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Background: Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques. Methods: We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression. Results: The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern. Conclusions: There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique. [ABSTRACT FROM AUTHOR]

• Physical frailty is common in heart failure, especially among women. • Physical frailty among women may lead to worse quality of life. • Physical frailty among men may lead to worse clinical outcomes. • Sex-specific considerations are needed when managing frailty in heart failure. Physical frailty is strongly related to adverse outcomes in heart failure (HF), and women are more likely to be physically frail than men; however, it is unknown if this sex difference affects outcomes. To determine if there are sex differences in the associations between physical frailty and health-related quality of life (HRQOL) and clinical outcomes in HF. We conducted a prospective study of adults with HF. Physical frailty was assessed using the Frailty Phenotype Criteria. HRQOL was assessed using the Minnesota Living with HF Questionnaire. One-year clinical events (all-cause death or cardiovascular hospitalization or emergency department visit) were ascertained. We used generalized linear modeling to quantify associations between physical frailty and HRQOL, and Cox proportional hazards modeling to quantify associations between physical frailty and clinical events, adjusting for Seattle HF Model scores. The sample (n = 115) was 63.5 ± 15.7 years old and 49% women. Physical frailty was associated with significantly worse total HRQOL among women (p = 0.005) but not men (p = 0.141). Physical frailty was associated with worse physical HRQOL among both women (p < 0.001) and men (p = 0.043). There was a 46% higher clinical event risk for every one-point increase in physical frailty score among men (p = 0.047) but not women (p = 0.361). Physical frailty is associated with worse overall HRQOL among women and higher clinical event risk among men, indicating a need to better understand contributors to sex-specific health differences associated with physical frailty in HF. [ABSTRACT FROM AUTHOR]

Objective: Adults with heart failure (HF) may be at high risk for falling due to age, comorbidities and frailty; however, few studies have examined falls in HF. The purpose of this study was to quantify the frequency and predictors of falls over 1 year among adults with HF.Methods: We conducted a prospective study of adults with New York Heart Association (NYHA) functional class I-IV HF. After baseline assessment of physical frailty and clinical characteristics, participants self-reported falls every 3 months during 1 year. Comparative statistics were used to identify baseline differences between those who fell vs those who did not. A stepwise negative binomial regression model was used to identify predictors of fall rate over 1 year.Results: The sample (n = 111) was 63.4 ± 15.7 years old, 48% were women, 28% had HF with preserved ejection fraction, and 41% were frail. Over 1 year, 43 (39%) of participants reported at least 1 fall and 28 (25%) of participants reported 2+ falls. Among those who fell, 29 (67%) reported injurious falls. Those who fell had significantly higher body mass indexes and were more likely to have NYHA class III/IV, type 2 diabetes and HF with preserved ejection fraction and to meet slowness and physical exhaustion criteria than those who did not fall. The fall rate was elevated among those with type 2 diabetes and those meeting the slowness and physical exhaustion criteria for physical frailty.Conclusions: Nearly 40% of adults with HF experienced a fall within 1 year. Screening for comorbidities, slowness and exhaustion may help to identify those at risk for a fall. [ABSTRACT FROM AUTHOR]

Background: Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptoms during transitions are unclear. The purpose of this article is to describe the background and design of a study that addresses these knowledge gaps, entitled Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF).Methods and Results: BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to (1) identify clusters of change in physical symptoms, (2) quantify longitudinal associations between biomarkers and physical symptoms, and (3) quantify longitudinal associations between physical frailty and physical symptoms among adults with HF. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months after hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty after HF hospitalization and associations therein.Conclusions: This innovative study will advance HF symptom science by using a multibiomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF.Lay Summary: Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We explore how symptoms, biomarkers, and physical frailty change after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. METHODS: We prospectively enrolled adults with class I-IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. RESULTS: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81-11.84], P=0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non-physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non-physically frail men. CONCLUSIONS: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics. [ABSTRACT FROM AUTHOR]

