| 1. |
- Liljeroos, Maria, 1965-, et al.
(författare)
-
Quality of life and family function are poorest when both patients with heart failure and their caregivers are depressed.
- 2022
-
Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 21:3, s. 220-226
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: Patients with heart failure (HF) and their family caregivers commonly experience depressive symptoms associated with low quality of life (QOL) at the individual level. However, there is a lack of knowledge about how QOL and family function are associated with depressive symptoms at the dyad level. The aim of this article is to compare QOL and family function among dyads stratified by depressive symptoms.METHODS AND RESULTS: Outpatients with HF and their primary caregivers completed the Beck Depression Inventory-II for depressive symptoms, the Short Form 36 for physical and mental QOL, and the McMaster Family Assessment Device for a family function. Analysis of variance was used to compare QOL and family function among the four dyad groups. A total of 91 dyads were categorized into four groups: neither member having depressive symptoms (43.9%), only the caregiver having depressive symptoms (13.2%), only the patient having depressive symptoms (23.1%), and both members having depressive symptoms (20.9%). Dyads without depressive symptoms had the highest levels of physical and mental QOL among the groups. The dyads with both members having depressive symptoms had the lowest levels of physical and mental QOL (P < 0.001) and the lowest levels of general family functioning, problem-solving ability, and communication ability (P < 0.001). Intermediate levels of QOL were seen in dyads with only one member having depressive symptoms, and a similar pattern of intermediate scores was found in all three subscales of family function.CONCLUSION: Dyads with both members having depressive symptoms may be at greatest risk of having poor QOL and low family functioning.
|
|
| 2. |
- Miller, Jennifer L., et al.
(författare)
-
Missed opportunities! End of life decision making and discussions in implantable cardioverter defibrillator recipients
- 2019
-
Ingår i: Heart & Lung. - : MOSBY-ELSEVIER. - 0147-9563 .- 1527-3288. ; 48:4, s. 313-319
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Recent guidelines highlight the need for clinician-patient discussions regarding end-of-life (EOL) choices prior to implantable cardioverter defibrillator (ICD) implantation. Health literacy could affect the quality and quantity of such discussions. Objective: Our objective was to determine the association of health literacy with experiences, attitudes, and knowledge of the ICD at EOL. Methods: In this cross-sectional study, we used validated instruments to measure health literacy and patient experiences, attitudes, and knowledge of the ICD at EOL. Results: Of the 240 ICD recipients, 76% of participants reported never having discussed the implications of a future withdrawal of defibrillation therapy with their healthcare provider. Increased odds of choosing to maintain defibrillation therapy were associated with female gender and lower ICD knowledge. Conclusions: From patients perspectives, EOL discussions with providers were minimal. Most patients hold misperceptions about ICD function that could interfere with optimal EOL care, particularly for those with inadequate health literacy. (C) 2019 Elsevier Inc. All rights reserved.
|
|
| 3. |
- Waldreus, Nana, et al.
(författare)
-
Trajectory of thirst intensity and distress from admission to 4-weeks follow up at home in patients with heart failure
- 2018
-
Ingår i: Patient Preference and Adherence. - : DOVE MEDICAL PRESS LTD. - 1177-889X. ; 12, s. 2223-2231
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression). Patients and methods: In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after discharge. Thirst intensity (visual analog scale, 100 mm) and distress (Thirst Distress Scale-HF, score 9-45) were used. Trajectories were examined using growth modeling. Results: Trajectory of the thirst intensity was significantly different, for patients with low and high thirst intensity levels (median cut-off 39 mm), from admission to 4 weeks follow up (thirst increased and decreased, respectively). Patients with high level of thirst distress (median score amp;gt;22) at admission, having fluid restriction and women continued to have higher thirst distress over time. Patients feeling depressed had higher thirst intensity over time. There were no differences in the trajectories of thirst intensity and distress by age, BMI, plasma urea, and anxiety. Conclusion: Intensity and distress of thirst, having fluid restriction, and feeling depressed at the admission were critical in predicting the trajectory of thirst intensity and distress after discharge to home in patients with HF. Effective intervention relieving thirst should be provided before their discharge to home.
|
|
| 4. |
- Andreae, Christina, 1969-, et al.
