Psychometric Validation of the Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index ( CC-SCHFI)

Funding Acknowledgements

Type of funding sources: None.

Background

The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support Heart Failure ( HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to the self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients, self-care. To date, the CC-SCHFI was never tested in Spanish speaking populations.

Purpose

To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics.

Method

CC-SCHFI translation and back-translation was performed according to the Beaton el al. Methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with Exploratory factor analysis (EFA) with oblique rotation. Cronbach’s alpha coefficient was used to test CC-SCHFI reliability.

Results

Caregivers had a mean age of 60,5 and the majority was female (85%) Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors" factors) and self-care monitoring subscale ("Illness behaviors" and "Prevention behaviors" factors) and one factor for self-efficacy subscale. The Cronbach’s alpha coefficient was = 0.838)

Nutritional Status among patients with Heart Failure and Thyroid Diseases - Result of Nutritional Status Heart Study (NSHS)

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Wroclaw Medical University

Background

Nutritional status is related to the prognosis and the length of hospitalization of individuals with heart failure. The effects of thyroid dysfunction in patients with pre-existing heart failure and nutritional status have not been adequately studied.

Purpose

This study aims to assess how nutritional status affects thyroid disease in patients with heart failure.

Methods

We performed a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of our University Clinical Hospital between September 2017 and September 2020 due to acute heart failure (HF) (ICD10: I50). We analyzed all the patients who met the inclusion criteria (diagnosis of HF, age ≥18 years old). A final group of 1056 patients’ medical records was analyzed. The analysis included data such as age, gender, patients’ body mass index (BMI), and laboratory results such as total data on past and comorbid disease units and assessment of the nutritional status of the patient via the NRS-2002. Our study was approved by the independent Bioethics Committee of the Wroclaw Medical University (decision no. KB–590/2020). Statistical analysis was performed using Statistica 13.1 (StatSoft, Inc., Tulsa, OK, USA). The results were considered statistically significant at p<0.05

Results

A total of 1056 individuals were included in the analysis. It included more men than women (66,7%) Due to a lack of data for some parameters, those numbers are smaller and are provided for each variable. More than 76% of participants were overweight or obese. 4.3% of patients were in risk of malnutrition. Thyroid disease registered in 15.1% of patients (Hyperthyroidism – 5.3% and Hypothyroidism 9.8%)

Based on BMI, four groups were distinguished: <18.5, 18.5–24.9, 25.0–29.9, and ≥30 The occurrence of Hyperthyroidism was more frequently observed in the group of overweight patients (p=0,02) (table 1).

Based on NRS2002, two groups were distinguished: <3 and ≥3. In the group with risk of malnutrition (NRS ≥3) patients had a mean statistically significant higher FT4 (<0.001) than the group with no risk of malnutrition (NRS <3) ( x̅ : 2,02 ng/dl vs x̅ : 1.35 ng/dl, p<0.001). Additionally, lower scores of FT3 were observed in the group NRS ≥3 (x̅ : 1.91 ng/dl, p<0.001) (table2).

Conclusion

This study shows that patients with thyroid disease and heart failure were often overweight and obese. The risk of malnutrition status correlates with a lower result of FT3 and the highest FT4. Undoubtedly, those phenomena require further research.

Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day»

OBJECTIVE

To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines).

DESIGN

Prospective, cross-sectional, multi-centre study.

SCOPE

Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain.

PARTICIPANTS

1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7 ± 3.8 and average stay of 10.62 ± 17.49 days.

VARIABLES

Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act.

RESULTS

Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8 g/dL (95% CI: 6-9-8.5) and 9.8 g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p < 0.001. The transfusion units had a mean of 2.5 ± 2.4 per patient. The most commonly used blood product was red blood cell concentrate (CH) (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p = 0.006). 5.4% (7/129) of patients who received CH died compared to 2.4% (31/1302) who did not (p = 0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant.

CONCLUSIONS

In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish Critical Care Units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.

Resilience among caregivers of patients with heart failure: a convergent mixed methods study

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): HFA Nurse training Fellowship Award Center for Excellence for Culture and Nursing Research (CECRI)Nursing Scholarship OPI Rome Italy

Introduction

Resilience is a dynamic process of utilising abilities to harness personal, social, and spiritual resources and coping characteristics and developing regulatory flexibility to manage challenges and bounce back from emotional and physical distress. Caregivers of patients with heart failure are prone to increased stress and reduced resilience while assisting their family members in meeting self-care needs, activities of daily living, and complex medical and dietary regimens. To date, limited research exists on resilience and its predictors among caregivers of people with heart failure.

Purpose

To develop a comprehensive understanding of resilience and its predictors among caregivers of patients with heart failure. 

Methods

A convergent mixed methods design was used. In total, 50 caregivers completed the Connor-Davidson Resilience Scale (CDRS) (score range: 0–100, with higher scores indicating higher resilience), the Caregiver Burden Inventory (CBI) (higher scores indicate greater caregiver burden; there are no cut-off points for classifying burden), and the Hospital Anxiety and Depression Scale (HADS) (two subscales, range score 0 and 21 per each subscale; higher scores mean worse anxiety and depression) and participated in semi-structured face-to-face interviews. Data were analysed using multiple regression, qualitative content analysis, and joint displays. 

Results

The caregivers’ mean age was 62.8 ± 12.83 years. The CDRS mean score was 62.37 ± 24.2, and the mean HADS scores for anxiety and depression were 12.38 ± 2.74 and 8.54 ± 2.49, respectively. The mean CBI score was 16.82 ± 17.12. Regression analysis showed that the resilience score was only predicted by depression (B = -1.491, p = 0.031). Qualitative analysis generated three resilience-inhibiting factors (psychological outlook, physical weariness, and affective state) and two promoting factors (community interconnectedness and self-comforting activities). Mixed analysis confirmed that depression decreased caregivers’ resilience.  

Conclusions

Caregivers of people with heart failure are likely to experience extreme stress and anxiety that affect their resilience to provide better care for their family members. This study identified that depression, hopelessness, pessimism, powerlessness, physical fatigue, and fluctuating emotional states affected negatively caregivers’ resilience. However, self-comforting activities and community interconnectedness improved caregivers’ resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers’ resilience.

Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day»

OBJECTIVE

To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines).

DESIGN

Prospective, cross-sectional, multi-centre study.

SCOPE

Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain.

PARTICIPANTS

1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7±3.8 and average stay of 10.62±17.49 days.

VARIABLES

Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act.

RESULTS

Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8g/dL (95% CI: 6-9-8.5) and 9.8g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p<0.001. The transfusion units had a mean of 2.5±2.4 per patient. The most commonly used blood product was red blood cell concentrate (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p=0.006). 5.4% (7/129) of patients who received red blood cell concentrate died compared to 2.4% (31/1302) who did not (p=0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant.

CONCLUSIONS

In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish critical care units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.