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Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a significant health problem in the United States, attributed to more than 30% of all deaths annually. Anxiety has been associated with cardiovascular disease risk and is thought to be associated with cardiovascular disease risk through inflammatory pathways. Objective: The purposes of this study were to examine the relationship between anxiety and systemic inflammation in individuals at risk for cardiovascular disease and to determine if single-nucleotide polymorphisms (SNPs) associated with inflammation moderate this relationship. Methods : A secondary analysis was conducted using baseline data from a study investigating the impact of genetics on response to a cardiovascular disease risk reduction intervention. Anxiety was measured using the Brief Symptom Inventory. Protein levels for C-reactive protein and interleukin-6 (IL-6) were measured in serum, and genomic DNA was assayed for SNPs in the C-reactive protein, IL-6, and IL-6R genes. Multiple linear regressions were performed to examine if anxiety predicted inflammation and if SNPs moderated associations. Results : Participants (N = 398) were white, aged 51 +/- 13 years, and 73% women. There was a significant interaction between rs4129267 genotype and anxiety (P =.010), with the association significant only for individuals with the CC genotype (b = 0.243, SE = 0.04, P <.001). No moderation effect existed for rs1205 or rs1800797. Conclusion : Anxiety was positively associated with IL-6 protein levels, but moderation analysis indicated that this was significant only for individuals with the rs4129267 CC genotype. This suggests that genotypic differences may exist in anxiety response, placing certain individuals at higher risk for inflammation and, subsequently, cardiovascular disease. [ABSTRACT FROM AUTHOR]

Effective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died. There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group. Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low back pain (LBP) is a prevalent condition with overwhelming healthcare costs and high disability rates. Characterization of clinical and psychosocial variables over time in patients experiencing an episode of acute LBP and the identification of factors that differ between those who develop chronic LBP and those who do not could aid in the development of improved targeted treatment. PURPOSE: The purpose of this study was to evaluate the trajectory of depression, pain catastrophizing, life purpose, pain sensitivity, and disability in persons presenting with an acute/subacute episode of LBP, evaluating whether there are changes over time and differences in these variables between those who developed chronic LBP and those who did not. METHODS: Prospective analysis (baseline, 2.5 months, 6 months, and weekly diaries) of 42 patients experiencing an acute LBP episode was performed. Descriptive statistics, repeated-measures mixed modeling, and Fisher's least significant differences method were used during data analysis. RESULTS: Depressive symptoms vary over time. There was no difference over time in pain catastrophizing, life purpose, pain sensitivity, or disability. Those who met the criteria for chronic LBP at 6 months had increased pain catastrophizing scores and higher disability scores compared with those who do not meet the criteria for chronic LBP. Depressive symptoms, life purpose, and pain sensitivity were not different between those who met the criteria for chronic LBP and those who did not. CONCLUSION: Findings from this study characterize factors potentially contributory to the development of chronic LBP over time. Those participants who developed chronic LBP had higher pain catastrophizing scores averaged across all time points in this study, suggesting it could be an interesting factor to target to improve LBP chronicity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to understand the association of psychological empowerment (PE) with workplace bullying and intent to leave among nurse leaders. BACKGROUND: Nurse leaders who experience bullying cope in varied ways. Some leaders have higher levels of empowerment and resilience, whereas others are more negatively impacted by bullying. METHODS: This study used a descriptive, cross-sectional survey design. Instruments used in the study included 2 PE tools: a bullying instrument and an intent-to-leave tool. The analysis tested for bivariate correlations and used analysis of variance to discern differences among nurse leaders. RESULTS: PE was negatively correlated with both bullying and intent to leave. Chief nursing officers and directors had significantly higher PE than did nurse managers, but there was no significant difference in intent to leave among the leader groups. CONCLUSIONS: PE may help protect against the impact of bullying. Continued development of leaders to strengthen their PE is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Life purpose in acute low back pain patients is not well described in published literature. METHODS/PURPOSE: We used linear regression models to describe the relationship of life purpose with perceived functional disability and depression in persons with acute low back pain ( N = 42) participating in a randomized clinical trial to prevent transition to chronic low back pain. RESULTS: In our predominantly female sample (81.8%) with a mean age of 53 years ( SD = 11.6 years), 52% worked full-time. Adjusting for age, gender, and working status, life purpose was a signifi cant correlate of depression ( p = .007). For every 10-unit increase in life purpose score, the estimated depression score decreased by almost 2.5 points. A signifi cant relationship between life purpose and perceived functional disability was not identifi ed. CONCLUSION: Life purpose likely is a modifiable risk factor for depression in acute low back pain patients. [ABSTRACT FROM AUTHOR]