(författare)
-
Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure
- 2018
-
Ingår i: Journal of Cardiovascular Nursing. - : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 33:2, s. E15-E20
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status. Objective: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association. Methods: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status. Results: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001). Conclusions: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.
|
|
| 5. |
- Andreae, Christina, et al.
(författare)
-
Diet variety mediates the relationship between appetite and micronutrient intake in patients with heart failure
- 2022
-
Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 22:5, s. 537-543
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease desire to eat a varied diet leading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrient intake has not been investigated in patients with heart failure. The purpose with the study was to determine whether the relationship between appetite and micronutrient insufficiency was mediated through diet variety.METHODS AND RESULTS: A total of 238 patients with heart failure, mean age 61 ± 12.1; 68% male and 45% NYHA class III/IV were included in this secondary analysis. Data collection consisted of a four-day food diary and self-reported appetite on a 10-point visual analog scale. Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for co-variates age, gender, NYHA-class and body mass index showed that diet variety mediated the relationship between appetite and micronutrient insufficiencies (indirect effect = -.0828, 95% CI: -.1585 to -.0150). There was no direct effect of appetite on micronutrient insufficiency (c´ = -.1802; 95% CI = -.3715 to.0111).CONCLUSIONS: Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake in patients with heart failure. More research is needed to validate these associations in patients with heart failure.
|
|
| 6. |
- Buck, Harleah G., et al.
(författare)
-
A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes
- 2018
-
Ingår i: International Journal of Nursing Studies. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0020-7489 .- 1873-491X. ; 77, s. 232-242
-
Forskningsöversikt (refereegranskat)abstract
- Background: Having support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes. Objective: To examine the components, context, and outcomes of dyadic self-care interventions. Design: A systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples. Review methods: We used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions. Results: Eighteen papers - 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed. Intervention components fell into three groups education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes. Conclusions: We found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice.
|
|
| 7. |
- Liljeroos, Maria, et al.
(författare)
-
Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners
- 2018
-
Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:6, s. 527-534
-
Tidskriftsartikel (refereegranskat)abstract
- Background: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. Aim: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. Methods: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. Results: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. Conclusion: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.
|
|
| 8. |
- Strömberg, Anna, 1967-, et al.
(författare)
-
Associations Among Perceived Control, Depressive Symptoms, and Well-being in Patients With Heart Failure and Their Spouses : A Dyadic Approach
- 2021
-
Ingår i: Journal of Cardiovascular Nursing. - : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 36:3, s. 198-205
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundHigh levels of perceived control and lower levels of depressive symptoms are associated with better well-being in both patients with heart failure and their spouses at an individual level. However, there is a knowledge gap about how these individual factors have reciprocal influences on partners' well-being within the patient-spouse dyads.ObjectiveThe aims of this study were to examine dyads of patients with heart failure and their spouses on whether the patients' perceived control over the management of heart failure and depressive symptoms predicts their own and their spouses' physical and emotional well-being and to examine whether patients' perceived control predicts their own and their spouses' depressive symptoms.MethodsA total 155 patient-spouse dyads (patients: 75% male, mean age of 71 years, 53% classified as New York Heart Association III; spouses: 75% female, mean age of 69 years) were recruited from 2 hospital-based outpatient heart failure clinics. Participants completed the Control Attitude Scale, the Beck Depression Inventory, and the Short-Form 36. Dyadic data were analyzed using multilevel regression of the actor-partner interdependence model.ResultsPerceived control had an actor effect on emotional well-being only for patients, and there were partner effects of perceived control on emotional well-being for both patients and their spouses. Depressive symptoms exhibited an actor effect on physical and emotional well-being for patients and spouses, but there were no partner effects of depressive symptoms on emotional well-being. Perceived control had partner effects on depressive symptoms for patients and spouses, but an actor effect of depressive symptoms was only found for patients.ConclusionIn an interdependent relationship within the patient-spouse dyads, each dyad member's perceived control influenced their partner's emotional well-being as well as depressive symptoms. The findings suggest development of dyadic interventions that can increase perceived control over the heart condition.
|
|
| 9. |
- Strömberg, Anna, et al.
