Abstract 12062: Patient and Caregiver Heart Failure Symptom Response Behaviors in 364 Patient-Caregiver Dyads

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julie T Bidwell ◽  
Ercole Vellone ◽  
Karen S Lyons ◽  
Shirin O Hiatt ◽  
Rosaria Alvaro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Social Support ◽  
Relationship Quality ◽  
Nyha Class ◽  
Secondary Analysis ◽  
Adult Child ◽  
Patient Health ◽  
Symptom Response ◽  
Recognition And Response ◽  
Response Behaviors

Introduction: Recognition and response to symptoms of heart failure (HF) is critical to reducing the risk of hospitalization and mortality. Although many patients have support from caregivers, little is known about caregivers’ contributions to HF symptom response behaviors. We hypothesized that patient-, caregiver-, and dyad-level factors would be associated with better symptom response behaviors. Methods: This was a secondary analysis of data on 364 Italian HF patient-caregiver dyads. HF symptom response behaviors were measured using patient and caregiver versions of the Self-Care of Heart Failure Index (0-100; higher = better). Health status (SF-12) and relationship quality (single item) were collected from patients and caregivers. Patient cognition and comorbidities were measured using the MMSE and Charlson Index. Caregiver social support was measured with the Carers of Older People in Europe Index. Hospitalizations were abstracted from the medical record. Multilevel modeling was used for all analyses. Results: Patients were older (age 76.3±10.8 years), predominantly male (57.3%) and most had NYHA Class II/III HF (72.2%). Caregivers were younger (age 57.7±14.6 years), and most were female (51.7%) and adult child (53.6%) or spousal (34.0%) caregivers. Symptom response behaviors were poor in patients (49.1±19.6) and caregivers (54.7±18.3). Patient gender (male β=-4.60±1.92, p<0.05), better cognition (β=0.40±0.19, p<0.05), worse caregiver health (β=-0.43±0.14, p<0.01), and higher relationship quality (β=2.28±0.83, p<0.01) were significant determinants of better patient symptom response. Nonspousal relationship (β=6.62±1.96, p<0.001), fewer patient comorbidities (β=-2.32±0.79, p<0.01), better patient health (β=0.41±0.12, p=0.001), more hospitalizations (β=3.06±1.41, p<0.05), higher relationship quality (β=2.12±0.84, p<0.01), and higher caregiver social support (β=1.09±0.43, p<0.05) were significant determinants of better caregiver symptom response. Conclusions: Combinations of individual and relationship factors were significant determinants of patient and caregiver responses to HF symptoms. Assessment of patient and caregiver as a dyad may be useful in evaluating risk for poor management of HF symptoms.

Abstract 13276: Dyad Gender and Relationship Quality Are Related to Heart Failure Self-care Maintenance

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael A Stawnychy ◽  
Ercole Vellone ◽  
Valentina Zeffiro ◽  
Barbara J Riegel
Keyword(s):  
Heart Failure ◽  
Relationship Quality ◽  
Reference Group ◽  
Secondary Analysis ◽  
Self Care ◽  
Italian Population ◽  
Dyadic Relationship ◽  
Health Maintenance ◽  
Gender Dyads ◽  
Mixed Gender

Background: Self-care, a process of health maintenance, monitoring and symptom management, improves morbidity and mortality in adults with HF. Caregivers are important in promoting patient self-care but little is known about the effect of relationship quality (RQ) on HF patient self-care, especially in same and mixed gender dyads. Aim: Quantify the contribution of dyadic gender and RQ on HF patient self-care maintenance. Methods: Secondary analysis of baseline data from a study of Italian adults with HF and their caregivers ( n =503). Dyads were enrolled to assess effectiveness of motivational interviewing on HF self-care maintenance measured with the Self-Care of Heart Failure Index v.6.2, validated in an Italian population. RQ was assessed with the Mutuality Scale, validated for HF patients and caregivers. Dyadic gender was categorized as Male-Male (M-M), Female-Male (Fpt-Mcg), Female-Female (F-F), and Male-Female (Mpt-Fcg; reference group). Univariate linear regression with backward elimination ( p <.05) was used to identify determinants of HF patient self-care maintenance. Results: The sample was 48% Mpt-Fcg, 27% F-F, 15% Fpt-Mcg, 10% M-M. Mpt-Fcg dyad patients were married (86%); with older (59±15 years), less educated (46% secondary or lower) spousal caregivers (66%). More F-F vs M-M patients lived alone (32% vs 4%). Determinants of better patient self-care were: living alone, receiving assistance for HF, better mental quality of life, patient and caregiver employment, caregiver married status, higher caregiver perceived social support, and more months caring for the patient. Dyad gender, RQ, and these covariates explained 23% of variance in patient self-care maintenance. Dyad gender independently contributed to self-care, but only for same gender dyads. Being in a M-M dyad was associated with higher patient self-care (ß=.52, p <.026). Better caregiver perception of RQ in both M-M and F-F dyads was associated with lower patient self-care (M-M: ß=-.97, p <.001; F-F: ß=-.55, p <.026). There were no significant interactions for patient RQ or mixed gender dyads. Conclusion: Dyadic relationship quality appears to be important for self-care, particularly in M-M dyads and should to be considered when working with HF patients and their caregivers.

scholarly journals Gender differences in reverse cardiac remodeling following initiation of sacubitril/valsartan in heart failure with reduced ejection fraction: real world experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P.S Savage ◽  
P.C Campbell ◽  
S.A Adams
Keyword(s):  
Heart Failure ◽  
Cardiac Remodeling ◽  
Significant Interaction ◽  
Nyha Class ◽  
Secondary Analysis ◽  
Cardiac Remodelling ◽  
Reduced Ejection Fraction ◽  
One Year ◽  
Gender Specific ◽  
Reverse Cardiac Remodeling

Abstract Background Gender related differences in physiology and pharamocokinetics have long been appreciated; however, the clinical relevance of these differences are unclear (1). Sacubitril/Valsartan has become established as a guideline directed therapy for the treatment of heart failure with reduced ejection therapy (HFref) and NYHA class II-IV symptoms. Interestingly; recent secondary analysis of key trials such as PARAGON-HF and PARADIGM, have highlighted possible differential gender specific benefits from Sacubitril/Valsartan therapy (2). We therefore sought to evaluate if there were gender specific effects of Sacubitril/Valsartan on both quantitative and qualitative measures of heart failure outcomes. Methods We performed a retrospective data interrogation of all patients commenced on Sacubitril/valsartan therapy in the SHSCT between 2016 and 2019. Data was extracted using electronic care records. Local ethical approval was granted. The primary endpoint were change in LVEF% on echocardiography and improvement in QOL (defined as NYHA score) at one year following initiation of Sacubitril/Valsartan. Differences in means between baseline and one year were assessed using a paired student's t-test. Interaction of gender on respective outcomes was assessed using a two way ANOVA. Significance defined as p&lt;0.05. Data expressed as mean ± SD. Analysis performed using SPSS™. Results A total of 422 patients were included (mean age 69.1±12.1 years; 66% male). The predominant NYHA class' were II (n=298, 67.7%) and III (n=118, 26.8%). Aetiology and comorbidities were similar across male and females. In both groups, there was a statistically significant improvement in LVEF% at one year following initiation of Sacubitril/Valsartan (female; 27.1±8.6 to 34.6±9.5, n=40 p&lt;0.01) (male; 27.4±7.5% to 32.6±9.3%, n=91, p&lt;0.01). There was a statistically significant interaction between gender and degree of reverse cardiac remodeling defined as LVEF% on echocardiography following initiation of Sacubitril/Valsartan (F[2,52]=8.280, p=0.04, partial n2=0.27) (Figure 1). Similarly, there was a significant improvement in NYHA scores in both groups (male; 2.2±0.5 to 2.02±0.6, n=331, p&lt;0.05) (female; 2.29±0.6 to 2.07±0.5, n=91, p&lt;0.05) (Figure 2). However; there was no statistically significant interaction between gender and NYHA score following initiation of Sacubitril/Valsartan (F[2,52]=0.133, P=0.716, partial n2≤0.0). Conclusion Sacubitril/Valsartan produced significant improvement in reverse cardiac remodelling and QOL measures in both groups. Notably, had a stronger effect of reverse cardiac remodelling in women – suggesting possible gender specific differential benefits. FUNDunding Acknowledgement Type of funding sources: None.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Patients With Heart Failure

2017 ◽  
Vol 25 (1) ◽  
pp. 90-102 ◽  
Author(s):  
Shannon C. Shumaker ◽  
Susan K. Frazier ◽  
Debra K. Moser ◽  
Misook L. Chung
Keyword(s):  
Heart Failure ◽  
Social Support ◽  
Depressive Symptoms ◽  
Perceived Social Support ◽  
Secondary Analysis ◽  
Reliability And Validity ◽  
Internal Consistency Reliability ◽  
Reliability Factor ◽  
Patients With Heart Failure ◽  
Valid Instrument

Background and Purpose: Low social support is associated with worse outcomes in patients with heart failure. Thus, the purpose of this study was to examine the reliability and validity of the Multidimensional Scale of Perceived Social Support (MSPSS). Methods: We performed a secondary analysis of registry data from patients (n = 475) with confirmed heart failure. Results: The MSPSS demonstrated excellent internal consistency reliability. Factor analysis yielded 3 factors that explained 83% of the variance in perceived social support. More than half of the sample had depressive symptoms (56%). Hypothesis testing demonstrated that worse perceived social support was a predictor of depressive symptoms. Conclusion: The MSPSS is a reliable and valid instrument to measure perceived social support in patients with heart failure.

Abstract 11015: Why Don’t Heart Failure Patients Respond to Worsening Symptoms?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chin-Yen Lin ◽  
Kathleen Dracup ◽  
Michele M Pelter ◽  
Martha J Biddle ◽  
Debra K Moser
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Nyha Class ◽  
Community Dwelling ◽  
Family Needs ◽  
Class Iii ◽  
Family Obligations ◽  
Symptom Appraisal ◽  
Patient Reported ◽  
Symptom Response

Background: Long delays in seeking medical care are common in patients with worsening symptoms of heart failure (HF) and lead to longer lengths of hospital stay, increased healthcare costs, and increased morbidity and mortality. However, patient-reported reasons for delay have rarely been explored. Objective: To describe patient-reported reasons for delay in seeking medical care for worsening symptoms. Methods: As part of a clinical trial designed to reduce HF readmission and mortality for worsening symptoms, we administered the HF Symptom Response Questionnaire to all patients prior to intervention. The instrument measures reasons why patients delay seeking treatment. All patients had a recent hospitalization for HF, were community dwelling in a rural location, and had no cognitive impairments as measured with the Mini-Cog. Results: A total of 614 HF patients (59% male, NYHA class III/IV 35%, 19% without a high school education, mean age 66±13 years, median b-type natriuretic peptide level 186 pg/ml [25th percentile = 72, 75th percentile = 462] were studied. The most common reasons for not seeking early treatment were symptom uncertainty (62.4%), symptoms seem vague or came on too gradually (67.4%), symptoms slightly different from last episode (55.2%) and the symptoms didn’t seem to be serious enough (62.2%). Other reasons include embarrassment at seeking treatment (23.9%), not wanting to second guess the doctor (21.7%), financial concerns (19.9%), transportation issues (16.4%), and other (10.7%). Reasons given in the other category included afraid/don’t like doctors or hospitals, care of pets at home, family needs them, not wanting to bother others, denial/don’t want to know/fear of knowing, and weather. Conclusions: Despite experiencing worsening HF symptoms of such intensity that hospitalization is required, most patients do not perceive that symptoms are intense or certain enough to warrant action. In many, treatment seeking decisions are superseded by factors not related to symptom appraisal such as family obligations, fear or denial, and embarrassment. Education to improve response to worsening HF symptoms requires skills in symptom appraisal, and counseling to overcome personal barriers to seeking treatment.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

scholarly journals Myeloperoxidase-Related Chlorination Activity Is Positively Associated with Circulating Ceruloplasmin in Chronic Heart Failure Patients: Relationship with Neurohormonal, Inflammatory, and Nutritional Parameters

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Aderville Cabassi ◽  
Simone Maurizio Binno ◽  
Stefano Tedeschi ◽  
Gallia Graiani ◽  
Cinzia Galizia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nitrosative Stress ◽  
Defense Mechanism ◽  
Nyha Class ◽  
Protein Nitration ◽  
Class Iii ◽  
Oxidative And Nitrosative Stress ◽  
Radical Production ◽  
Antioxidant Function ◽  
The Relationship

Rationale. Heart failure (HF) is accompanied by the development of an imbalance between oxygen- and nitric oxide-derived free radical production leading to protein nitration. Both chlorinating and peroxidase cycle of Myeloperoxidase (MPO) contribute to oxidative and nitrosative stress and are involved in tyrosine nitration of protein. Ceruloplasmin (Cp) has antioxidant function through its ferroxidase I (FeOxI) activity and has recently been proposed as a physiological defense mechanism against MPO inappropriate actions.Objective. We investigated the relationship between plasma MPO-related chlorinating activity, Cp and FeOxI, and nitrosative stress, inflammatory, neurohormonal, and nutritional biomarkers in HF patients.Methods and Results. In chronic HF patients (n=81, 76±9 years, NYHA Class II (26); Class III (29); Class IV (26)) and age-matched controls (n=17, 75±11 years, CTR), plasma MPO chlorinating activity, Cp, FeOxI, nitrated protein, free Malondialdehyde, BNP, norepinephrine, hsCRP, albumin, and prealbumin were measured. Plasma MPO chlorinating activity, Cp, BNP, norepinephrine, and hsCRP were increased in HF versus CTR. FeOxI, albumin, and prealbumin were decreased in HF. MPO-related chlorinating activity was positively related to Cp (r= 0.363,P<0.001), nitrated protein, hsCRP, and BNP and inversely to albumin.Conclusions. Plasma MPO chlorinated activity is increased in elderly chronic HF patients and positively associated with Cp, inflammatory, neurohormonal, and nitrosative parameters suggesting a role in HF progression.

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