Understanding psychological distress in heart failure dyads.

Caregiving experiences of older family caregivers of persons with heart failure: A mixed methods study

Background: Patients with heart failure may suffer from symptom distress, affecting their overall quality of life and psychological well-being including depression. Limited researches focused on the effects of intervention on symptoms and psychological distress for patients with heart failure. Research Hypothesis: Nutritional education and exercise intervention can significantly improve symptoms and psychological distress in patients with heart failure. Aims: To investigate the effectiveness of the Nutrition Instruction Combined Exercise and Support program (NICE-Support) on symptom and psychological distress in patients with heart failure. Methods: This randomized controlled trial recruited 240 patients with heart failure from two medical centers in Taiwan by convenience sampling. Participants were divided into two subgroups based on participation in the "Post-Acute Care Integration Program (PAC)." Each group was randomly assigned to the experimental group and control group, including PAC, PAC+NICE, N-PAC, and N-PAC+NICE groups. The experimental group received a 12-week NICE-Support intervention, encompassing nursing instruction, nutritional counseling, exercise, and support. The control group followed routine hospital care. Data were collected through a structured questionnaire, including basic information, the Heart Failure Symptom Distress Scale, Hospital Anxiety and Depression Scale at baseline, 4, 12, and 24 weeks after enrollment. Data were analyzed using SPSS 24, including descriptive, t-tests, one-way ANOVA, Pearson correlation coefficients, chi-square tests, and generalized estimating equations. Results: The overall symptom distress score was 45.02 (SD = 13.50). Anxiety and depression were reported in 23.8% and 30.9% patients, with the mean anxiety and depression score of 5.01 (SD = 4.50) and 5.98 (SD = 4.16), respectively. Compared with the N-PAC control group, the PAC+NICE group and N-PAC+NICE group exhibited significant greater improvements in symptom distress at 4, 12, and 24 weeks post-intervention, while the N-PAC+NICE group showed statistically significant greater improvement in anxiety at 12 and 24 weeks. Conclusion: The NICE-Support program effectively improves symptom and psychological distress in patients with heart failure and could implement in patients with heart failure.

Given the importance of improving health for patients with heart failure, the present study examined the temporal associations between eHealth literacy, insomnia, psychological distress, medication adherence, quality of life and cardiac events among older patients with heart failure. With a longitudinal design older patients with echocardiography verified heart failure (N=468; 50.4% New York Heart Association class II, mean age 69.3±7.3 years; 238 men) in need of cardiac care at seven Iranian university outpatient clinics went through clinical examinations and completed the following questionnaires at baseline: eHealth literacy scale (eHEALS, assessing eHealth literacy); 5-item medication adherence report scale (MARS-5, assessing medication adherence); Minnesota living with heart failure questionnaire (MLHFQ, assessing quality of life); insomnia severity index (ISI, assessing insomnia); and hospital anxiety and depression scale (HADS, assessing psychological distress). All the patients completed the ISI and HADS again 3 months later; and the MARS-5 6 months later. Also, their cardiac events were collected 18 months later. Three mediation models were then conducted. eHealth literacy had direct and indirect effects (through insomnia and psychological distress) on medication adherence and quality of life. Moreover, eHealth literacy had protecting effects on cardiac events (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.37, 0.65) through the mediators of insomnia (HR 0.19; 95% CI 0.15, 0.26), psychological distress (HR 0.08; 95% CI 0.05, 0.12) and medication adherence (HR 0.05; 95% CI 0.04, 0.08). As eHealth literacy was a protector for patients with heart failure, healthcare providers may plan effective programmes to improve eHealth literacy for the population. Additional benefits of improving eHealth literacy in heart failure may be decreased insomnia and psychological distress, improved quality of life, as well as decreased cardiovascular events.