Background: Although hypertension (HTN) treatment rates are similar across age groups of women, effective control is significantly worse among older women. Only 20% of hypertensive women aged 70 to 79 years have controlled blood pressure. Objectives: The purpose of this longitudinal study was to test the effects of the quality of mother-daughter relationship, inner strength, and control on HTN self-management and health-related quality of life (HRQOL) for both members of the dyad at 6 months. The Actor-Partner Interdependence Model was used to examine the direct ("actor") and indirect ("partner") effects of 46 dyads. Results: The mothers' perceived relationship quality with daughters directly impacted their own self-management of HTN and HRQOL while also indirectly affecting their daughters' self-management. Similarly, the daughters' perceived strength of their relationship with their mothers directly influenced their self-management and HRQOL and indirectly affected their mothers' self-management and HRQOL. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objectives of this study were to develop and test a scale designed to describe and assess nurse managers' practice environments. BACKGROUND: Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses' practice environment; however, no comparable scale for nurse managers exists. METHODS: A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states. RESULTS: Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach's a's ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale. CONCLUSIONS: The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance. [ABSTRACT FROM AUTHOR]

The chronic illness literature suggests that patient--informal caregiver dyads who are relationally oriented (share decisions and activities) are more efficient and effective than those who are not. But this is currently unknown in heart failure (HF). Our aim was to examine differences between individually and relationally oriented HF dyads relative to patient symptom management scores. This was a cross-sectional study of 55 dyads (spousal/adult child/relative) analyzed using Actor-Partner Interdependence Model techniques. Dyad orientation was measured by the Dyadic Symptom Management Type scale, and symptom management by Self-care of HF Index. On average, patients were older, white males with younger, female caregivers. Whether the dyads were individually oriented or relationally oriented did not make a difference. However, dyads' agreement on that orientation and the caregivers' HF-related knowledge impacted caregiver engagement in self-care maintenance or adherence and monitoring behaviors. It is assumed that caregivers will engage in HF care. Our study suggests that caregivers will engage if they agree with the patient on who is providing that care and are knowledgeable. The Dyadic Symptom Management Type scale is a 1-item question that can be administered in the clinical setting by a palliative care nurse in less than 2 minutes to assess agreement and target teaching. [ABSTRACT FROM AUTHOR]

Purpose Patient triage systems have been used to prioritize referred patients to facilitate timely treatment of acutely ill patients, but there is limited data to support the effectiveness of these systems as implemented in the clinic setting. Therefore, the purpose of this study was to evaluate the accuracy of a specialty provider triage system. Data sources A prospective study design was conducted ( N = 103) to compare the pre- and postappointment provider-assigned, prioritization system acuity scores. The intraclass correlation coefficient (ICC), paired t-test, and the Bland-Altman plotting method were used to summarize and analyze the data. Conclusions The ICC between the pre- and postappointment acuity scores was 0.50 ( p < .001) with no significant difference between the average means ( t = −1.17; p = .24). The Bland-Altman plot suggests scores were typically within the limits of agreement. Our findings suggest the specialty provider triage system was effective at accurately classifying rheumatologic patient acuity in this sample. Implications for practice When resources are limited and delayed evaluations and treatments result in negative health outcomes, the use of triage systems is likely an effective strategy to reduce the impact of limited provider availability relative to patient census. [ABSTRACT FROM AUTHOR]

Background--Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF. Methods and Results--This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P=0.006 and <0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P<0.001), demonstrating mediation. Conclusions--Health literacy mediates the relationship between age and health outcomes in adults with HF. Clinical Trial Registration--URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients who trust their providers have better health outcomes; a trusting patient-provider relationship is needed for optimal management of rheumatoid arthritis (RA), a chronic autoimmune disease. PURPOSES/METHODS: An observational study design (A/ = 100 RA patients) was used to: 1. assess associations between patients' trust and demographic factors; 2. determine if a patient's trust in his/her provider changes over time; 3. investigate associations between sources of information and patients' trust in their providers. Descriptive statistics, Pearson's partial moment correlation, two-sample t tests, paired t tests, and linear regression were used during data analysis. RESULTS: Patients' trust in their providers decreased over time. Less-educated persons and those who accessed information from the Internet reported less trust in their providers. Patients who consulted a larger number of information sources rated trust in their provider more positively. CONCLUSION: RA patients' trust in providers is a dynamic construct influenced by education and health information. [ABSTRACT FROM AUTHOR]

