Abstract 2724: Predictors of Depressive Symptoms in Caregivers of Patients with Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Misook L Chung ◽  
Susan J Pressler ◽  
Terry A Lennie ◽  
Debra K Moser

Millions of family members deliver informal care and support to patients with heart failure (HF). Accumulating evidence suggests that caregivers of patients with HF suffer from depressive symptoms, but factors associated with depressive symptoms are unknown. Identification of such factors could provide targets for intervention. Three possible factors that are amenable to intervention are caregivers’ functional status, their sense of caregiving burden, and perceived control. (1) To examine differences in functional status, perceived control, and caregiving experiences (time, difficulty, and burden) between depressed and non-depressed caregivers; (2) To examine whether these factors predict caregivers’ depressive symptoms. A total of 92 caregivers (mean age of 57 years; female 75%; spousal caregiver 80%) of patients with HF were recruited from outpatient clinics at two community hospitals and an academic medical center in central Kentucky. Their depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Functional status was assessed using the Duke Activity Status Index. Perceived control was assessed using the Control Attitudes Scale-Revised. Caregiving difficulty, time, and burden were assessed using the Bakas Caregiving Inventory and the Zarit Caregiver Burden Scale. Caregivers were grouped using the standard cut point of 13 on the BDI-II score. The 27% of caregivers with depressive symptoms had poorer functional status (21± 20 vs. 34 ± 19; p =.007), lower perceived control (22 ± 4 vs. 25 ± 4; p = .005), and higher caregiving burden (26 ± 14 vs. 13 ± 10; p< .001) than caregivers without depressive symptoms. Controlling for age and gender in a multiple regression, functional disability (sβ= −.298, p<.001), perceived control (sβ= −.298, p<.001), and caregiver burden (sβ= .328, p=.002) explained 45% of the variance in caregivers’ depressive symptoms. Caregivers’ functional disability, poor controllability, and burden related to caregiving were associated with depressive symptoms. These findings suggest that depressed caregivers of patients with HF may benefit from interventions that improve perceived control, address caregiving burden and functional status.

2018 ◽  
Vol 17 (6) ◽  
pp. 527-534 ◽  
Author(s):  
Maria Liljeroos ◽  
Anna Strömberg ◽  
Kristofer Årestedt ◽  
Misook L Chung

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.


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anna Strömberg ◽  
Maria Liljeroos ◽  
Susanna Ågren ◽  
Kristofer Årestedt ◽  
Misook L. Chung

Author(s):  
Thomas J Breen ◽  
Hiren Patel ◽  
Scott Purga ◽  
Steven A Fein ◽  
Edward F Philbin ◽  
...  

Background: Numerous quality improvement studies have attempted to identify variables that are predictive of repeat hospitalization in patients admitted with heart failure. The relationship between the length of hospital stay (LOS) during the index admission and the readmission risk in patients with heart failure has not been well investigated. Longer index LOS is likely in patients with multiple co-morbidities, which may also predict early readmission. Methods: The study included 720 patients with multiple admissions for heart failure to a single academic medical center between 2007-2016. Patients were stratified into four quartiles based on their LOS (days) during their initial admission. Demographic and clinical data were collected from charts. Results: The interquartile range of index admission LOS was 7 days. LOS of 1-7 days was observed in 439 patients (60.9%), 8-13 days in 175 (24.3%), 14-20 days in 58 (8.1%), and ≥21 days in 48 patients (6.7%). The longest re-admission interval of 553.5 (SD +/- 611) days was noted in patients with index admission LOS of 8-13 days, while the shortest re-admission interval of 329.1 (SD +/- 430.9) days was noted in patients with index admission LOS of ≥21 days (p=0.02). In comparison to patients with index admission LOS of 8-13 days, those admitted for 1-7 days had a readmission interval of 465.1 (SD +/- 630) days (p=0.11) and those admitted for 14-20 days lasted 444.7 (SD +/- 691.6) days (p=0.25). There were no significant differences in age, gender, race, tobacco use, or evidence-based medical treatment among the four groups. Insulin-dependent diabetes mellitus (IDDM) was more common in patients with increased index admission LOS of 14-20 days and ≥21 days (44.5% [26 of 58] and 47.9% [23 of 48], respectively), as compared to patients with LOS 1-7 days and 8-13 days (33.0% [145 of 439] and 28.6% [50 of 175], respectively, p=0.02). Similarly, chronic kidney disease (CKD) was more common in patients with LOS 14-20 days and ≥21 days (50% [29 of 58] and 56.3% [27 of 48], respectively). When adjusted for IDDM and CKD, the longest re-admission interval was still noted in patients with index admission LOS of 8-13 days, while the shortest re-admission interval was noted in patients with index admission LOS of ≥21 days (p=0.027). Conclusion: In our patients admitted with heart failure, 8 to 13-day index admission was associated with the longest readmission interval. It is possible that shorter index admission may not allow for sufficient medical optimization. This conclusion requires further study. While patients with prolonged index admission are more likely to have IDDM and CKD, these co-morbidities do not appear to result in shorter readmission intervals. There may be additional, currently not well investigated factors affecting readmission interval. Further research is needed to define optimal LOS and discharge criteria in patients admitted with a diagnosis of heart failure.


PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244453
Author(s):  
Waguih William IsHak ◽  
Samuel Korouri ◽  
Tarneem Darwish ◽  
Brigitte Vanle ◽  
Jonathan Dang ◽  
...  

Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. Conclusions The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. Registration ClinicalTrials.Gov Identifier: NCT03688100.


2020 ◽  
Vol 76 (12) ◽  
pp. 3363-3371
Author(s):  
Xiuting Zhang ◽  
Huijing Zou ◽  
Danhua Hou ◽  
Dengxin He ◽  
Xiuzhen Fan

2008 ◽  
Vol 7 ◽  
pp. 153-153
Author(s):  
I LESMANLEEGTE ◽  
T JAARSMA ◽  
H HILLEGE ◽  
R SANDERMAN ◽  
D VANVELDHUISEN

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