Caregivers Of Heart Failure Patients Research Articles

Effect of a supportive-educational program, based on COPE model, on quality of life and caregiver burden of family caregivers of heart failure patients: a randomized clinical trial study

BackgroundHeart failure (HF) is one of the most common and spreading diseases worldwide. As HF symptoms progress, it is affected the quality of life and the caregiver burden of the family. The present study aimed to determine the effectiveness of the supportive-educational program, based on the COPE (creativity, optimism, planning and expert advice) care model, on the quality of life and caregiver burden of family caregivers of HF patients.MethodThis clinical trial was conducted on 90 caregivers of HF patients admitted to Isfahan in 2021. The samples were divided into experimental (n = 45 people) and control (n = 45 people) groups based on random allocation (card method). The experimental group received problem-solving skills based on the four components of the COPE model in six sessions during one month. to collect data, the 36-Item Short Form Survey (SF-36) and the Zarit Burden Interview (ZBI) were used in two groups before, after and three months after the intervention.ResultsThere was a significant difference between the experimental and control groups regarding gender, but This confounding factor had no significant effect on the two components of quality of life and caregiver burden. There was a significant difference between the two groups in terms of the mean score of quality of life immediately(75.99),and three months after the intervention (78.78) (P < 0.05) and the mean score of care burden, immediately (16.60) and three months after the intervention (12.73) (P < 0.05).ConclusionsOne of the important duties of nurses is to implement educational-supportive programs for patients after the discharge of patients, These programs are family-oriented remotely for their caregivers.Trial registrationThis study was registered by the Iranian Registry of Clinical Trials with decree code: IRCT20211128053202N1on 2022–02-20.

Effects of Stress Management Skills Training on the Resilience of Family Caregivers of Heart Failure Patients: A Quasi-experimental Study

Background: Heart failure disrupts the lives of patients and their caregivers. Resilience is a dynamic process for adaptation in traumatic or disastrous events. As teaching stress management skills increases people’s adaptation in stressful situations, this study was determined the effects of stress management skills training on the resilience of family caregivers of heart failure patients. Objectives: To determine the effects of stress management skills training on the resilience of family caregivers of heart failure patients. Methods: This quasi-experimental study conducted in 30 family caregivers of patients with heart failure hospitalized in the cardiac care unit (CCU) of Amir al-Mominin Ali (AS) hospital in Zabol, Iran. They were randomly divided into two groups, intervention and control. Data was collected using a demographic characteristics questionnaire and Connor Davidson questionnaire of resilience which were completed before and after the intervention. Results: Independent t-test did not show a significant difference between the two groups before the intervention (P &gt; 0.05). However, the mean score of the resilience was significantly different after intervention (P &lt; 0.001). Conclusions: The intervention of stress management skills training can be effective for family caregivers of heart failure patients in a sample of Iranian society. The results are consistent with the results of other studies. It is absolutely necessary and effective to provide such educational services in the healthcare service delivery system for patients’ caregivers.

A quasi-experimental study to assess the effectiveness of structured counseling among caregivers of heart failure patients on selected outcomes

A quasi-experimental study to assess the effectiveness of structured counseling among caregivers of heart failure patients on selected outcomes

Factors affecting the quality of life of family caregivers of patients with heart failure: A cross-sectional study.

