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Aims: This study aimed to describe symptom prevalence of pain, shortness of breath, anxiety, and nausea and to identify factors associated with symptom relief in patients with heart failure during their last week of life., Methods and Results: This nationwide study used data from the Swedish Register of Palliative Care and the Swedish Causes of Death Certificate Register. The sample included 4215 patients with heart failure as the underlying cause of death. Descriptive statistics and logistic regression were used to analyse data. Pain was the most prevalent symptom (64.0%), followed by anxiety (45.1%), shortness of breath (28.8%), and nausea (11.4%). Pain was the most often totally relieved (77.5%), followed by anxiety (68.4%), nausea (54.7%), and shortness of breath (37.1%). Key aspects of palliative care such as documented palliative care in the patient record, individual medication prescriptions by injection, symptom assessment with validated scales, documented end-of-life discussions with patients and/or family members, and external consultation were significantly associated with symptom relief. Relief of pain, shortness of breath, anxiety, and nausea were significantly better managed in nursing homes and hospice/inpatient palliative care compared with care in hospitals., Conclusions: The results show that key aspects of palliative care during the last week of life are significantly associated with symptom relief. Increased access to palliative care could provide a way to improve care during the last week of life for patients with heart failure. Home-based settings provided more symptom relief than hospitals, which may indicate that the latter focuses on treatments and saving lives rather than promoting life before death., (© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: High levels of perceived control and lower levels of depressive symptoms are associated with better well-being in both patients with heart failure and their spouses at an individual level. However, there is a knowledge gap about how these individual factors have reciprocal influences on partners' well-being within the patient-spouse dyads., Objective: The aims of this study were to examine dyads of patients with heart failure and their spouses on whether the patients' perceived control over the management of heart failure and depressive symptoms predicts their own and their spouses' physical and emotional well-being and to examine whether patients' perceived control predicts their own and their spouses' depressive symptoms., Methods: A total 155 patient-spouse dyads (patients: 75% male, mean age of 71 years, 53% classified as New York Heart Association III; spouses: 75% female, mean age of 69 years) were recruited from 2 hospital-based outpatient heart failure clinics. Participants completed the Control Attitude Scale, the Beck Depression Inventory, and the Short-Form 36. Dyadic data were analyzed using multilevel regression of the actor-partner interdependence model., Results: Perceived control had an actor effect on emotional well-being only for patients, and there were partner effects of perceived control on emotional well-being for both patients and their spouses. Depressive symptoms exhibited an actor effect on physical and emotional well-being for patients and spouses, but there were no partner effects of depressive symptoms on emotional well-being. Perceived control had partner effects on depressive symptoms for patients and spouses, but an actor effect of depressive symptoms was only found for patients., Conclusion: In an interdependent relationship within the patient-spouse dyads, each dyad member's perceived control influenced their partner's emotional well-being as well as depressive symptoms. The findings suggest development of dyadic interventions that can increase perceived control over the heart condition., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: This study used extended theory of planned behavior (extended TPB) to understand the underlying factors related to help-seeking behavior for sexual problems among Iranian women with heart failure (HF). Methods: We recruited 758 women (mean age = 61.21 ± 8.92) with HF at three university-affiliated heart centers in Iran. Attitude, subjective norms, perceived behavioral control, behavioral intention, self-stigma of seeking help, perceived barriers, frequency of planning, help-seeking behavior, and sexual function were assessed at baseline. Sexual function was assessed again after 18 months. Structural equation modeling was used to explain change in sexual functioning after 18 months. Results: Attitude and perceived behavioral control were positively correlated to behavioral intention. Behavioral intention was negatively and self-stigma in seeking help was positively correlated to perceived barriers. Behavioral intention was positively and self-stigma in seeking help was negatively correlated to frequency of planning. Perceived behavioral control, behavior intention, and frequency of planning were positively and self-stigma in seeking help and perceived barriers were negatively correlated to help-seeking behavior. Help-seeking behavior was positive correlated to the change of FSFI latent score. Conclusions: The extended TPB could be used by healthcare professionals to design an appropriate program to treat sexual dysfunction in women with HF.

Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF., Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II-IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted., Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps ( p = 0.019) and the six-minute walk test ( p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps ( p = 0.001) and metabolic equivalent daily averages ( p = 0.040) remained significant., Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.

Background: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners., Aim: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners., Methods: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately., Results: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners., Conclusion: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.

ABSTRACTObjective:Chronic heart failure is a disease with high morbidity and symptom burden for patients, and it also places great demands on family members. Patients with heart failure should have access to palliative care for the purpose of improving quality of life for both patients and their families. In the PREFER randomized controlled intervention, patients with New York Heart Association classes III-IV heart failure received person-centered care with a multidisciplinary approach involving collaboration between specialists in palliative and heart failure care. The aim of the present study was to describe family members' experiences of the intervention, which integrated palliative advanced home and heart failure care., Method: This study had a qualitative descriptive design based on family member interviews. Altogether, 14 family members participated in semistructured interviews for evaluation after intervention completion. The data were analyzed by means of content analysis., Results: Family members expressed gratitude and happiness after witnessing the patient feeling better due to symptom relief and empowerment. They also felt relieved and less worried, as they were reassured that the patient was being cared for properly and that their own responsibility for care was shared with healthcare professionals. However, some family members also felt as though they were living in the shadow of severe illness, without receiving any support for themselves., Significance of Results: Several benefits were found for family members from the PREFER intervention, and our results indicate the significance of integrated palliative advanced home and heart failure care. However, in order to improve this intervention, psychosocial professionals should be included on the intervention team and should contribute by paying closer attention and providing targeted support for family members.

Background: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF)., Objective: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran., Methods: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA)., Results: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47)., Conclusions: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

Background: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed., Objective: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals., Design: This is a national register study., Setting/subjects: The study included 3981 patients with diagnosed heart failure as the underlying cause of death., Measurements: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients' last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies., Results: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory., Conclusion: The results indicate inadequate palliative care for patients with heart failure during their last week of life.

Background: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status., Objective: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association., Methods: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status., Results: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001)., Conclusions: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

Introduction: Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention., Methods/analysis: The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management., Ethics and Dissemination: The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences., Trial Registration Number: NCT02823795; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role., Objective: Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden., Design: A randomized controlled study design, with a follow-up assessment after 24 months., Setting and Participants: Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden., Intervention: A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners' physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity., Results: One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time., Discussion and Conclusion: Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial. REGISTERED ON CLINICALTRIALS., Gov Identifier: NCT02398799.

Aims and Objectives: To explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure., Background: Decreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group., Design: Observational, cross-sectional study., Methods: A total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite., Results: Seventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance., Conclusion: In this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors., Relevance to Clinical Practice: Loss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs., (© 2016 John Wiley & Sons Ltd.)

Background: Decreased appetite in heart failure (HF) may lead to undernutrition which could negatively influence prognosis. Appetite is a complex clinical issue that is often best measured with the use of self-report instruments. However, there is a lack of self-rated appetite instruments. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are validated instruments developed primarily for elderly people. Yet, the psychometric properties have not been evaluated in HF populations. The aim of the present study was to evaluate the psychometric properties of CNAQ and SNAQ in patients with HF., Methods and Results: A total of 186 outpatients with reduced ejection fraction and New York Heart Association (NYHA) functional classifications II-IV were included (median age 72 y; 70% men). Data were collected with the use of a questionnaire that included the CNAQ and SNAQ. The psychometric evaluation included data quality, factor structure, construct validity, known-group validity, and internal consistency. Unidimensionality was supported by means of parallel analysis and confirmatory factor analyses (CFAs). The CFA results indicated sufficient model fit. Both construct validity and known-group validity were supported. Internal consistency reliability was acceptable, with ordinal coefficient alpha estimates of 0.82 for CNAQ and 0.77 for SNAQ., Conclusions: CNAQ and SNAQ demonstrated sound psychometric properties and can be used to measure appetite in patients with HF., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: To date, contemporary heart failure care remains patient-focused, but awareness of the partners' and families' situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners., Methods: This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support., Results: The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients., Conclusion: This study may be regarded as a first step in trying to understand dyads' need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes., Trial Registration: ClinicalTrials.gov NCT02398799.

Background: The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed., Objective: The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners., Methods: A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach's alpha were used to validate the CAS., Results: The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74-0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex., Conclusions: The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred., (© The European Society of Cardiology 2014.)