Transitioning from education to practice is stressful for new nurses and those entering new roles and can lead to workforce attrition and burnout. This dynamic is likely complicated when graduates are transitioning to practice during a pandemic. The purpose of this study was to describe recent nurse graduates' perceptions of the impact of the COVID-19 pandemic on their transition from education to practice. We conducted an online survey of BSN, RN-BSN, and DNP students who graduated between December 2019 and April 2020 (n = 82), including demographics, employment information, and free-response questions about the impact of the pandemic on their transition experiences, post-graduation plans, and perceptions of nursing. We used a qualitative descriptive approach to content analysis to synthesize and summarize the data. Participants expressed three overarching concerns: 1) altered plans such as difficulty finding employment; 2) logistical, system-related stressors including licensing delays and chaotic onboarding; and 3) feeling pride in profession despite perceiving ambivalence in public discourse. COVID-19 exacerbated challenges often experienced by new graduates. Common stressors, intensified during the pandemic, could exert long-term effects on the workforce. Educators and healthcare organizations must work to ensure nursing graduates receive the necessary support for a successful transition. • The COVID-19 pandemic impacted new nursing graduates' transition to practice. • The pandemic negatively influenced job opportunities for new graduates. • The COVID-19 pandemic limited workplace and academic training for new graduate nurses. • The COVID-19 pandemic negatively impacted post-graduation plans for new nurses. • Despite these challenges, new graduates expressed continued pride in the profession. [ABSTRACT FROM AUTHOR]

• Adults with heart failure experience numerous physical and affective symptoms. • Physical and affective heart failure symptom clusters are strongly associated. • Three symptom subgroups based on heart failure symptom clusters were identified. • Those in the incongruent symptom subgroup had worse 180-day event-free survival. • Congruence between severity of symptom clusters is relevant. The relationship between physical and affective symptom clusters in heart failure (HF) is unclear. To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups. This was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively. In this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival. Congruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes. [ABSTRACT FROM AUTHOR]

Background: Clinical response to left ventricular assist devices (LVADs), as measured by health-related quality of life, varies among patients after implantation; however, it is unknown which pathophysiological mechanisms underlie differences in clinical response by health-related quality of life. Objective: The purpose of this study was to compare changes in sympathetic markers (b-adrenergic receptor kinase-1 [bARK1], norepinephrine [NE], and 3,4-dihydroxyphenylglycol [DHPG]) between health-related quality of life clinical responders and nonresponders from pre-- to post--LVAD implantation. Methods:We performed a secondary analysis on a subset of data from a cohort study of patients from pre-- to 1, 3, and 6 months after LVAD implantation. Clinical response was defined as an increase of 5 points or higher on the Kansas City Cardiomyopathy Questionnaire Clinical Summary score from pre-- to6months post--LVAD implantation.We measured plasma bARK1 level with an enzyme-linked immunosorbent assay and plasma NE and DHPG levels with high-performance liquid chromatography with electrochemical detection. Latent growth curvemodeling was used to compare the trajectories ofmarkers between groups. Results: The mean (SD) age of the sample (n = 39) was 52.9 (13.2) years, and most were male (74.4%) and received LVADs as bridge to transplantation (69.2%). Preimplantation plasma bARK1 levels were significantly higher in clinical responders (n = 19) than in nonresponders (n = 20) (P = .001), but change was similar after LVAD (P = .235). Preimplantation plasma DHPG levels were significantly lower in clinical responders than in nonresponders (P = .002), but the change was similar after LVAD (P = .881). There were no significant differences in plasma NE levels. Conclusions: Preimplantation bARK1 and DHPG levels are differentiating factors between health-related quality of life clinical responders and nonresponders to LVAD, potentially signaling differing levels of sympathetic stimulation underlying clinical response. [ABSTRACT FROM AUTHOR]

Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms. To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months. Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale). The mean age of the sample (n = 49) was 62years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90days reported on average, 130% higher dyspnea (p = 0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p = 0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p = 0.003; CI 19.1%, 257%) and 40% higher anxiety (p = 0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90days were also significantly associated with a clinically meaningful decrease in HRQOL (β = −16.16 ± 6.32; p = 0.01). Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3months. [ABSTRACT FROM AUTHOR]

