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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.

One billion of the world's population has hypertension, resulting in four million deaths per year. Data on the prevalence of hypertension in the Arab world are very limited. This review summarizes existing knowledge regarding prevalence, awareness, and control of hypertension in Arab countries. The PubMed, Cochrane Library, Scopus, and CINAHL databases were searched for publications on HTN among Arab people from 1980 to January 2011. Only 13 studies were identified in the literature from 10 Arab countries. The overall estimated prevalence of hypertension was 29.5% (n = 45 379), which indicates a higher prevalence of hypertension among Arabs compared to people from the USA (28%) and sub-Saharan African (27.6%). Awareness of hypertension was reported for 46% of the studies and varied from 18% (Jordan) to 79.8% (Syria). The control rate varied from 56% (Tunisia) to 92% (Egypt and Syria). The prevalence of hypertension was found to increase with age, occurring more frequently in Arab women.

BackgroundPrevious literature has implicated that there might be an individual susceptibility difference in terms of race/ethnicity and gender in response to second hand smoke (SHS) exposure. This study was done to examine the effect of SHS exposure on lung function in non-smoking Korean women.MethodsThis cross-sectional study was conducted using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008-2011. A total of 2,513 female participants, age 40 yr and older, with no respiratory symptoms or prior lung diseases, were included in this study. Participants' smoking status was examined using both self-reported history and measurement of urinary cotinine level. Lung function was assessed using spirometry data, including FVC and FEV1. T-test and Chi-square tests were performed to compare diverse variables between groups. Analysis of covariance (ANCOVA) adjusted for age, height, alcohol consumption, and level of exercise was used to see any statistical differences in lung function parameters between non-SHS exposed and SHS-exposed groups.ResultsAmong 2,513 non-smoking females, 767 (30.5%) were SHS-exposed. The urinary cotinine levels clearly distinguished SHS exposure, and the mean urinary cotinine levels were 7.1±0.4 and 11±0.7 in non-SHS exposed group vs. SHS-exposed group, respectively (P < 0.001). Urinary cotinine levels were correlated with duration of SHS exposure. However, both groups had normal lung function and there was no significant difference between the two groups in lung function.ConclusionsUrinary cotinine is a valuable marker of SHS exposure. Korean women may have higher tolerance for SHS exposure-induced lung function decline.

There is ample research to support the potential benefits of a high protein diet on clinical outcomes in overweight/obese, diabetic subjects. However, nutritional management of overweight/obese individuals with heart failure (HF) and type 2 diabetes mellitus (DM) or metabolic syndrome (MS) is poorly understood and few clinical guidelines related to nutritional approaches exist for this subgroup. This article describes the design, methods, and baseline characteristics of study participants enrolled in Pro-HEART, a randomized clinical trial to determine the short term and long term effects of a high protein diet (30% protein [~110 g/day], 40% carbohydrates [150 g/day], 30% fat [~50 g/day]) versus a standard protein diet (15% protein [~55 g/day], 55% carbohydrates [~200 g/day], 30% fat [~50 g/day]) on body weight and adiposity, cardiac structure and function, functional status, lipid profile, glycemic control, and quality of life. Between August, 2009 and May, 2013, 61 individuals agreed to participate in the study; 52 (85%) - mean age 58.2 ± 9.8 years; 15.4% Blacks; 57.7% Whites; 19.2% Hispanics; 7.7% Asians; 73.1% male; weight 112.0 ± 22.6 kg - were randomized to a 3-month intensive weight management program of either a high protein or standard protein diet; data were collected at baseline, 3 months, and 15 months. This study has the potential to reveal significant details about the role of macronutrients in weight management of overweight/obese individuals with HF and DM or MS.

We previously developed and validated the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) to measure adherence behaviors (e.g., hemodialysis attendance, medication use, fluid restrictions, and diet) of patients on maintenance hemodialysis. To determine whether the ESRD-AQ can be used to measure adherence behaviors in non-English-speaking patients, we translated and adapted the ESRD-AQ into Spanish (SESRD-AQ) using forward and backward translation and cultural adaptation of the content. Validity and reliability were measured using item-level content validity indexes, intraclass correlation coefficients, and known-group analysis. All validity indices were within an acceptable range; strong test-retest stability existed across all items, with intraclass correlation coefficients ranging from 0.82 to 1.00. The developed SESRD-AQ is a valid assessment tool for use among Spanish-speaking patients on maintenance hemodialysis. This instrument refinement and validation process can be replicated with other maintenance hemodialysis population groups.

Aims and objectivesThis randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners.BackgroundThere are few studies evaluating cost-effectiveness of interventions among HF patient-partner dyads.MethodsDyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D.ResultsA total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners.ConclusionThe intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient-partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved.Relevance to clinical practiceThe study shows trends of a cost-effective education and psychosocial care of HF patient-partner dyads.

BackgroundHypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. Hypertension detection and blood pressure (BP) control are critically important for reducing the risk of myocardial infarction and strokes. Although there are more than 3.5 million Arab Americans in the United States, there are no national or regional data on HTN prevalence among Arab Americans.ObjectiveThis study aims to estimate the prevalence of HTN in a community sample of Arab Americans; assess levels of awareness, treatment, and control in hypertensive patients; and describe and compare lifestyle behaviors (eg, physical activity, nutrition, and weight control).MethodsIn this cross-sectional, descriptive study, 126 participants completed a self-administered questionnaire to measure physical activity, nutrition, and medical history. Height and weight were measured. Three BP measurements were obtained at 60-second intervals after resting for 5 minutes. Hypertension was defined as a mean systolic BP of 140 mm Hg or higher, or a diastolic BP 90 mm Hg or higher, and/or taking antihypertensive medications.ResultsOverall, 36.5% of participants had HTN and 39.7% had pre-HTN. Among hypertensive participants, only 67.4% were aware of their high BP, and 52.2% were taking antihypertensive medication. Among those taking medication, 46% had controlled BP. The prevalence of HTN was higher in men than in women (45.9% and 23.2%, respectively; P = .029) and increased with age (P = .01). Hypertensive participants also had higher body mass index (mean, 31.55 kg/m) compared with normotensive participants (mean, 28.37 kg/m; P = .01).ConclusionOur results indicate that HTN and pre-HTN are highly prevalent in Arab Americans. Hypertension awareness and control rates were inadequate and low compared with national data. These results emphasize the urgent need to develop public health strategies to improve the prevention, detection, and treatment of HTN among Arab Americans.

BackgroundVital exhaustion, a psychological state characterized by extreme fatigue, is an independent predictor of future cardiac events. However, the attributes of vital exhaustion following coronary artery bypass (CABG) surgery are poorly understood.ObjectiveThe study objective was to assess correlates of vital exhaustion following CABG surgery.MethodsIn a descriptive, exploratory study, 42 patients who had CABG surgery were evaluated for exhaustion 4-8 weeks post-hospital discharge. Demographic and clinical data were obtained from self-report and medical chart review.ResultsOf the total sample (mean age 67.9 ± 12.5, 90% male, 70% Caucasian, 3.12 ± 1.3 grafts), approximately 41% reported exhaustion. When compared to their exhausted post-CABG counterpart, non-exhausted post-CABG patients had a significantly higher frequency of preoperative insulin use. Exhausted patients were significantly more likely to have higher left ventricular ejection fraction ([LVEF], OR: 1.07, p = 0.04), and elevated hemoglobin (OR: 2.98, p = 0.03) and eosinophils (OR: 1.02, p = 0.02) than those who were not exhausted.ConclusionClinicians should evaluate all patients for exhaustion post-CABG surgery; patients with elevated LVEF, hemoglobin, and eosinophil levels warrant increased scrutiny.

Abstract Background and Objective There is little evidence to support whether interventions that engage patients with symptomatic heart failure (HF) in preparedness planning impacts completion of advance directives (ADs). This study was conducted to assess the impact of a palliative care intervention on health perceptions, attitudes, receipt of information and knowledge of ADs, discussion of ADs with family and physicians, and completion of ADs in a cohort of patients with symptomatic HF. Methods Thirty-six patients hospitalized for HF decompensation were recruited and referred for an outpatient consultation with a palliative care specialist in conjunction with their routine HF follow-up visit after discharge; telephone interviews to assess health status and attitudes toward ADs were conducted before and 3 months after the initial consultation using an adapted version of the Advance Directive Attitude Survey (ADAS). Information pertaining to medical history and ADs was verified through medical chart abstraction. Results and Conclusion The current study found support for enhancing attitudes and completion of ADs following a palliative care consultation in patients with symptomatic HF. Despite a significant increase in attitudes toward completion of ADs following the intervention, only 47% of the participants completed ADs. This finding suggests that although education and understanding of ADs is important and can result in more positive attitudes, it does not translate to completion of ADs in all patients.

BackgroundWe conducted this prospective comparative study to examine the feasibility and effectiveness of a palliative care consultation along with standard heart failure care in an outpatient setting regarding symptom burden, depression, and quality of life (QOL).Methods and resultsThirty-six patients (53.6 ± 8.3 years old) were referred for an outpatient palliative care consultation after discharge. Changes in symptom burden, depression, and QOL at 3 months were compared with 36 patients with symptomatic heart failure matched on age, sex, race, and New York Heart Association functional class. Improvements were observed in symptom burden, depression, and QOL in both groups over time (all P

This topic review employed Walker and Avant's method of concept analysis to explore the construct of hope in elderly adults with chronic heart failure. The articles analyzed revealed that hope, as the belief of the occurrence of a positive result without any guarantee that it will be produced, is necessary for the survival and wellbeing of the elderly adults enduring this disease.