Background: Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression., Methods: This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses., Results: Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression., Conclusions: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Patient participation is important for improving outcomes, respect for self-determination and legal aspects in care. However, how patients with heart failure view participation and which factors may be associated with participation is not known. The aim of this study was therefore to describe the influence of structured home care on patient participation over time in patients diagnosed with heart failure, and to explore factors associated with participation in care., Methods: The study had a prospective pre-post longitudinal design evaluating the influence of structured home care on participation in patients at four different home care units. Patient participation was measured using 3 scales and 1 single item. Self-care behavior, knowledge, symptoms of depression, socio- demographic and clinical characteristics were measured to explore factors associated with patient participation. Repeated measure ANOVA was used to describe change over time, and stepwise regression analyses were used to explore factors associated with patient participation., Results: One hundred patients receiving structured heart failure home care were included. Mean age was 82 years, 38 were women and 80 were in New York Heart Association functional class III. One aspect of participation, received information, showed a significant change over time and had increased at both six and twelve months. Better self-care behavior was associated with all four scales measuring different aspects of participation. Experiencing lower degree of symptoms of depression, having better knowledge, being of male sex, being of lower age, cohabiting and having home help services were associated with one or two of the four scales measuring different aspects of participation., Conclusion: Patients experienced a fairly high level of satisfaction with participation in care at baseline, and there was a significant improvement over time for participation with regard to received information after being admitted to structured home care. Higher level of patient participation was consistently associated with better self-care behavior. This study shows that patient participation may need to be further focused upon, and that the association with self-care may be interesting to target in future interventions.

Objective: To evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0-100 score with a higher score meaning better self-care., Methods: A sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD)., Results: We identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index=0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9., Conclusion: The new factorial structure of the EHFScBS-9 showed supportive psychometric properties., Practice Implications: The EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure., Aims: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity., Methods: Data were collected in a sample of 349 patients (≥ 65 years) with chronic heart failure. Patients' HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors., Results: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions., Conclusion: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.

IntroductionThere is a paucity of research about the impact of palliative care (PC) on perceived control (i.e. one's perceived influence over outcomes or events in the environment) and activation (i.e. ability to self-manage) in patients with symptomatic heart failure (HF). Likewise, little is known about the association between perceived control, activation, and symptom distress in this patient population. We hypothesized that patients with advanced HF who received ongoing PC services (i.e. ≥2 PC consultations) vs no access or a single PC consultation would have greater improvements in perceived control and activation and greater reductions in symptom distress three months post-discharge for HF exacerbation.MethodsForty-two patients (average age 53.9±8.0 years; predominantly male (72%), White (61%) and married (69%)) participated in the study. However, only 36 (85.7%) patients completed an outpatient PC consultation of which 29 (69%) patients returned for additional follow-up visits with the PC team. Data on perceived control, activation, and symptom distress were collected at baseline and three months. Parametric statistical models were applied to draw conclusions.ResultsFindings showed that the patients who received ≥2 PC consultations had greater improvements in perceived control and activation than their counterparts; these increases were associated with greater reductions in symptom distress.ConclusionOur findings suggest that on-going PC interventions enhance perceived control and activation in patients with advanced HF and open up the possibility of planning larger studies to assess the effect of PC on these variables as possible mediators to improvements in self-management and clinical outcomes.

Introduction: This study used extended theory of planned behavior (extended TPB) to understand the underlying factors related to help-seeking behavior for sexual problems among Iranian women with heart failure (HF).Methods: We recruited 758 women (mean age = 61.21 ± 8.92) with HF at three university-affiliated heart centers in Iran. Attitude, subjective norms, perceived behavioral control, behavioral intention, self-stigma of seeking help, perceived barriers, frequency of planning, help-seeking behavior, and sexual function were assessed at baseline. Sexual function was assessed again after 18 months. Structural equation modeling was used to explain change in sexual functioning after 18 months.Results: Attitude and perceived behavioral control were positively correlated to behavioral intention. Behavioral intention was negatively and self-stigma in seeking help was positively correlated to perceived barriers. Behavioral intention was positively and self-stigma in seeking help was negatively correlated to frequency of planning. Perceived behavioral control, behavior intention, and frequency of planning were positively and self-stigma in seeking help and perceived barriers were negatively correlated to help-seeking behavior. Help-seeking behavior was positive correlated to the change of FSFI latent score.Conclusions: The extended TPB could be used by healthcare professionals to design an appropriate program to treat sexual dysfunction in women with HF. [ABSTRACT FROM AUTHOR]

Background: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). Objective: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. Methods: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). Results: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, j0.25Y0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, j0.69), no items displayed substantial DIF across NYHA classes (DIF contrast,j0.40 to 0.47). Conclusions: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF. [ABSTRACT FROM AUTHOR]

Aims Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction. Methods and results In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea–hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition. Conclusion The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition. [ABSTRACT FROM PUBLISHER]