Abstract Background We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF). Objectives The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF. Methods This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage. Linear modeling was used to compare relationships among biomarkers and physical symptoms between cohorts. Results Worse myocardial stress, systemic inflammation and endothelial dysfunction were associated with worse physical symptoms in moderate HF (n =48), but less physical symptom burden in advanced HF (n =48). Conclusions Where patients are in the HF trajectory needs to be taken into consideration when exploring biological underpinnings of physical HF symptoms. [ABSTRACT FROM AUTHOR]

Background The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear. Objective To quantify the relationship between plasma β-adrenergic receptor kinase-1 (βARK1) and physical symptoms among adults with HF. Methods We performed a secondary analysis of data collected from two studies of adults with HF. Plasma βARK1 was quantified using an enzyme-linked immunosorbent assay. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS). Generalized linear modeling was used to quantify the relationship between βARK1 and HFSPS scores. Results The average age ( n = 94) was 54.5 ± 13.1 years, 76.6% were male, and a majority (83.0%) had Class III or IV HF. βARK1 was significantly associated with HFSPS scores (β = 0.22 ± 0.10, p = 0.038), adjusting for other predictors of physical symptoms (model R 2 = 0.250, F (7, 70) = 3.34, p = 0.004). Conclusions Higher βARK1 is associated with worse physical HF symptoms, pinpointing a potential pathophysiologic underpinning. [ABSTRACT FROM AUTHOR]

Background: Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL. Objective: The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL. Methods: In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire). Results: The mean age of the sample (N = 202) was 57 T 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL. Conclusion: In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptomswhen examining patient HRQOL. [ABSTRACT FROM AUTHOR]

Background: Although we know that the quality of life generally improves after left ventricular assist device (LVAD) implantation, we know little about how symptoms change in response to LVAD. Methods: The purpose of this study was to compare the changes in symptoms between bridge and destination therapy patients as part of a prospective cohort study. Physical (dyspnea and wake disturbances) and affective symptoms (depression and anxiety) were measured before LVAD and at 1, 3, and 6 months after LVAD. Multiphase growth modeling was used to capture the 2 major phases of change: initial improvements between preimplant and 1 month after LVAD and subsequent improvements between 1 and 6 months after LVAD. Results: The sample included 64 bridge and 22 destination therapy patients as the preimplant strategy. Destination patients had worse preimplant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge patients (all P < .05); subsequent change in both symptoms were similar between groups (both P > .05). Destination patients had worse preimplant depression (P = .042) but experienced similar initial and subsequent improvements in depression in response to LVAD compared with bridge patients (both P > .05). Destination patients had similar preimplant anxiety (P = .279) but experienced less initial and greater subsequent improvements in anxiety after LVAD compared with bridge patients (both P < .05). Conclusion: There are many differences in the magnitude and timing of change in symptom responses to LVAD between bridge and destination therapy patients. Detailed information on changes in specific symptoms may better inform shared decision-making regarding LVAD. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a complex clinical syndrome associated with significant symptom burden; however, our understanding of the relationship between symptoms and physical frailty in HF is limited. Objective: The aim of this study was to quantify associations between symptoms and physical frailty in adults with HF. Methods: A sample of adults with symptomatic HF were enrolled in a cross-sectional study. Physical symptoms were measured with the HF Somatic Perception Scale-Dyspnea subscale, the Epworth Sleepiness Scale, and the Brief Pain Inventory short form. Affective symptoms were measured with the Patient Health Questionnaire-9 and the Brief Symptom Inventory-Anxiety scale. Physical frailty was assessed according to the Frailty Phenotype Criteria: shrinking, weakness, slowness, physical exhaustion, and low physical activity. Comparative statistics and generalized linear modeling were used to quantify associations between symptoms and physical frailty, controlling for Seattle HF Model projected 1-year survival. Results: The mean age of the sample (n = 49) was 57.4 T 9.7 years, 67% were male, 92% had New York Heart Association class III/IV HF, and 67% had nonischemic HF. Physically frail participants had more than twice the level of dyspnea (P < .001), 75% worse wake disturbances (P < .001), and 76% worse depressive symptoms (P = .003) compared with those who were not physically frail. There were no differences in pain or anxiety. Conclusions: Physically frail adults with HF have considerably worse dyspnea, wake disturbances, and depression. Targeting physical frailty may help identify and improve physical and affective symptoms in HF. [ABSTRACT FROM AUTHOR]