Heart failure is a chronic disease requiring lifetime self-management at home by patients, who often require additional support. However, the long-term nature of this self-management presents great challenges for both heart failure patients and their family caregivers. The role of family caregivers is critical, but little is known about the relationship between the burden, stress, depressive symptoms, and quality of life in the family caregivers of heart failure patients. We aimed to explore caregiver burden, stress, depressive symptoms, and quality of life in both patients with heart failure and their family caregivers and identify the factors associated with family caregivers’ quality of life.The sample included 120 participants (60 heart failure patients and 60 corresponding family caregivers) from cardiovascular outpatient clinics at 2 university-affiliated hospitals in South Korea from September 2018 to July 2019. The mean ages of the heart failure patients and their caregivers were 72.72 (SD = 12.73) and 57.03 (SD = 13.42) years, respectively. Caregiver burden (r = −0.601, P < .001) and caregiver depressive symptoms (r = -0.535, P < .001) were negatively correlated with the caregivers’ quality of life. The result of the hierarchical multiple regression analysis identified 3 significant factors related to the family caregivers’ quality of life: caregiver’s age (β = −0.257, P = .012), caregiver burden (β = −0.408, P = .002) and caregiver depressive symptoms (β = −0.298, P = .018), with overall explanatory power of 47.5%.It is necessary to develop practical strategies to improve family caregivers’ quality of life by alleviating their burden and depressive symptoms. Healthcare providers should be engaged with not only heart failure patients but also their family caregivers during the disease management process to improve patients’ outcomes.

The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study.

Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran. The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software. The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were "family caregiver's unmet needs" (with 5 subcategories), "Empowering Informal Caregivers" (with 3 subcategories), and "access to a standard home healthcare system" (with 7 subcategories). Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients' hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.

Abstract 9364: Caregiver Anxiety Significantly Reduced from Baseline to 24 Months After Surgery: Findings from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Circulatory Support ( Sustain-it) Study

Introduction: We previously reported higher health-related quality of life (HRQOL), lower depression scores, and decreased anxiety in caregivers (CGs) of older (60-80 years) heart failure (HF) patients (PTs) treated with destination therapy mechanical circulatory support (DT MCS) or heart transplantation (HT) from baseline (before surgery) to 12 months post-surgery. We expand the analysis of CGs’ HRQOL and symptoms of depression and anxiety through 24-months post-surgery. Methods: From 10/1/15-12/31/18, 13 U.S. centers enrolled 301 CGs of HF PTs: 193 awaiting HT (92 with MCS, 101 without MCS) and 108 DT MCS. At baseline and 24-months post-surgery, CGs completed the following instruments: EQ-5D-3L (Visual Analog Scale [VAS]: 0 [worst]-100 [best] imaginable health state); PHQ-8 (range=0-24; score &gt; 10=current depressive symptoms); and STAI-State (range=20-80, higher score=more anxiety). Analyses included paired t-tests and baseline-adjusted linear regression. Results: CGs average age was 60.9±10 years, 85% were Caucasian, 85% female, and 83% spouses. No significant differences in HRQOL and depressive symptoms were found between groups at baseline, nor were significant changes observed between baseline and 24-months within any group. At baseline, anxiety was higher for CGs of DT MCS PTs compared to CGs of HT MCS (p=0.026) and HT non-MCS PTs (p&lt;0.001; Figure). Between baseline and 24-months, STAI-State total scores were reduced among DT MCS and HT Non-MCS CGs (p=0.019 and p=0.001, respectively), but not among HT MCS CGs (p=0.86). At 24 months, significant between-group differences were observed in all scales: HRQOL was highest in HT non-MCS, depressive symptoms and anxiety highest in HT MCS CGs. Conclusions: Recognizing the impact of HT and DT MCS on CGs of older HF PTs may allow clinicians to provide targeted support to CGs, especially related to anxiety. These findings also may inform PT and CG decision making when considering surgical treatments for HF.

Abstract 11455: Does Caregiver Burden Change from Before to 24 Months After Surgery: Findings from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support ( Sustain-it ) Study

