .010) but fully mediated the relationship between depressive symptoms and CVD risk in women (indirect effect: 0.10, P < .001). These findings confirmed our hypothesis that inflammatory properties of diet at least partially mediate the relationship between depressive symptoms and CVD risk in men and women. Our findings suggest that interventions designed to reduce depressive symptoms should contain strategies to reduce pro-inflammatory and increase anti-inflammatory properties of diet to decrease CVD risk.
Collapse
Affiliation(s)
- JungHee Kang
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA; College of Public Health, University of Kentucky, 725 Rose Street, Lexington, KY 40536, USA.
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Susan S Smyth
- College of Medicine, University of Kentucky, 741 South Limestone Street, Lexington, KY 40536, USA
| | - Olga A Vsevolozhskaya
- College of Public Health, University of Kentucky, 725 Rose Street, Lexington, KY 40536, USA
| |
Collapse
|
48
|
Arnold ER, White-Williams C, Miltner RS, Hites L, Su W, Shirey MR. Transitional Care Home Visits Among Underserved Patients With Heart Failure. Nurs Adm Q 2020; 44:268-279. [PMID: 32511186 DOI: 10.1097/naq.0000000000000426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Heart failure (HF), a global public health problem affecting 26 million people worldwide, significantly impacts quality of life. The prevalence of depression associated with HF is 3 times higher than that of the general population. Evidence, though, supports the use of transitional care as a method to enhance functional status and improve rates of depression in patients with HF. This article discusses the findings of a quality improvement project that evaluated health outcomes in underserved patients with HF who participated in a transitional care home visitation program. The visitation program exemplifies the role of leadership in facilitating transitions across the health care continuum. The 2-year retrospective review included 79 participants with HF. Comparisons of outcomes were made over 6 months. Although not statistically significant, clinically significant differences in health outcomes were observed in participants who received a home visit >14 days compared with ≤14 days after hospital discharge. A home visitation program for underserved patients with HF offers opportunities to enhance care across the continuum. Ongoing evaluation of the existing home visitation program is indicated over time with the goal of offering leaders data to enhance patient and family-centered transitional care coordination.
Collapse
Affiliation(s)
- Erica R Arnold
- University of Alabama at Birmingham Hospital (Dr Arnold); Center for Nursing Excellence, and Heart Failure Transitional Care Services for Adults (HRTSA) Clinic, University of Alabama at Birmingham Hospital (Dr White-Williams); The University of Alabama at Birmingham School of Nursing (Drs White-Williams and Miltner); Community Medicine & Population Health, College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa (Dr Hites); The University of Alabama at Birmingham School of Public Health (Dr Su); and Clinical and Global Partnerships, Jane H. Brock-Florence Nightingale Endowed Professor in Nursing, The University of Alabama at Birmingham School of Nursing (Dr Shirey)
| | | | | | | | | | | |
Collapse
|
49
|
Denfeld QE, Bidwell JT, Gelow JM, Mudd JO, Chien CV, Hiatt SO, Lee CS. Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure. Heart Lung 2019; 49:151-157. [PMID: 31753526 DOI: 10.1016/j.hrtlng.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship between physical and affective symptom clusters in heart failure (HF) is unclear. OBJECTIVES To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups. METHODS This was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively. RESULTS In this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival. CONCLUSION Congruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes.
Collapse
Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA.
| | - Julie T Bidwell
- University of California Davis Betty Irene Moore School of Nursing, Sacramento, CA, USA
| | - Jill M Gelow
- Providence Heart & Vascular Institute, Portland, OR, USA
| | - James O Mudd
- Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| |
Collapse
|
50
|
Johansson P, Jaarsma T, Andersson G, Lundgren J. The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure: A secondary analysis of a randomised controlled trial. Int J Nurs Stud 2019; 116:103454. [PMID: 31727306 DOI: 10.1016/j.ijnurstu.2019.103454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. OBJECTIVES To investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DESIGN A secondary analysis of data collected in a pilot randomized controlled study. SETTING 50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden. METHODS Patients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. RESULTS No significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). CONCLUSION Improvement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.
Collapse
Affiliation(s)
- Peter Johansson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundgren
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| |
Collapse
|