Background: Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. Objective: The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. Methods: This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. Results: Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. Conclusions: This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy. [ABSTRACT FROM AUTHOR]

Falls are highly prevalent among older adults with potentially devastating and life-altering consequences. Adults with heart failure (HF) are at high risk for falling given their age, comorbidities, and high degree of physical frailty; however, very few studies have examined falls among adults with HF. To quantify the frequency and predictors of falls over one year among adults with HF. This was a prospective study of adults with New York Heart Association (NYHA) Functional Class I-IV HF. After a baseline assessment of symptoms and physical frailty phenotype (unintentional weight loss, slowness, weakness, physical exhaustion, and low physical activity) and collection of clinical characteristic data, participants self-reported number of falls and injuries resulting from falls every three months for one year. Comparative statistics were used to identify baseline characteristics of persons with a future fall(s). A stepwise negative binomial regression model was used to identify predictors of number of falls over one year, presented as the incident rate ratio (IRR) and corresponding 95% confidence interval (CI). The sample (n = 111) was 63.4±15.7 years old, 48% women, and 28% had HF with preserved ejection fraction. Over one year, 43 (39%) of participants reported at least one fall (range 0-12 falls). Of those who fell ("fallers"), 25 (64%) reported two or more falls ("recurrent fallers") and about half reported injuries from their fall. At baseline, compared with non-fallers, fallers had significantly higher body mass index and were more likely to be NYHA Functional Class III/IV, have type 2 diabetes mellitus, have HF with preserved ejection fraction, and have worse pain interference symptoms. There was no significant association with a physical frailty phenotype, but fallers were significantly more likely to meet the slowness and physical exhaustion criteria than non-fallers. In the regression model, incident falls were increased among those with type 2 diabetes mellitus (IRR 2.5, 95% CI 1.3-5.0) and non-ischemic etiology (IRR 2.6, 95% CI 1.1-6.0) and those meeting the slowness (IRR 2.7, 95% CI 1.4-5.3) and physical exhaustion (IRR 3.3, 95% CI 1.1-9.6) criteria for physical frailty. Interestingly, incident falls were decreased among those meeting the weakness criterion (IRR 0.5, 95% CI 0.2-0.95). About two out of every five adults with HF experienced a fall within one year. Screening for comorbidities, slowness, and fatigue, among other factors, may help identify those at risk for a fall. [ABSTRACT FROM AUTHOR]

Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child–Turcotte–Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P <.05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P <.001). Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population. [ABSTRACT FROM AUTHOR]