Purpose A sample of 150 patients with rheumatoid arthritis (RA) participated in a predictive, descriptive, cross-sectional study which compared contextual factors of patients who perceived higher quality communication with those who perceived lower quality, and determined the predictive power of contextual factors for higher quality patient-provider communication. Data sources A validated, self-report scale measured patient perception of quality of patient-provider communication. Data were analyzed using chi-square tests of association, two-sample t-tests, and multiple linear regression. Conclusions/implications for practice There were no differences in external environmental or internal personal factors between those who perceived higher and lower quality of communication. From the linear regression, patients with fewer years of education ( p = .008), those taking a greater number of RA medications ( p = .03), and those living in an urban area ( p = .04) perceived the quality of communication more positively. The findings from this study suggest that contextual factors (years of education, residence, and the number of medications) may affect RA patient perception of the quality of patient-provider communication. This underscores the need for development of appropriate and effective interventions to improve communication and optimize RA patient outcomes. [ABSTRACT FROM AUTHOR]

The purpose was to determine racially classified social group differences in smoking, nicotine dependence, and readiness to quit between African American and Caucasian smokers. The cross-sectional study included 53 African American and 839 Caucasian smokers participating in a larger population-based cessation intervention study. Data were analyzed from the interview conducted before the intervention; half of the participants were in the treatment group, recruited from those who had joined a cessation contest, whereas control group participants were recruited using random-digit dialing and were not in the contest. African Americans began smoking later, smoked fewer cigarettes daily, reported lower nicotine dependence, and had greater readiness to quit smoking than Caucasians. Of those who had ever used an evidence-based method, African American smokers were more likely to only use evidence-based quit methods, whereas Caucasian smokers were more likely to mix evidence-based with "cold turkey." Controlling for demographics and treatment group, racially classified social group was a predictor of readiness to quit smoking. Later, age of initiation, positive partner support, and using evidence-based quit methods also predicted greater readiness to quit. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objectives of this study were to develop and test a scale designed to describe and assess nurse managers' practice environments. BACKGROUND: Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses' practice environment; however, no comparable scale for nurse managers exists. METHODS: A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states. RESULTS: Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach's α's ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale. CONCLUSIONS: The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance. [ABSTRACT FROM AUTHOR]

A preferred format to deliver interprofessional education (IPE) has not been described. The aim of this study was to compare students' (N = 150) perceived value and improvement in communication between an IPE activity delivered using a comprehensive versus an abbreviated format. Although both formats were perceived by students to improve their communication skills and add value to their education, students indicated the abbreviated format was more effective than the comprehensive format. [ABSTRACT FROM AUTHOR]

The article focuses on the study which examines the effects of the smoke-free ordinance to the bar and restaurant workers three to six months after its implementation. Sample was taken from the randomly chosen bars and restaurants in Lexington, Kentucky, and was assessed either through interviewing in person or by phone, both during the time when the law was not introduced yet and when it was implemented 3 and 6 months after. Of all the factors both the hair nicotine and respiratory symptoms were mainly assessed. As the results were qualitatively assessed, it was known that there was a 56 percent decline in hair three months after the implementation of the said smoke-ordinance. There was also a significant decrease in the prevalence of most respiratory symptoms over time.

The purposes of this international study were to determine the predictors of adaptation and to assess potential moderating effects of parents' sense of coherence and family hardiness on the relationship of severity of illness of a child with asthma and family and caregiving demands as predictors of family adaptation. For both parents, sense of coherence and family hardiness predicted family adaptation. Icelandic mothers perceived their family's adaptation more favorably than did their American counterparts. For the fathers, family demands predicted adaptation. Sense of coherence moderated the effect of family demands on adaptation for both parents. These findings underscore the importance of strengthening individual and family resiliency as a mechanism for improving family adaptation. [ABSTRACT FROM AUTHOR]

Background. Tobacco-growing states have few tobacco control laws, which are relatively weak compared with those in non-tobacco-growing states. Region of the country has been shown to be a predictor of legislators' intentions to vote for cigarette tax increases. Methods. A total of 116 lawmakers (84%) participated in face-to-face interviews before the 1998 Kentucky General Assembly. Five regions of Kentucky were identified by the five political caucuses. Legislative voting records on two tobacco control bills introduced during the 1998 Kentucky General Assembly were examined. Results. There was little regional variation in opinions toward tobacco control policy among Kentucky legislators. Regional variation was evident only in relation to reducing the state's dependence on tobacco production, raising cigarette taxes, and adopting a law to prohibit teen possession of tobacco products. Conclusions. Health advocates from tobacco-growing states might use regional information to garner support for selected tobacco control policies among lawmakers. [ABSTRACT FROM AUTHOR]

Background: In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed., Purpose: This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2., Methods: Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association., Results: Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers., Conclusion: Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities)., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 International Association of Forensic Nurses.)