Purpose: Caregivers (CGs) provide essential support to older (60-80 years) patients with advanced heart failure (HF), yet caregiving may be burdensome. Understanding the caregivers time spent and difficulty in caring for patients may inform CG support needs before and after cardiac surgery. We compared CG burden before and 24 months after heart transplantation (HT), with or without baseline mechanical circulatory support (MCS), and long-term MCS as destination therapy (DT). Methods: Between 10/1/15-12/31/18, we enrolled 301 CGs of HF patients from 13 U.S. hospitals: 193 awaiting HT (92 with and 101 without MCS), and 108 scheduled for long-term MCS. At baseline (pre-surgery) and 24 months post-surgery, CGs completed the Oberst Caregiving Burden Scale (OCBS), which has 15 items with 2 subscales: (1) time: range=1-5, higher score=more time spent on task and (2) difficulty: range=1-5, higher score=higher task difficulty. Statistical analyses included t-tests and baseline-adjusted linear regression models. Results: CGs’ average age was 60.9±10 years, 83% were spouses, 85% female, and 85% white. Across all groups and both time points, time spent on caregiving tasks was moderate and task difficulty was rated low. Time spent on caregiving decreased significantly from baseline to 24-months for all groups (p-value &lt;0.05 for all; Figure 1A) but task difficulty did not (Figure 1B). At 24-months, mean OCBS time and difficulty scores were significantly higher among CGs of DT patients compared with CGs of HT MCS and HT non-MCS patients. Conclusions: CG time on tasks decreased from baseline to 24-months post-surgery in all groups, and both time and difficulty scores were persistently higher for CGs of DT patients. These results may inform identification of support options to reduce time and difficulty of CG tasks, particularly for those who care for destination therapy HF patients.

A psychometric evaluation of the Caregiver Contribution to Self-Care of Heart Failure Index in a Thai population

BackgroundCaregivers are major contributor to the self-care of patients with heart failure. The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions across three scales: self-care maintenance (symptom monitoring and treatment adherence); self-care management (dealing with symptoms); and confidence in contributing to the self-care (self-efficacy in managing self-care) of patients with heart failure. Informal caregivers play a vital role in supporting family members with heart failure in Thailand, yet no validated tool exists to measure their contribution. We examined the psychometric properties of the CC-SCHFI in a Thai population.MethodsThe CC-SCHFI was translated into Thai using a standard forward and backward translation procedure. A cross-sectional design was used to examine the psychometric properties of the Thai version of the CC-SCHFI in 100 family caregivers of heart failure patients in Southern Thailand. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.ResultsThe Thai version of the CC-SCHFI demonstrated acceptable internal consistency (composite reliability of each scale ranged from 0.76 to 0.99). Reliability estimates were adequate for each scale (McDonald’s omega ranged from 0.75 to 0.96). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.98–1.00; root-mean-square error of approximation = 0.00–0.07).ConclusionsThe Thai version of the CC-SCHFI appears to be a valid and reliable instrument for measuring caregiver contributions to self-care maintenance and self-care management as well as contributing to caregiver confidence in the self-care of Thai heart failure patients.

P006. Relationship of Heart Failure Patient Caregivers Mutuality and Preparedness to Caregiving Role Strain and Burden during COVID-19

<h3>Background</h3> The hospitalization rates among Heart Failure (HF) patients has increased from 23% in 2000 to 29% in 2010 necessitating the efforts to improve care and reduce cost (CDC, 2014). This is causing an increase burden on the health care system, families, and the society. At discharge, patients are educated on self-care, which is a non-pharmacological approach towards patients managing their own disease state. Self-care is a difficult concept for most Heart Failure patients to master because it requires adapting to new life-style changes. The caring burden increases as patient's advance in the disease state. HF patients rely on informal care givers who are family and friends (Hooker, Schmiege, Trivedi, Amoyal & Beleman, 2019). The sudden transition to the Heart failure patient's caregiver role can be a social, financial, emotional, and physical strain that effects effective role adaptation. It is important to consider mutuality and preparedness when preparing care givers to their new role. Caregiver mutuality and preparedness can have mediating effects on caregiver role strain and burden over time (Schumacher, Stewart, & Archbold, 2007). <h3>Methods</h3> The purpose of this cross-sectional correlational study was to investigate the relationship between Heart failure patient's caregiver mutuality and preparedness for caregiving to role strain and burden. Two hypotheses were tested in this study: 1) There will be a negative relationship between Heart failure patient's caregiver mutuality and preparedness to caregivers role strain and burden 2) There will be a negative relationship between mutuality and preparedness to caregivers role strain and burden. The Roy Adaptation Model guided this research. The sample consisted of 195 adult Heart failure patient caregivers who participated via Amazon Mechanical Turk (M Turk) a crowd sourcing marketplace for survey participation and data collection. Predictor measures included mutuality and preparedness. Mutuality was measured by the Mutuality Scale and preparedness was measured by the Preparedness for Caregiving Scale. The outcome measure, role strain, was measured by the caregiver's perception of financial, physical, and social strain, and burden was measured with the Zarit burden scale. <h3>Results</h3> This study demonstrated that there was a statistically significant negative relationship between caregiver mutuality and preparedness to role strain, r (195) =.058, <i>p</i> < .001 and a statistically significant negative relationship between caregiver mutuality and preparedness to burden, r(195) =.071, <i>p</i> < .001. These findings indicate that mutuality and preparedness are important predictors of caregiver role strain and burden. The Heart failure certified nurse is positioned to translate the evidence of caregiver role research to the assessment, planning, and evaluation of interventions that can assist the informal caregiver during the dynamic phases of caregiver role adaptation. <h3>Conclusion</h3> Assessing the caregiver's preparation for caregiving, in addition to caregiver mutuality, is an important step in individualizing interventions that will have a positive effect on the role transition to caregiver. Furthermore, individual interventions based on the demand of caregiving will assist in the preparation of the caregiver during the transition to the community setting. This output includes descriptive on the variables, custom tables that display the set of responses for each of your composite variables and a few regressions to explore your states hypotheses. •Regression (multivariate): Mutuality and Preparedness vs Strain ○ R2=.058 (low) and p=.001 (signif) ○ Coefficients: ▪ Mutuality: -.216 (p=.042) — a negative impact (decreases) on strain (not much, but significant) ▪ Preparedness: .435 (p=.000) – a positive impact (increases) on strain •Regression (bivariate): <b>Preparedness vs Strain</b> ○ R2=.042 (low) and p=.002 (signif) ○ Coefficient: .275 (p=.002) – a positive impact (increases) on strain •Regression (bivariate): <b>Mutuality vs Strain</b> ○ R2=-.004, p=.600 <b>NOTE:</b> Mutuality not statistically significant on its own. Interplay with Preparedness •Regression (bivariate): <b>Mutuality and Preparedness vs Burden</b> ○ R2=.071 (low), p=.001 (signif) ○ Coefficients: ▪ Mutuality: -.427 (p=.000) – negative impact (decreases) perceived Burden ▪ Preparedness: .475 (p=.000) – positive impact (increases) perceived Burden ○ Regression: Mutuality vs Burden – NOT SIGNIFICANT ○ Regression: Preparedness vs Burden –NOT SIGNIFICANT •Regression: <b>Burden vs Strain</b> ○ R2=.312 (stronger impact than those above), p=.000 (signif) ○ Coefficient for Burden = .515 (p=.000) (For each one point increase in the Burden score, there is a half point increase in the Strain score. Remember that these scores only range from 0 to 4, so this is a heavy hit

Caregivers of Patients with Heart Failure: Burden and the Determinants of Health-Related Quality of Life.

PurposeTo assess the burden among caregivers of patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤60%. The burden by New York Heart Association (NYHA) functional class was also characterized.Patients and MethodsA cross-sectional study was conducted in France, Germany, Italy, Spain, and UK from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive HF patients. Caregivers who accompanied the patient to their consultation completed a caregiver self-completion survey voluntarily, which included the Family Caregiver Quality of Life Questionnaire (FAMQOL) and 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L).ResultsWe analyzed 361 caregivers of patients with HF (NYHA class I, n=41; II, n=212; III IV, n=108). Mean age of caregivers was 58.8 years (NYHA I/II/III–IV: 59.1/60.8/54.6 years; p=0.0029), with majority being females (73.1%). Caregivers spent on average 19.8 hours/week caring for a HF patient, which increased with increase in NYHA class (I/II/III–IV: 11.8/18.1/25.9 hours/week; p=0.0094). Caregivers (24.1%) reported providing emotional support/encouragement to patients as the most troublesome/inconvenient caregiving activity (no significant difference across NYHA class). Nearly one-third of caregivers experienced stress (NYHA I/II/III–IV: 17.1%/28.8%/40.7%; p=0.0111) and anxiety (26.8%/24.1%/39.8%; p=0.0127) due to caregiving burden. The overall FAMQOL mean score decreased significantly (poorer QoL) with increase in NYHA class (I/II/III–IV: 58.1/56.3/52.2; p=0.0069). A trend of decreasing scores with increasing NYHA class was observed across physical, emotional, and social domains (each p≤0.012).ConclusionCaregivers of HF patients with LVEF ≤60% experienced a significant burden, which was higher among caregivers of patients with more severe and symptomatic disease.

Lessons learned from the implementation of a video health coaching technology intervention to improve self-care of family caregivers of adults with heart failure.

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients ("Virtual Caregiver Coach for You"-ViCCY). A randomized controlled trial is currently in progress to test the efficacy of the intervention to improve self-care. In this trial, 250 caregivers will be randomly assigned to receive health information via a tablet computer (hereafter, tablet) plus 10 live health coaching sessions delivered virtually (intervention group; n = 125) or health information via a tablet only (control group; n = 125). Each tablet has specific health information websites preloaded. To inform others embarking on similar technology projects, here we highlight the technology challenges encountered with the first 15 caregivers who received the ViCCY intervention and the solutions used to overcome those challenges. Several adaptations to the implementation of ViCCY were needed to address hardware, software, and network connectivity challenges. Even with a well-designed research implementation plan, it is important to re-examine strategies at every step to solve implementation barriers and maximize fidelity to the intervention. Researcher and interventionist flexibility in adapting to new strategies is essential when implementing a technology-based virtual health coaching intervention.

Abstract 13558: Caregiver Anxiety Reduced From Baseline to 12 Months After Surgery: Findings From the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Circulatory Support ( Sustain-it ) Study

Introduction: Caregivers (CGs) of heart failure (HF) patients (PTs) who undergo heart transplantation (HT) or Destination Therapy Mechanical Circulatory Support (DT MCS) provide support to PTs before and after surgery, which may affect their own health-related quality of life (HRQOL). In SUSTAIN-IT, we previously reported that CG HRQOL was good at baseline (i.e., before HT and DT MCS surgery) and was impacted by CG comorbidities and CG anxiety. This report explores change in CG overall HRQOL, depression, and anxiety from baseline to 12 months after HT or DT MCS surgery. Methods: From 10/1/15-12/31/18, 13 U.S. centers enrolled 301 CGs of HF PTs: 193 awaiting HT (92 HT with MCS as a bridge to transplant [HT BTT] and 101 HT without MCS [HT non-BTT]), and 108 awaiting DT MCS. At baseline, 3, 6, and 12 months post HT or DT MCS surgery, CGs completed the following instruments: EQ-5D-3L (Visual Analog Scale [VAS]: 0 [worst] to 100 [best] imaginable health state), PHQ-8 (range=0-24; score ≥10=depressive symptoms requiring evaluation), and STAI-State (range=20-80, higher score=more anxiety). Analyses included unadjusted and baseline-adjusted linear regression models. Results: CGs were age 61.0±10.3 years; the majority were Caucasian (86%), female (86%), spouses (85%) of enrolled HF PTs. At baseline, CG EQ-5D-3L VAS and PHQ-8 average scores were 83.8 ± 13.99 (high) and 2.6 ± 2.85 (low), respectively, for the entire cohort. No significant interval changes in CG HRQOL and depressive symptoms were found within or between groups. DT MCS and HT non-BTT CG anxiety significantly decreased over time (baseline to 12 months) (Figure). Levels of CG anxiety were similar among all groups at 12 months after HT or DT MCS surgery. Conclusions: The demonstrated reduction in anxiety among CGs in the post-operative period provides clinicians with important information to share with CGs when PTs are considering surgical treatment options for HF.

Abstract 13701: Change in Caregiver Burden From Before to 1 Year After Surgery: Findings From the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support ( Sustain-IT ) Study

Purpose: Caregivers (CGs) for patients with advanced heart failure (HF) assist in HF-specific disease management. In the SUSTAIN-IT study, we reported CG perception of difficulty and time needed to perform tasks for patients awaiting surgery in 3 groups: HF patients awaiting heart transplant (HT) without mechanical support (HT-non-MCS), HF patients awaiting HT bridged with mechanical support (HT-MCS), and HF patient awaiting left ventricular device implantation as destination therapy (DT-MCS). In this report, we compare CG perceived burden from baseline to 1 year after surgery. Methods: We enrolled 301 CGs of HF patients between 10/1/15-12/31/18 from 12 U.S. hospitals: 193 awaiting HT (92 with and 101 without MCS), and 108 scheduled for DT-MCS. Prior to surgery and 3, 6, and 12 months after surgery, CGs completed the Oberst Caregiver Burden Scale (OCBS) which has 15 items with 2 subscales: (1) time and (2) difficulty: range=1-5, higher score=more time required for tasks and more task difficulty. Analyses included t-tests, chi-square tests, and baseline-adjusted linear regression models. Results: CGs were age 61.0±10.3 years, the majority were spouses (85%), female (86%), and white (86%). Average time spent on caregiving was moderate and decreased significantly from baseline to 12 months after surgery for all groups (Figure). DT-MCS CGs spent significantly more time than HT CGs on tasks 12 months after surgery. There were no significant differences in perceived difficulty (which was low) in performing CG tasks in all groups from baseline to 12 months. DT-MCS CGs did perceive tasks to be more difficult than HT CGs at 12 months. Conclusion: CGs of advanced HF patients adapted well to assisting with care, without increased burden, 1 year after HT and DT-MCS surgery. CGs of DT-MCS patients required more time and reported CG tasks to be more difficult than HT CGs. Understanding differences in CG burden will aid in pre surgical risk discussions and post-surgical follow-up.

Caregiver burden of patients with heart failure with a left-ventricular ejection fraction (LVEF) less than or equal to 60%: a cross-sectional survey in the EU

Abstract Background and purpose The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%). Methods A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs. Results 361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1). Conclusions Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

Caregiver Comorbidities and Anxiety are Related to Caregiver Quality of Life: Findings from the Sustaining QualIty of Life of the Aged: HT or MCS Study

Involvement of caregivers (CGs) is crucial to successful outcomes of patients (PTs) awaiting heart transplantation (HT) and scheduled for durable mechanical circulatory support (MCS). Importantly, CG quality of life (QOL) may be impacted by providing care for older PTs with advanced heart failure (HF) awaiting these surgeries. We sought to identify both PT and CG factors related to QOL for CGs providing care to pts (60-80 years old (yo)) awaiting HT (with and without MCS) and destination therapy (DT) MCS. Between 10/1/15-12/31/18, we enrolled 302 CGs of HF PTs from 13 U.S. sites: 193 awaiting HT (92 HT with MCS [HT BTT] and 101 HT without MCS [HT non BTT]), and 109 DT MCS. At baseline, CGs completed the EQ-5D-3L (Visual Analog Scale [VAS]: 0 [worst] to 100 [best] imaginable health state); STAI-State (range=20-80, higher score=more anxiety); PHQ-8 (range=0-24; score >10=significant depressive symptoms); and Oberst Caregiving Burden Scale (OCBS): 15 items (2 subscales, 1-5 range each): (1) time: higher score=more time spent on task, and (2) difficulty: higher score=more difficulty of task. CG demographics and clinical history (medical and surgical) were also collected. PTs completed the KCCQ-12 (an HF-specific QOL measure) and all above measures except the OCBS. Analyses included multivariable logistic regression models in which the binary outcome was whether the CG EQ-5D-3L VAS score was less than the cohort median value of 90. CGs (n=302) were 61.1±9.7 yo, 85% white, 85% female, and 85% spouses. CGs reported high overall QOL at baseline (mean/median VAS=83.8±14.0 and 90) with no significant differences between groups. CG EQ-5D VAS score less than 90 was correlated with number of CG comorbidities (p=0.001) and STAI-state (p=0.002) after adjusting for other covariates in the model. See table. CG- and not PT-specific factors were related to CG QOL prior to HT and DT MCS. Awareness of these factors may foster support of CGs.

Determinants of caregiver burden in heart failure: does caregiver contribution to heart failure patient self-care increase caregiver burden?

The burden is high in caregivers of heart failure patients, but the literature on patient and caregiver predictors of caregiver burden is inconsistent. Also, it is unknown if caregiver contribution to heart failure self-care maintenance (i.e. helping patients to maintain heart failure stable) and self-care management (i.e. helping patients to act in case of heart failure worsening) increases caregiver burden. To identify caregiver and patient predictors of caregiver burden in heart failure; and to evaluate if caregiver contribution to heart failure self-care maintenance and management increases caregiver burden. A cross-sectional study with the enrolment of 505 caregivers of heart failure patients. We used the caregiver burden inventory and the caregiver contribution to self-care of heart failure index. We analysed the data using hierarchical regression. Heart failure caregivers, mostly women (52.5%), with a mean age 56.5 (±14.9) years, cared for heart failure patients, mostly men (55.2%), with a mean age of 75.9 (±10.4) years. Caregiver predictors of higher caregiver burden were older age, female gender, fewer caregiving hours and poor social support. Patient predictors of higher caregiver burden were older age, better education, taking fewer medications and higher quality of life. Caregiver contribution to self-care maintenance and management were not significant predictors of caregiver burden. Our results could help providers to identify heart failure caregivers who are more exposed to burden. As caregiver contribution to heart failure self-care improves patient outcomes and seems not burdensome for caregivers, providers may consider educating caregivers about self-care as a viable option for improving patient outcomes without increasing caregiver burden.

Influence of preparedness on anxiety, depression, and quality of life in caregivers of heart failure patients: Testing a model of path analysis

ObjectivesTesting the influence of heart failure (HF) caregiver preparedness on anxiety and depression, and the influence of HF caregiver anxiety and depression on caregiver physical and mental QOL. MethodsIn this cross-sectional study, we used the Caregiver Preparedness Scale (CPS), the Hospital Anxiety and Depression Scale (HADS) with the anxiety (HADS-A) and depression (HADS-D) subscales, and the Short-Form 12 (SF-12) measuring the physical component summary (PCS) and the mental component summary (MCS) of QOL. Socio-demographic data and patients’ clinic data were also collected. Data analysis was conducted with descriptive statistics, correlations, and path analysis. ResultsA total of 366 HF caregiver and patient dyads were enrolled. Caregivers were mostly females (73.3%) with a mean age of 58.61 (SD = 15.66) years. The tested model showed excellent fit indices with the following significant paths: CPS scores predicted HADS-D scores; HADS-A scores predicted MCS scores; and HADS-D scores predicted both PCS and MCS scores. Also, HADS-D mediated the relationship between CPS and MCS scores. ConclusionPreparedness influences HF caregiver depression and depression influences caregiver physical and mental QOL. Depression mediates between preparedness and HF caregiver mental QOL. Practice implicationsInterventions focused on improving HF caregiver preparedness may improve caregivers’ depression and QOL.