(författare)
-
ICD Recipients Understanding of Ethical Issues, ICD Function, and Practical Consequences of Withdrawing the ICD in the End-of-Life
- 2014
-
Ingår i: Pacing and Clinical Electrophysiology. - : Wiley-Blackwell. - 0147-8389 .- 1540-8159. ; 37:7, s. 834-842
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The current international expert consensus statements recommend that clinicians should discuss elective implantable cardioverter defibrillator (ICD) deactivation before implantation of the device, and then consistently during the illness trajectory. However, no previous studies have investigated predictors of ICD patients knowledge about end-of-life issues or whether knowledge influences patients attitudes about deactivation. Methods: This nationwide survey study (n = 3,067) had a cross-sectional correlational design of self-reported data. Participants were recruited from the Swedish ICD and Pacemaker Registry and asked to complete a questionnaire about knowledge in relation to the ICD and end-of-life. Results: Only 79 respondents (3%) scored correctly on all 11 questions. The mean sample score was 6.6 +/- 2.7 out of a maximum score of 11. A total of 835 participants (29%) had an insufficient knowledge when using the 25th percentile as a cutoff. Younger ICD recipients, those cohabiting, male participants, and those who had received shocks, had a generator replacement, or who had discussed illness trajectory with their physician were more likely to have sufficient knowledge on the end-of-life issues. Insufficient knowledge was associated with indecisiveness to make decisions about ICD deactivation in the end-of-life situations, and with favorable attitudes about replacing the ICD even if seriously ill or have reached an advanced age, and keeping the shock therapy of the ICD even in a terminal phase of life when dying from cancer or other serious chronic illnesses. Conclusion: Insufficient knowledge is common among ICD recipients and is associated with attitudes and decisions that may result in a stressful and potentially painful end-of-life situation.
|
|
| 10. |
- Strömberg, Anna, 1967-, et al.
(författare)
-
Psychometric Validation of the Heart Failure Caregiver Questionnaire (HF-CQ (R))
- 2017
-
Ingår i: Patient. - : ADIS INT LTD. - 1178-1653 .- 1178-1661. ; 10:5, s. 579-592
-
Tidskriftsartikel (refereegranskat)abstract
- Background The Heart Failure Caregiver Questionnaire (HF-CQ (R)) was developed to assess subjective outcomes of heart failure caregivers. The HF-CQ (R) comprises 21 questions on three domains, namely physical, emotional/psychological and lifestyle. The objective of this study was to evaluate the psychometric properties of the HF-CQ (R). Methods Patients (n = 150) with heart failure and their primary caregivers (n = 150) were recruited from 11 sites in USA. Caregivers completed the HF-CQ (R) and additional questionnaires, namely Caregiver Reaction Assessment, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain, and the Hospital Anxiety and Depression Scale. Patient-completed Global Impression of Severity, construct validity, concurrent validity, reliability and responsiveness of the HF-CQ (R) were also assessed. Results In the physical and lifestyle domains, all items showed acceptable validity. No high correlations between HF-CQ (R) scores and other caregiver-completed instruments, including the Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain or Caregiver Reaction Assessment, were reported. The intra-class correlation coefficient exceeded the threshold for reliability (amp;gt;0.7) across the physical well-being (0.785), emotional/psychological (0.797), lifestyle (0.787) and total scores (0.850), indicating acceptable reliability. Internal consistency results using Cronbachs alpha showed the total aggregate score of 0.942 to be reliable. In the responsiveness analyses, each of the three scales and the total score showed responsiveness to changes defined by the Caregiver Global Impression of Severity. The overall caregiver burden score increased with increased severity of illness in the cared-for patients. Conclusions The study provides initial evidence for the acceptable validity of the HF-CQ (R) as an instrument to measure heart failure caregiver burden.
|
|