Background: Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men., Methods: We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples., Results: Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± 5.0), 64.2% were White and 35.8% were Black. Black incarcerated men were younger (P = .047) with lower levels of health literacy (P < .001). All 3 indirect effects of race on CVD were significant, whereas the direct effect of race was not. Black incarcerated men had higher levels of CVD risk through health literacy (a1b1 = 0.3571; 95% CI, 0.0948-0.7162) and lower levels of CVD risk through perceived control (a2b2 = -0.1855; 95% CI, -0.4388 to -0.0077). Black incarcerated men had higher levels of CVD risk through health literacy influenced by perceived control (a1b2d21 = 0.0627; 95% CI, 0.0028-0.1409), indicating that despite the protective effect of higher levels of perceived control in Black incarcerated men, CVD risk remained higher compared with their White counterparts., Conclusion: Future CVD risk reduction interventions in incarcerated men, specifically Black incarcerated men, should include goals of improving health literacy and perceived control as modifiable risk factors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background/objective: Despite effective therapies, rheumatoid arthritis (RA) can result in joint destruction requiring total joint arthroplasty to maintain patient function. An estimated 16% to 70% of those undergoing total joint arthroplasty of the hip or knee will receive a blood transfusion. Few studies have described risk factors for blood transfusion following total joint arthroplasty in patients with RA. The aim of this study was to identify demographic and clinical risk factors associated with receiving a blood transfusion following total joint arthroplasty among patients with RA., Methods: A retrospective study (n = 3270) was conducted using deidentified patient health claims information from a commercially insured, US data set (2007-2009). Data analysis included descriptive statistics and multivariate logistic regression., Results: Females were more likely to receive a blood transfusion (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87; p = 0.001). When compared with those in the South, patients residing the Midwest were less likely to receive a blood transfusion following total joint arthroplasty (OR, 0.56; 95% CI, 0.44-0.71). Relative to those receiving total knee arthroplasty, patients who underwent total hip arthroplasty were more likely to receive a blood transfusion (OR, 1.39; 95% CI, 1.14-1.70), and patients who underwent a total shoulder arthroplasty were less likely to receive a blood transfusion (OR, 0.14; 95% CI, 0.05-0.38; p < 0.001). Patients with a history of anemia were more likely to receive a blood transfusion compared with those who did not have this diagnosis (OR, 3.30; 95% CI, 2.62-4.14; p < 0.001)., Conclusions: Risk factors for the receipt of blood transfusions among RA patients who have undergone total joint arthroplasty were identified.

Objective: The aim of this study was to explore the influence of the practice environment on nurse managers' (NMs') job satisfaction and intent to leave., Background: Nurse managers are a ready pool of talent to fill impending strategic leadership vacancies. Job satisfaction as an NM is a deciding factor for senior leadership aspirations., Methods: This study used a secondary analysis of 2012 survey data of 355 NMs. The Nurse Manager Practice Environment Scale was used to identify organizational features that influence NMs' job satisfaction and intent to leave., Results: Mean (SD) job satisfaction was 4.5 (1.1) on a 6-point scale. Mean (SD) intent to leave was 5.0 (2.1) on a scale ranging from 3 to 9. The Nurse Manager Practice Environment Scale was a significant predictor of both job satisfaction and intent to leave., Conclusions: Features of the organizational context can be modified to improve job satisfaction and reduce intent to leave among NMs.

Background: Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF., Methods and Results: This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation., Conclusions: Health literacy mediates the relationship between age and health outcomes in adults with HF., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545., (© 2015 American Heart Association, Inc.)

Background: Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable., Objective: The objective of the study was to compare symptom clusters between men and women with HF, differences in patient characteristics among symptom clusters, and the impact of symptom clusters on cardiac event-free survival., Methods: A total of 331 patients with HF recruited from HF clinics were included (35% were female and 62% were of New York Heart Association classes III/IV). Cluster analysis was used to identify symptom clusters between men and women based on ratings of distress related to 7 symptoms. Analysis of variance or chi test was used to compare characteristics of patient groups that were divided by the median split of total distress scores of each cluster. Cox proportional hazards regression was used to determine whether total scores of symptom distress in symptom clusters predicted time to first cardiac event., Results: Two identical symptom clusters were identified in men and women: a physical symptom cluster composed of dyspnea, fatigue/increased need to rest, fatigue/low energy, and sleep disturbances and an emotional/cognitive symptom cluster composed of worrying, feeling depressed, and cognitive problems. Patients with higher distress from the physical symptom cluster were primarily females and of New York Heart Association classes III and IV (P < .05). Patients with higher distress from the emotional/cognitive symptom cluster were younger than those with lower distress (P < .05). The total symptom distress score in the emotional/cognitive cluster, but not the physical cluster, was an independent predictor of cardiac event-free survival (hazard ratio, 1.18; 95% confidence interval, 1.03-1.37)., Conclusion: Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes.