A Model Predicting Health Status of Patients With Heart Failure

Objective: To test the causal relationships among the components of sociodemographics,illnesscharacteristics, and selfmanagement ability, and health status in the model of health status of patients with heart failure (HSHF). Design: Descriptive cross-sectional study Materials and methods: Four hundred heart failure patients, either hospitalized or attending out-patient clinics at six hospitals in southern Thailand, were interviewed. Questionnaires covered sociodemographics, the duration of illness, severity of illness, comorbid diseases, measured by the New York Heart Association Functional Classification (NYHA-FC) using the Charlson Comorbidity Index, self-management ability, using the Self-Care of Heart Failure Index (SCHFI), and health status using the Short Form-36 Health Survey (SF-36). The relationships among the study variables were tested and modified under the structural equation modeling (SEM) technique by using LISREL. Results: The collected data were found not to fit with the initial hypothesized model but after modification the new derived model gave an adequate fit with the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status ( β =-0.20, p β =-0.13, p β =0.12, p β =-0.05; -0.05, p β =0.09, p β =-0.31; -0.16, p β =-0.06; -0.05, p β =0.38, p Conclusions: The final model provides a guideline for explaining and predicting the health status of patients with heart failure. To improve health status continuity care programs promoting self management ability should be developed and imple-mented both in hospital-based and home-based settings.

Resilience mediates the relationship between depression and psychological health status in patients with heart failure: A cross-sectional study

Comorbid Renal Disease and Treatment Adherence Are Determinants of Symptom Recognition and Treatment in Patients with Symptomatic Heart Failure

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

The purpose of this study was to examine the causal relationship among bio-physiological status (LVEF), social support, symptom status, functional status (NYHA), general health perception, and health-related quality of life (HRQOL) in Thai heart failure patients. The hypothesized causal model of HRQOL in Thai heart failure patients was based on Wilson and Cleary’s Health-Related Quality of Life Conceptual Model. Stratified four stage random sampling was employed to obtain the sample of 422 heart failure patients aged 18 years and above who visited nine hospitals from four regions of Thailand and metropolitan Bangkok. Research instruments consisted of Personal Information Questionnaire, the personal LVEF medical record sheet, the ENRICHD Social Support Instrument (ESSI), the Cardiac Symptom Survey (CSS), the subjective NYHA functional classification, a General Health Perception, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Data were analyzed using SPSS and AMOS computer programs. Goodness of fit indices indicated that the model fitted well with the empirical data ([chi square] =19.87, df = 13,[chi square] /df =1.53, p = 0.10, GFI = 0.99, AGFI = 0.97, and RMSEA = 0.04). The overall model explained approximately 58% of the variance in overall health-related quality of life in Thai heart failure patients. Symptom status of heart failure was the most influential factor affecting HRQOL by having both negative direct and indirect effects through functional status and general health perception ([beta] = -0.69, p <.0001). In addition, functional status (NYHA) had negative direct and indirect effects on HRQOL through general health perception ([beta] = -0.32, p <.05). General health perception had only a positive direct effect on HRQOL ([beta] = 0.24, p < .0001). Bio-physiological status (LVEF) had a positive indirect effect on HRQOL through functional status and general health perception (b = 0.16, p< .0001). However, social support was the least influential factor affecting HRQOL ([beta] = 0.04, p < .05). It had a negative direct effect on HRQOL, but a positive indirect effect on HRQOL through symptom status and general health perception. The findings indicated the prominent components of nursing intervention focusing on maintaining or enhancing HRQOL in Thai heart failure patients The intervention components should consist of symptom controlling and symptom management to decrease symptom frequency and symptom severity. This will help heart failure patients to maintain or improve their functional ability to perform their normal daily activities, and their self-care ability. Nurses should consider about bio-logical status, social support, and general health perception and some mediator factors such as age, gender, affecting HRQOL in planning the intervention.

he ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and
\naccurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