Background: There are several gender differences that may help explain the link between biology and symptoms in heart failure (HF). Objective: The aim of this study was to examine gender-specific relationships between objective measures of HF severity and physical symptoms. Methods: Detailed clinical data, including left ventricular ejection fraction and left ventricular internal end-diastolic diameter, and HF-specific physical symptoms were collected as part of a prospective cohort study. Gender interaction terms were tested in linear regression models of physical symptoms. Results: The sample (101 women and 101 men) averaged 57 years of age and most participants (60%) had class III/IV HF. Larger left ventricle size was associated with better physical symptoms for women and worse physical symptoms for men. Conclusion: Decreased ventricular compliance may result in worse physical HF symptoms for women and dilation of the ventricle may be a greater progenitor of symptoms for men with HF. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a heterogeneous condition of both symptoms and hemodynamics. Objective: The goals of this study were to identify distinct profiles among integrated data on physical and psychological symptoms and hemodynamics and quantify differences in 180-day event risk among observed profiles. Methods: A secondary analysis of data collected during 2 prospective cohort studies by a single group of investigators was performed. Latent class mixture modeling was used to identify distinct symptom-hemodynamic profiles. Cox proportional hazards modeling was used to quantify difference in event risk (HF emergency visit, hospitalization, or death) among profiles. Results: The mean age (n = 291) was 57 ± 13 years, 38% were female, and 61% had class III/IV HF. Three distinct symptom-hemodynamic profiles were identified: 17.9% of patients had concordant symptoms and hemodynamics (ie, moderate physical and psychological symptoms matched the comparatively good hemodynamic profile), 17.9% had severe symptoms and average hemodynamics, and 64.2% had poor hemodynamics and mild symptoms. Compared with those in the concordant profile, both profiles of symptom-hemodynamic mismatch were associated with a markedly increased event risk (severe symptoms hazards ratio, 3.38; P = .033; poor hemodynamics hazards ratio, 3.48; P = .016). Conclusions: A minority of adults with HF have concordant symptoms and hemodynamics. Either profile of symptom-hemodynamic mismatch in HF is associated with a greater risk of healthcare utilization for HF or death. [ABSTRACT FROM AUTHOR]

Background: The majority of heart failure (HF) self-care research remains focused on patients, despite the important involvement of family caregivers. Although self-care confidence has been found to play an important role in the effectiveness of HF self-care management on patient outcomes, no known research has examined self-care confidence within a dyadic context. Objective: The purpose of this study was to identify individual and dyadic determinants of self-care confidence in HF care dyads. Methods: Multilevel modeling, which controls for the interdependent nature of dyadic data, was used to examine 329 Italian HF dyads (caregivers were either spouses or adult children). Results: Both patients and caregivers reported lower-than-adequate levels of confidence, with caregivers reporting slightly higher confidence than patients. Patient and caregiver levels of confidence were significantly associated with greater patient-reported relationship quality and better caregiver mental health. Patient confidence in self-care was significantly associated with patient female gender, nonspousal care dyads, poor caregiver physical health, and low care strain. Caregiver confidence to contribute to self-care was significantly associated with poor emotional quality of life in patients and greater perceived social support by caregivers. Conclusions: Findings are supportive of the need for a dyadic perspective of HF self-care in practice and research as well as the importance of addressing the needs of both members of the dyad to maximize optimal outcomes for both. [ABSTRACT FROM AUTHOR]

Background: There is a common dissociation between objective measures and patient symptomatology in heart failure (HF). Objective: The aim of this study was to explore the relationship between cardiac biomechanics and physical and psychological symptoms in adults with moderate to advanced HF. Methods: We performed a secondary analysis of data from 2 studies of symptoms among adults with HF. Stepwise regression modeling was performed to examine the influence of cardiac biomechanics (left ventricular internal diastolic diameter, right atrial pressure [RAP], and cardiac index) on symptoms. Results: The average age of the sample (n = 273) was 57 T 16 years, 61% were men, and 61% had class III or IV HF. Left ventricular internal diastolic diameter (" = 4.22 T 1.63, P = .011), RAP (" = 0.71 T 0.28, P = .013), and cardiac index (" = 7.11 T 3.19, P = .028) were significantly associated with physical symptoms. Left ventricular internal diastolic diameter (" = 0.10 T 0.05, P = .038) and RAP (" = 0.03 T 0.01, P = .039) were significantly associated with anxiety. There were no significant biomechanical determinants of depression. Conclusion: Cardiac biomechanics were related to physical symptoms and anxiety, providing preliminary evidence of the biological underpinnings of symptomatology among adults with HF. [ABSTRACT FROM AUTHOR]