This study aimed to identify the heterogeneous trajectories of frailty and determine the predictors of distinct trajectories in patients with heart failure. A longitudinal study. A total of 253 patients with heart failure were recruited at the cardiology department of a tertiary hospital between February and December 2023. Frailty was assessed at baseline, 1 and 4 months after discharge. Patients' sociodemographic characteristics, physical symptoms, nutritional status, psychological distress, illness perception and social networks were obtained at baseline using a structured questionnaire. Group-based trajectory modelling was performed to identify the heterogeneity of the trajectories of frailty. Multiple logistic regression and decision tree models were used to explore the predictors of heterogeneous trajectories of frailty. Three distinct trajectories of frailty were identified in patients with heart failure: low frailty with high-degree improvement group (46.2%), moderate frailty with high-degree improvement group (41.1%) and high frailty with low-degree improvement group (12.6%). Multiple logistic regression analysis showed that physical symptoms, nutritional status, illness perception and employment status were entered as independent predictors of heterogeneous trajectories of frailty. The decision tree model demonstrated that physical symptoms were the primary predictors, followed by nutritional status, illness perception and psychological distress. Three distinct categories of frailty trajectories were identified in patients with heart failure. Physical symptoms, nutritional status, psychological distress, illness perception and employment status were independent predictors of heterogeneous trajectories of frailty, with physical symptoms being the most important predictor. Dynamic frailty assessment is recommended. Interventions aimed at alleviating physical symptoms, psychological distress and negative illness perception, and improving nutritional status may be conducive to delaying or reversing frailty in patients with heart failure, particularly in unemployed individuals. The reporting followed the STROBE guideline. No patient or public contribution.

BackgroundExisting research indicates that fear of progression influences the quality of life of patients with various diseases. However, the influence of fear of progression on the quality of life of patients with heart failure and its underlying mechanisms remain unclear. This study aimed to identify the link between fear of progression and quality of life in patients with heart failure and explore the multiple mediating roles of psychological distress and resilience in this association.MethodsThis multicenter, cross-sectional study was conducted between March and December 2023 across four tertiary hospitals in China. Data on fear of progression, psychological distress (anxiety and depression), resilience, and quality of life were collected. The PROCESS macro in SPSS was used to analyze the multiple mediation model.ResultsThe study involved 277 patients. The total indirect effect of fear of progression on quality of life was significant. Fear of progression influenced physical quality of life through two pathways: (i) resilience independently, and (ii) psychological distress-depression and resilience serially. Additionally, fear of progression influenced mental quality of life through three pathways: (i) psychological distress (anxiety and depression) independently, (ii) resilience independently, and (iii) psychological distress (anxiety and depression) and resilience serially. However, psychological distress-anxiety or resilience had no mediating effect on the relationship between fear of progression and physical quality of life in patients with heart failure.ConclusionsFear of progression had a negative association with quality of life in patients with heart failure. In addition, the relationship between fear of progression and quality of life was mediated by psychological distress and resilience. Interventions targeting the reduction of psychological distress and enhancement of resilience may mitigate the impact of fear of progression on quality of life in patients with heart failure.

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

Sleep disturbance is common in patients with heart failure. The aims of this study were to assess the prevalence of sleep disturbance in patients with heart failure, and to examine the serial multiple mediation effects of psychological distress and sleep hygiene practices on the relationship between symptom burden and sleep quality. We recruited eligible heart failure patients in a large, university-affiliated hospital in Shandong Province, China, from November 2018 to June 2019. The Pittsburgh Sleep Quality Index, Heart Failure Somatic Perception Scale, Hospital Anxiety and Depression Scale, and Sleep Hygiene Practice Scale were used to assess patients' sleep quality, symptom burden, psychological distress, and sleep hygiene practices. The mediation effects were analyzed using the PROCESS tool in SPSS. Two hundred and thirty seven heart failure patients were included in the final analyses. Among these patients, 189 patients (67.1%) had a sleep disturbance (Pittsburgh Sleep Quality Index score of >5). Higher symptom burden, higher level of psychological distress, and poorer sleep hygiene practices were associated with patients' poorer sleep quality. The psychological distress and sleep hygiene practices had mediation effects on the relationship between symptom burden and sleep quality in patients with heart failure. Patients' symptom burden could affect their sleep quality through psychological distress and sleep hygiene practices besides a direct effect. Thus, psychological distress and sleep hygiene practices should be fully considered in the development of interventions to improve patients' sleep quality, apart from alleviating patients' symptom burden.

POSTER PRESENTATIONS

The objective of this study was to examine the burden of psychological distress among individuals with different forms of heart disease in a large representative sample of adults. Data were obtained from the 2002 National Health Interview Survey, which is a large annual survey of the US non-institutionalized civilian population. Psychological distress was assessed with a standardized questionnaire (K6) and heart disease diagnoses were based on self-report. Among non-diseased individuals, the estimated prevalence of psychological distress was 2.8%, whereas the estimates were 10, 6.4, and 4.1% among those with congestive heart failure (CHF), myocardial infarction (MI), and coronary heart disease (CHD), respectively. Over 1 million individuals with one or more of these conditions are estimated to experience psychological distress. However, only 31-35% of the participants with heart disease and psychological distress have visited a mental health professional. The logistic regression model results indicate that MI (OR 2.0, 95% CI 1.4-3.0) and CHF (OR 3.1, 95% CI 1.8-5.1) are significantly associated with psychological distress. These findings imply that psychological distress is a significant comorbidity of cardiovascular disease. Other investigations have demonstrated a link between psychological distress and morbidity and mortality. Taken together, these findings provide the impetus for future investigations that assess the role that a medical and mental health care professional intervention may have in altering these outcomes when targeted at this distress.

Background: The incidence of heart failure continues to rise in the United States, with more than 600,000 new cases diagnosed each year. The progressive nature of heart failure predisposes individuals to physical and psychological sequelae, including physical activity intolerance and depressive symptoms. Coping is beneficial in assisting individuals to live with heart failure. Evidence suggests that how individuals cope with heart failure may influence heart failure-related outcomes, such as psychological well-being, self-care, health-related quality of life, and mortality. Thus, a better under- standing of coping styles can assist clinicians and researchers to develop interventions that improve heart failure outcomes. Purpose: To provide a systematic review and synthesis of evidence regarding the influence of coping styles in HF. A conceptualization of coping commonly used in heart failure-related literature within the context of stress and cognitive appraisal of stress is described. In addition, this review will identify what is known about: (1) individual factors that influence coping styles in heart failure; (2) the influence of coping styles on heart failure-related outcomes; and (3) interventions that promote effective (e.g., problem-focused) coping in heart failure. Methodological issues associated with this empirical literature and implications for clinicians and research also were discussed. Methods: This article provides a systematic review of current empirical evidence regarding the influence of coping styles on heart failure-related outcomes. Results: This review of empirical literature revealed several factors that may influence coping style in individuals with HF, including co-morbidities, personality, illness knowledge and beliefs, and sense of coherence. Additionally, the use of problem-focused coping strategies was found to be related to positive HF outcomes, such as psychological well-being, enhanced self-care, and improved health-related quality of life. Whereas, the use of emotion-focused coping strategies was found to be associated with negative HF outcomes, such as psychological distress, decreased health-related quality of life, and increased HF-related mortality. Although limited, experimental work in this area suggests that problem-focused coping strategies may be beneficial in improving HF-related outcomes. Conclusions: Effective coping aids the successful management of heart failure, specifically the management of associated physical symptoms and psychological sequelae that may result. Problem-focused strategies may be more beneficial than emotion-focused strategies in assisting individuals to cope with heart failure and improve heart failure outcomes, such as psychological well-being, self-care, and health-related quality of life. Conversely, emotion-focused strategies may nega- tively influence heart failure outcomes, such as psychological distress, decreased health-related quality of life, and heart failure-related mortality. Therefore, nurses should include problem-focused coping strategies in patient and family education. Research on the effectiveness of problem-focused strategies is sparse, thus more experimental studies, particularly longitudinal designs, is warranted to determine the efficacy of problem-focused interventions throughout the progression of heart failure.

Psychological distress is common among patients with heart failure (HF); however, somatic symptoms are also common and may confound its assessment. Understanding the contributions of symptoms to psychological distress may assist in focusing treatment. The purpose of this study was to evaluate differences between HF patients and a non-HF comparison group on psychological distress (anxiety and depression); the association of anxiety and depression with common somatic symptoms of HF (fatigue, sleep disturbance, dyspnea, and excessive daytime sleepiness); and the extent to which somatic symptoms and HF diagnosis explain psychological distress. In this cross-sectional study, 61 stable systolic HF outpatients and a comparison group of 57 persons recruited from the community completed the Centers for the Epidemiological Studies of Depression Scale, Profile of Mood States-Short Form, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Multidimensional Assessment of Fatigue Scale, and the Multidimensional Assessment of Dyspnea Scale. The HF patients scored higher on depression, as measured by the Centers for the Epidemiological Studies of Depression Scale, but not on the other depression or anxiety scales. Group-related differences in depression were explained by sleep disturbance, fatigue, and excessive daytime sleepiness, after accounting for the effects of age, sex, minority status, comorbidity, and physical function.

Summary Background Heart failure is commonly associated with psychological symptoms. These symptoms are often neglected, underdiagnosed or inadequately treated and therefore impact negatively on the recovery of and quality of life of these patients. This study aimed at determining the frequency of psychological distress (anxiety and/or depression) and its correlates in Nigerian patients with heart failure. Methods The subjects comprised one hundred (100) confirmed heart failure patients in steady state. They were recruited consecutively from the cardiology outpatient clinics of two tertiary hospitals in Nigeria. A self administered questionnaire was used to collect sociodemographic and clinical data. Psychological distress was assessed using a psychometric questionnaire – the Hospital Anxiety and Depression Scale (HADS) and the severity of heart failure was assessed according to the New York Heart Association criteria (NYHA). Results Anxiety was found in 16% of the patients, depression in 13% and 39% had anxiety co-morbidly presenting with depression. Psychological distress was more common in younger patients (less than 50years) ( p p >0.05). Conclusion Anxiety and depression have been found to be common in heart failure patients in Nigeria and affects more of the younger patients. More attention should be focused on psychological co-morbidity in heart failure in order to improve clinical outcome.

The purpose of this study was to examine the level of fatigue perceived by patients with heart failure and to explore the potential factors influencing fatigue. A cross-sectional, correlational design was used. A convenience sample of 105 patients was recruited between July and September 2003 in northern Taiwan. The patients were interviewed, and their perceived fatigue was assessed with the modified Piper Fatigue Scale. The factors influencing fatigue were determined using a stepwise linear regression model. The majority of patients with heart failure experienced mild-to-moderate fatigue. Patients with higher levels of fatigue had worse physical functioning and more severe symptomatic and psychological distress. Symptomatic distress, psychological distress (depression and anxiety), New York Heart Association class, activities of daily living (ADL) and appraisal support by health care providers could explain 57.4% of the total variance of fatigue. Symptomatic distress was the strongest predictor of fatigue. Higher levels of fatigue were found in patients with heart failure who had symptomatic or psychological distress. Additional research focusing on developing effective methods to reduce fatigue in patients with heart failure is recommended. Nurses should help patients with heart failure to monitor their symptoms and report them to health care providers. Early management of symptoms and support by health care providers may reduce patients' fatigue, help maintain their physical functioning and improve their quality of life.

Atrial fibrillation (AF) is a life-complicating illness adversely affecting morbidity, health-related quality of life (HRQOL), and healthcare use. Studies using HRQOL instruments suggest that patients diagnosed with AF experience more psychological distress than do healthy controls. Psychological distress in forms of anxiety and depression in patients with heart failure or coronary artery disease is related to increased mortality, morbidity, and consumption of healthcare. However, there is a critical lack of knowledge regarding the type and extent of psychological distress and its consequences in patients diagnosed with AF. This article will review the current state of scientific knowledge regarding psychological distress in patients with AF and offer suggestions for future studies. Medline, CINAHL, PscyhInfo, and Psychology and Behavioral Sciences Collection databases up to June 2009 were reviewed for key terms atrial fibrillation, psychological distress, affective distress, mood, emotional distress, psychological stress, negative affect, anxiety, depression, anger, and hostility. Ten studies using tested instruments to measure psychological distress were retained. The prevalence of psychological distress was not consistently reported. Combined findings revealed that psychological distress in the form of depression and/or anxiety uniquely contributed to greater AF symptom severity, diminished HRQOL, and recurrence of AF. Studies describing interventions to address psychological distress were not found. Lack of conceptual clarity and diversity of study purposes, designs, participants, and instruments limit the ability to draw coherent conclusions from findings. Nevertheless, findings suggest that psychological distress is present in a substantial portion of patients diagnosed with AF and its presence is related to adverse outcomes. Further study to identify the prevalence, characteristics, and consequences of psychological distress in patients diagnosed with AF is required to extend our knowledge and provide a foundation for development of interventions to address psychological distress in this rapidly increasing population.

Background: Evidence suggests psychological distress is common in people with heart failure (HF) and associated with adverse clinical and quality of life outcomes. Recent national guidelines highlight that there is a need to improve psychological care in HF. Purpose: This retrospective study of 11 917 clinic letters written by specialist heart failure nurses (SHFNs) contained within 2488 patient files aimed to benchmark documented recognition and management of psychological distress in HF patients by SHFNs in 11 NHS Scotland health boards. Conclusions: The study indicated SHFN case note documentation of recognition and management of psychological distress in HF fell dramatically short of clinical guidelines. Few people with HF are recognised as having associated psychological distress and fewer still are accessing evidence-based interventions. Clinical implications: Improvement to the documentation, identification and management of psychological distress in people with HF by SHFNs should be supported by training delivered by accredited psychology practitioners. There is a need for services to have clinical pathways in place to support any increases in identification of psychological distress in HF.