The purpose of this study was to develope and test the structural model for depression in middle-aged women. A hypothetical model was constructed on the basis of previous studies and a review of literatures. The conceptual framework was built around eight constructs. Exogenous variables included in this model were volunteer activity, health status & economic status. Endogenous variables were meaning of life, self-esteem, perceived life stress & depression. Empirical data for testing the hypothetical model was collected using a self-report questionnaire from 216 middle-aged women in Pusan City. The Data was collected from May to June, 1999. Reliability of the seven instruments tested with Cronbach's alpha was ranged from .86-.94. For the data analysis, SPSS 7.5 WIN Program and LISREL 8.12 WIN Program were used for descriptive statistics and covariance structural analysis. The results of covariance structure analysis were as follows: 1. The hypothetical model showed a good fit with the empirical data. [/df=2.87(p=.72), GFI=1.00, AGFI=.98, RMSR=.025, NFI=.99, standardized residuals ()]. 2. To heighten for the parsimony and fitness of the model, a modified model was constructed by deleting according to the criteria of statistical significance and meaning. 3. The modified model also showed a good fit with the data. [=5.26(01=7,p=.63), GFI=.99, AGFl=.97, RMSR=.025, NFI=.99, standardized reslduals ()] Results of the testing of the hypothesis were as follows : 1. Self-esteem(=-.48, t=-5.64) had a negative and perceived life stress(=.20, t=3.21)had a positive direct effect on depression. Meaning of life had a negative direct(=-.17, t=-2.19) and a negative indirect effect through self-esteem on depression. Volunteer activity had a negative indirect effect through meaning of life, meaning of life and self-esteem on depression. Health status had a negative direct and a negative indirect effect through meaning of life, meaning of life and self-esteem on depression. Economic status had a negative indirect effect through perceived life stress on depression. Self-esteem was the most significant variable. 2. Volunteer activity(=.43, t=6.78) and health status(=.35, t=4.88) had positive direct effect on meaning of life. 3. Meaning of life(=.50, t=6.53) had a positive direct effect on self-esteem. Volunteer activity had a positive indirect effect through meaning of life on self-esteem. Health status had a positive direct(=.18, t=2.23) and a indirect effect through meaning of life on self-esteem. Meaning of life was the most significant variable. 4. Economic status (=-.44, t값=-6.01) had a positive direct effect on perceived life stress. The results of this study showed that self-esteem had the most significant direct effect on depression. Meaning of life and health status had significant direct effect on this self-esteem. Volunteer activity and health status had direct effect on meaning of life. The results of this study suggested that there is a need to develope intervention to promote degree of self-esteem and alleviate degree of depression in middle-aged women.

Self-management has a vital role in treating Congestive Heart Failure (CHF) patients to manage themselves and maintain the ability of body functions. Self-management can be seen in how heart failure patients perform compliance actions in treatment and the patient's ability to know changes in behaviour towards the patient's health status. In addition, it is crucial for people with congestive heart failure to learn about their disease to relieve the signs and symptoms. This study aimed to determine the relationship between knowledge of heart failure care and self-management compliance in CHF patients. This method uses a quantitative correlation research type to determine the relationship between the two variables using an analytical cross-sectional study approach. The sampling technique uses accidental sampling from March to April 2021 at the heart poly Hospital of UNS Surakarta to 100 respondents. Sample criteria: Respondents with a diagnosis of CHF who checked their health at the heart polyclinic of UNS Surakarta Hospital, aged 17 years, patients with NYHA classification 1-3, and willing to be respondents. The research instrument used a demographic questionnaire, knowledge of heart failure care and the Self Care Heart Failure Index (SCHFI) to determine the self-care knowledge of CHF patients and adherence to self-management. The results obtained through the chi-square test showed a p-value of 0.010, meaning there is a relationship between knowledge of heart failure care and self-management compliance. Knowledge of heart failure care can affect the level of compliance of CHF patients because CHF patients need self-management compliance to minimize symptoms of recurrence or worsening of signs and symptoms and reduce the impact of re-hospitalization.

Relationship between sitting time and health status in patients with heart failure

Background: A foundation of current clinical trials is to categorize the severity of heart failure (HF) by New York Heart Association (NYHA) classification to ensure that enrolled patients have similar disease severity. Because the NYHA represents a clinician’s assessment of patients’ health status, it may vary from patients’ perspectives and can lead to more or less symptomatic patients being enrolled in clinical trials. We sought to directly compare the ranges of patient-reported health status, as assessed by the well-validated and reliable Kansas City Cardiomyopathy Questionnaire (KCCQ), with NYHA class in recent clinical studies. Methods: We used data from 2 contemporary HF clinical trials, HF-ACTION in patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and TOPCAT in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), and 1 prospective cohort study, the KCCQ Interpretability study (KCCQINT) in patients with HFrEF, where both NYHA and the KCCQ were contemporaneously collected. The distributions of KCCQ Overall Summary (KCCQ-os) scores by NYHA and the variation in assigned NYHA classes among patients with KCCQ scores ≥80 (congruent with NYHA Class I) were then described. Results: A total of 6,072 patients (mean age 64±12 years, 41% female) were included across the 3 studies. Figure 1 shows marked overlap in KCCQ scores across NYHA classes. In KCCQINT, 148 (27%) out of 545 patients reported a KCCQ-os score ≥80, of whom 39 (26%), 81 (55%) and 28 (19%) were coded as NYHA Class I, II and III. None were classified as NYHA Class IV. In HF-ACTION, 677 (32%) of 2129 patients reported a KCCQ-os score ≥80, of whom 548 (81%), 128 (19%) and 1 (<1%) were coded as NYHA Class II, III and IV, respectively. In TOPCAT, 484 (14%) out of 3398 patients reported a KCCQ-os score ≥80, of whom 410 (85%) and 74 (15%) were considered NYHA Class I-II and III-IV, respectively. Conclusions: Although the NYHA is used to identify similarly ill patients for enrollment in clinical trials, there is marked variability within and across studies in patients’ self-reported health status. Future trials should consider patient-reported outcome measures as the basis for defining patient eligibility to enroll a more homogenous cohort of disease severity.