Unexplained heterogeneity in response to ventricular assist device (VAD) implantation for the management of advanced heart failure impedes our ability to predict favorable outcomes, provide adequate patient and family education, and personalize monitoring and symptom management strategies. The purpose of this article was to describe the background and the design of a study entitled "Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure" (PREMISE). Study Design and Methods: PREMISE is a prospective cohort study designed to (1) identify common and distinct trajectories of change in physical and psychological symptom burden; (2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction; and (3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Latent growth mixture modeling, including parallel process and cross-classification modeling, will be used to address the study aims and will entail identifying trajectories, quantifying associations between trajectories and both clinical and quality-of-life outcomes, and identifying predictors of favorable symptom and biomarker responses to VAD implantation. Conclusions: Research findings from the PREMISE study will be used to enhance shared patient and provider decision making and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a heterogeneous symptomatic disorder. The goal of this study was to identify and link common profiles of physical and psychological symptoms to 1-year event-free survival in adults with moderate to advanced HF. Methods: Multiple valid, reliable, and domain-specific measures were used to assess physical and psychological symptoms. Latent class mixture modeling was used to identify distinct symptom profiles. Associations between observed symptom profiles and 1-year event-free survival were quantified using Cox proportional hazards modeling. Results: The mean age of the participants (n = 202) was 57 ± 13 years, 50% were men, and 60% had class III/IV HF. Three distinct profiles, mild (41.7%), moderate (30.2%), and severe (28.1%), that captured a gradient of both physical and psychological symptom burden were identified (P < .001 for all comparisons). Controlling for the Seattle HF Score, adults with the moderate symptom profile were 82% more likely (hazard ratio, 1.82; 95% confidence interval, 1.07-3.11; P = .028) and adults with the severe symptom profile were more than twice as likely (hazard ratio, 2.06; 95% confidence interval, 1.21-3.52; P = .001) to have a clinical event within 1 year than patients with the mild symptom profile. Conclusions: Profiling patterns among physical and psychological symptoms identifies HF patient subgroups with significantly worse 1-year event-free survival independent of prognostication based on objective clinical HF data. [ABSTRACT FROM AUTHOR]

Background: Previous interventions to improve dementia care planning have relied upon self‐reported needs assessments, which are subject to bias and can be inaccurate, especially as dementia progresses, insight diminishes, caregiver burden increases, and needs change more frequently. The Remote Assessment and Dynamic Response (READyR) Program was created to deliver continuous objective in‐home assessments of dementia‐related care needs through a comprehensive sensor platform. The objective of this study was to refine and validate READyR for use by professional care managers of older adults with early‐stage dementia and their spouses/partners. Method: Evaluation of the READyR Program by 11 professional care coordinators and case managers for families with dementia (across three semi‐structured focus group interview sessions) was used to explore the utility of READyR for assessing dementia‐related needs. Conventional content analysis was used to iteratively code focus group data and to describe prevalent themes. Result: Prevalent themes included barriers to (e.g. family relationship strain, chaotic assessments, complex care needs) and facilitators of (e.g. proactive family caregivers, tailored assessments, upholding care values) the optimal process for assessing dementia‐related care needs by professional care managers, as well as advantages (e.g. providing new objective insights into safety, function, and routines) and disadvantages (e.g. bringing up new questions about care) for incorporating the READyR remote monitoring data into a values‐based needs assessment. Conclusion: Qualitative data supported the utility and validity of the READyR Program. Discussion will focus on the potential of READyR as a dynamically tailored needs assessment to improve preparation for future care, mitigate the stress process of dementia, and improve health and well‐being in the spousal care dyad. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of pain in older persons with dementia, pain remains highly underdiagnosed and undertreated. A major factor in unrecognized pain in persons with dementia is their inability to communicate verbally. Behavioral symptoms and other expressions of pain are common means of communicating pain in persons with dementia. Clinical results of a National Institutes of Health--funded pilot intervention study to prevent and reduce pain in nursing home residents with moderate and advanced dementia during morning care are presented. This article summarizes the challenges associated with both pain assessment and pain treatment as well as lessons learned during the analgesic medication component of this study. [ABSTRACT FROM AUTHOR]

Management of end-stage liver disease (ESLD) has implications for not only patients' quality of life (QOL), but also their caregivers'. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL. We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data. Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], –9.19; standard error [SE], 2.28) and caregivers (B, –5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, –3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19). Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both. [ABSTRACT FROM AUTHOR]