Psychosocial Factors Related to Adverse Outcomes in Caregivers of Heart Failure Patients: A Structural Equation Modeling Analysis

Background HF caregivers often experience caregiving burden, impacting their physical and psychological well-being. Social support and social problem-solving, as coping resources, may influence the effect of caregiving burden on self-care, depressive symptoms, and quality of life. Yet, studies examining these coping resources on HF caregiver outcomes are lacking. Purpose To investigate whether social support and social problem-solving mediate the relationships among caregiving burden, self-care, depressive symptoms, and quality of life in HF caregivers. Methods Using a descriptive, cross-sectional, correlational design, HF caregivers (n=530) completed online surveys, including the Dutch Objective Burden Inventory, the Interpersonal Support Evaluation List-12, the Social Problem-Solving Inventory Revised-Short, the Center for Epidemiological Studies - Depression scale, the Denyes Self-care Practice Instrument, and the Bakas Caregiving Outcomes Scale. Path analytic methods were used to examine a hypothesized mediating role of social support and social problem solving in the relationships between caregiving burden and caregiver self-care, depressive symptoms, and quality of life. The analysis proceeded in two phases: 1) a model-development phase with ∼62% of the sample (n=329) used to make data-based decisions on measurement indicators and structure of the path model; and 2) a confirmatory phase with ∼38% of the sample (n=201) used to provide unbiased inference on the model structure resulting from the initial phase. Results Participants were 41.39 (± 10.38) years old, Caucasian (78.3%), men (50.9%) caring for their spouse with HF (44.9%). Perceived caregiver burden was a predictor of caregiver social support (standardized effect B= -.4), self-care (Total B= -.39), depressive symptoms (Total B= .45), and quality of life (Total B= -.33). Higher level of caregiver burden was associated with less social support, worse self-care, more depression and decreased quality of life. Social support mediated the relationship between caregiving burden and depression (56% of Total effect), but did not appear to relevantly mediate the relationship between caregiving burden and self-care (11% of Total effect) or quality of life (0% of Total effect). When considered simultaneously with social support, social problem-solving was not a relevant mediator between caregiving burden and outcomes. Conclusions Caregiving burden negatively impacts caregiver outcomes. Social support appears more beneficial in mediating the effects of caregiving burden on depression, but has little mediational effect on caregiver self-care or quality of life.

Reliability and validity of Family Caregiver Quality of Life Scale in heart failure.

In this study, the Family Caregiver Quality of Life scale developed specifically for family caregivers of heart failure patients was translated into the Turkish language, and its reliability and validity was performed. The scale was first translated into Turkish and back-translated, adapting it to the Turkish culture. The Turkish questionnaire of the scale was applied to 200 family caregivers. To evaluate the reliability of the scale and all subscales, test-retest was applied, and the Cronbach's alpha reliability coefficients were calculated. The structural validity of the scale was examined through the factor analysis. The internal consistency reliability (a=0.82) of the Turkish Questionnaire of the scale was proved. Two-week test-retest reliability was supported by an intraclass correlation coefficient of 0.91. The questionnaire's factor structure demonstrated acceptable fit, indicating that it could be applied to the Turkish population. The item loads found by the factor analysis ranged from 0.32 to 0.99, explaining %63 of the variance (eigenvalue=2.61-4.06). Criterion-related validity was supported by correlations with the Short Form-36 General (r=0.473, p<0.01) and Mental (r=0.406; p<0.01) Health subscales. The Turkish version of this scale can measure the quality of life of family caregivers of heart failure patients with adequate reliability and validity.

1253The Caregiver Preparedness Scale is valid and reliable to measure preparedness in caregivers of heart failure patients

1253The Caregiver Preparedness Scale is valid and reliable to measure preparedness in caregivers of heart failure patients