The purpose of this study was to explore the effects of family structure(parentral marital status and socioeconomic status), parental communication, academic problems, and peer relationship on juvenile delinquency. The participants were 1009 middle school and high school students in Seoul city and Gyeonggi Province. The major results were as follows: 1) Parental marital status(divorced/seperated) had both direct and indirect positive effects and lower class in socioeconomic status had an indirect positive effect on academic problems and peer relationship on juvenile delinquency rates. 2) Open maternal communication had a direct negative effect on juvenile delinquency rates. However, open paternal communication had both direct and indirect negative effects. 3) Academic problems had both direct and indirect positive effects on juvenile delinquency rates. 4) Peer relationship had a direct positive effect on juvenile delinquency rates. 5) The level of effects that each variable had differed by delinquency types. Based on these results, implications for preventing juvenile delinquency were discussed.

To examine a causal model of health status among older people with knee osteoarthritis. A cross-sectional, correlational design was used with a convenience sample of 220 older Thai people with knee osteoarthritis (mean age 68.96 years; SD = 6.22). Participants were asked to complete a demographic questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, The Medical Outcomes Study Social Support Survey, and the Arthritis Impact Measurement Scales 2-Short Form. Structural Equation Model was used to examine a hypothesized model. Using Chi-square, hypothesized model was statistically nonsignificant. A model of health status fitted with the empirical data and explained 19.2% of variance. Pain catastrophizing had negative direct effect on self-efficacy and health status. Pain catastrophizing also had negative indirect effect on health status through self-efficacy. Self-efficacy and social support had positive direct effects on health status. However, pain-related fear had no direct or indirect effect on health status. Lower level of pain catastrophizing can improve self-efficacy. Increasing of self-efficacy and social support can then lead to improvement on health status. This study highlighted the effect of psychosocial factors on health status. It is necessary to develop a program to minimize pain catastrophizing, improve social support, and promote self-efficacy to improve the health status of older people with knee osteoarthritis.

Promoting patients' sense of security is among the goals of nursing care within heart failure management. The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status (P < .01) and sense of security (P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.

The Effect of Vitamin D on Aldosterone and Health Status in Patients With Heart Failure

The purpose of this cross-sectional, descriptive correlation study was to test a model that explains the influence of financial status, education, social support, symptom severity, barriers, knowledge, depression, and self-efficacy on medication adherence in post-myocardial infarction patients (MI). The conceptual framework was World Health Organization’s multidimensional adherence model (MAM). A cluster sampling using multi-stage process of 348 post-MI patients was recruited from nine regional hospitals of Thailand. All participants responded to a set of nine questionnaires in a structured interview format. Research instruments were the Demographic Characteristics Questionnaire, Modified ENRICHD Social Support Instrument, Cardiovascular Society Classification, Center for Epidemiologic Studies Depression Scale, Barriers to Medication Adherence, Coronary Heart Disease Awareness and Knowledge Questionnaire, Self-efficacy for Appropriate Medication Use Scale, and Morisky’s Self-reported Measure of Medication Adherence. The reliability of instruments were .92, .72, .87, .87, .91 and .65, respectively. A linear structural relationship (LISREL) 8.72 was used to test the hypothesized path model.The study findings revealed that the hypothesized model fit the empirical data and explained 20% of the variance of medication adherence (chi square = 5.87, df = 5, p &lt; .43, Chi-square/df = 0.97, GIF = 0.99, RMSEA = 0.065, SRMR = 0.041, AGFI = 0.97). Depression was the most influential factor affecting medication adherence which it had negative direct effect (-.40, p &lt; .05) and had negative indirect effect on medication adherence through self-efficacy (-.77, p &lt; .05). Self-efficacy and knowledge had positive direct effect on medication adherence (.17 and .05, p &lt; .05, respectively). Barriers had positive direct effect on medication (.10, p &lt; .05) and negative indirect effect on medication adherence through self-efficacy (-.07, p &lt; .05). Symptom severity, financial status, and social support had negative direct effect on medication adherence (-.06, -.05, and -.05, p &lt; .05, respectively). Social support and knowledge had positive indirect effect through self-efficacy (.21 and .08, p &lt; .05, respectively) and had negative indirect effect through depression and self-efficacy (-.27 and -.11, p &lt; .05, respectively). Moreover, education had positive direct effect on medication adherence (.03, p &lt; .05), positive indirect effect through knowledge and self-efficacy (.10, p &lt; .05), and negative indirect effect on medication adherence through depression and self-efficacy (-0.01, p &lt; .05).These findings demonstrated that the highest impact factors influencing medication adherence was depression followed by self-efficacy and barriers, respectively. Therefore, nurse should identify or aware of barriers and depression on medication adherence. Further nursing interventions should promote self-efficacy to enhance medication adherence and improve quality of life among persons with post-acute MI.