In heart failure (HF), the prevalence of physical frailty is high, and women are more likely to be frail than men; however, the reasons for gender differences in physical frailty in HF are unknown. Frailty has been associated with younger age at menopause and a history of hysterectomy, possibly reflecting accelerated aging. The relationship between physical frailty and later life reproductive factors might elucidate mechanisms of physical frailty among women with HF. : We hypothesized that, among women with HF, physical frailty will be associated with history of hysterectomy, post-menopause, and reproductive cancer. : This was an analysis of data collected from a study of gender differences in physical frailty in HF. We examined reproductive factors of hysterectomy, post-menopause, and reproductive cancer history among women in the sample. Physical frailty was measured using the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. Comparative statistics were used to compare reproductive factors with physical frailty. Logistic regression was used to quantify associations between reproductive factors and physical frailty, accounting for age, etiology, HF type (reduced or preserved ejection fraction), and Charlson Comorbidity Index. The average age of women in our sample (n = 56) was 65.0±16.3 years and 83.9% had non-ischemic etiology of HF. The majority (82%) were in menopause transition or post-menopause. Physical frailty was identified in 58.9% of women. There was no significant association between physical frailty and history of a hysterectomy (χ2 = 1.52, p = 0.22), post-menopause (χ2 = 0.87, p = 0.65), or reproductive cancer (χ2 = 0.19, p = 0.67). In separate multivariate logistic regression models, history of hysterectomy (OR 1.75, 95% CI [0.48, 6.34]), post-menopause (OR 0.38, 95% CI [0.03, 5.07]), or reproductive cancer (OR 0.35, 95% CI [0.04, 2.95]) were not significantly associated with physical frailty in women. Mid and later life reproductive factors, as well as age, do not appear to be significantly associated with physical frailty among women with HF, indicating that physical frailty affects women across the lifespan. However, future studies should explore a comprehensive reproductive history, including age of menarche, pregnancy, breastfeeding, and other reproductive life events, as variables that may impact physical frailty among women with HF. [ABSTRACT FROM AUTHOR]

Physical frailty is highly prevalent in heart failure (HF); however, little is known about the role of age, gender, ejection fraction phenotype (HF with reduced ejection fraction (HFrEF) vs. HF with preserved ejection fraction (HFpEF)), and HF etiology (ischemic vs. non-ischemic) in explaining physical frailty in HF. There is a higher prevalence of physical frailty in adults with HF who are ≥ 65 years, are women, have HFpEF, and have non-ischemic HF etiology. This was an analysis of data collected from a study of adults with HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. Physical frailty was determined by the number of criteria met; those who met 0-2 criteria were not physically frail, and those who met 3-5 were considered physically frail. Comparative statistics were used to compare prevalence of physical frailty between adults ≥ 65 years vs. < 65 years, women vs. men, those with HFrEF vs. HFpEF, and those with ischemic etiology vs. non-ischemic etiology. Logistic regression was used to identify significant predictors of physical frailty. The average age of the sample (n = 65) was 62.0±16.6 years, and 35.3% were female. A majority (84.6%) had HFrEF, and most (76.9%) had non-ischemic etiology. Physical frailty was identified in 43% of the sample. Adults ≥ 65 years were more likely to be physically frail than those < 65 years (χ2 = 4.77, p = 0.029). Women were more likely to be physically frail than men (χ2 = 10.19, p = 0.001). Those with HFpEF were more likely to be physically frail than those with HFrEF (χ2 = 6.57, p = 0.015). There were no significant differences in etiology (χ2 = 0.004, p = 0.95). In a multivariate logistic regression model, gender was the only significant predictor of physical frailty. Women were over 4 times more likely to be physically frail compared with men (OR [95% CI] = 5.5 [1.57, 19.38]). In HF, women have higher rates of physical frailty compared with men, irrespective of age, ejection fraction phenotype, and etiology, indicating that women with HF may be at increased risk for poor outcomes related to physical frailty. [ABSTRACT FROM AUTHOR]