Single-ventricle congenital heart disease (SVCHD) requires multiple palliative surgical procedures that leave visible surgical scars and physical deficits, which can alter body-image and self-esteem. This study aimed to compare sex and age differences in body-image, self-esteem, and body mass index (BMI) in adolescents and adults with SVCHD after surgical palliation with those of a healthy control group. Using a comparative, cross-sectional design, 54 adolescent and adult (26 male and 28 female) patients, age 15–50 years, with SVCHD were compared with 66 age-matched healthy controls. Body-image and self-esteem were measured using the Multidimensional Body-Self Relations Questionnaire–Appearance Scale and Rosenberg Self-Esteem Scale. Height and weight were collected from retrospective chart review, and BMI was calculated. Female adolescents and adult patients with SVCHD reported lower body image compared with males patients with SVCHD and healthy controls (p = 0.003). Specific areas of concern were face (p = 0.002), upper torso or chest (p = 0.002), and muscle tone (p = 0.001). Patients with SVCHD who were \21 years of age had lower body image compared with healthy controls (p = 0.006). Self-esteem was comparable for both patients with SVCHD and healthy peers. There were no sex differences in BMI; BMI was higher in subjects[21 years of age (p = 0.01). Despite the similarities observed in self-esteem between the two groups, female patients with SVCHD\21 years of age reported lower perceived body-image. Our findings support the need to recognize poor psychological adjustment related to low self-esteem in patients with SVCHD; female patients warrant increased scrutiny. Strategies to help patients with SVCHD cope with nonmodifiable aspects of body-image during the difficult adolescent–to–young adult years may potentially enhance self-esteem and decrease psychological distress.

BackgroundChronic heart failure (CHF) causes great suffering for both patients and their partners. The aim of this study was to evaluate the effects of an integrated dyad care program with education and psychosocial support to patients with CHF and their partners during a postdischarge period after acute deterioration of CHF.MethodsOne hundred fifty-five patient-caregiver dyads were randomized to usual care (n = 71) or a psychoeducation intervention (n = 84) delivered in 3 modules through nurse-led face-to-face counseling, computer-based education, and other written teaching materials to assist dyads to develop problem-solving skills. Follow-up assessments were completed after 3 and 12 months to assess perceived control, perceived health, depressive symptoms, self-care, and caregiver burden.ResultsBaseline sociodemographic and clinical characteristics of dyads in the experimental and control groups were similar at baseline. Significant differences were observed in patients' perceived control over the cardiac condition after 3 (P < .05) but not after 12 months, and no effect was seen for the caregivers.No group differences were observed over time in dyads' health-related quality of life and depressive symptoms, patients' self-care behaviors, and partners' experiences of caregiver burden.ConclusionsIntegrated dyad care focusing on skill-building and problem-solving education and psychosocial support was effective in initially enhancing patients' levels of perceived control. More frequent professional contact and ongoing skills training may be necessary to have a higher impact on dyad outcomes and warrants further research.

Gains in knowledge and self-efficacy using human patient simulation (HPS) in the education of prelicensure nursing students have been reported. However, the predictors of improved learning outcomes using this teaching methodology are not known. Using a two-group (participated in HPS, did not participate in HPS), repeated-measures, experimental design, we examined the predictors of higher scores on a Knowledge Questionnaire in 162 students (age = 25.7 ± 6.6, gender = 85.5% female) from four prelicensure cohorts at three nursing schools. Statistical analysis consisted of t-tests, ANOVA and stepwise logistic regression. Covariates included age, gender, learning style, baseline critical thinking, baseline self-efficacy, group membership (control or experimental), and school. Membership in the experimental group was the only statistically significant independent predictor (P < .001) of knowledge gains among the covariates entered into the regression analysis. Members of the control group were two times less likely than those in the experimental group to be in the higher scored group (P < .001), yet this changed once the control group participated in HPS. Our findings show that HPS can independently improve test scores. This study provides evidence that HPS; is an effective teaching methodology for prelicensure nursing students regardless of age, learning style, or critical thinking ability.

This study examined whether racial/ethnic differences in illness perceptions exist among patients on maintenance hemodialysis. One hundred sixty-one patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis (20% African Americans, 44% Hispanics, 9% Filipinos, and 27% Koreans) completed the Revised Illness Perception Questionnaire. Korean participants had higher emotional disturbance than their counterparts, whereas African-American participants had higher negative perceptions of personal intervention or medical treatment controlling their disease. This study indicates that patients from different racial/ethnic backgrounds undergoing maintenance hemodialysis may perceive their disease differently. This phenomenon could affect clinical outcomes and may require different therapeutic approaches.

Congestive heart failure (CHF) is a leading cause of death in the United States affecting approximately 670,000 individuals. Due to the prevalence of CHF related issues, it is prudent to seek out methodologies that would facilitate the prevention, monitoring, and treatment of heart disease on a daily basis. This paper describes WANDA (Weight and Activity with Blood Pressure Monitoring System); a study that leverages sensor technologies and wireless communications to monitor the health related measurements of patients with CHF. The WANDA system is a three-tier architecture consisting of sensors, web servers, and back-end databases. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation. This study shows that CHF patients monitored by WANDA are less likely to have readings fall outside a healthy range. In addition, WANDA provides a useful feedback system for regulating readings of CHF patients.

Congestive heart failure (CHF) is a leading cause of death in the United States. WANDA is a wireless health project that leverages sensor technology and wireless communication to monitor the health status of patients with CHF. The first pilot study of WANDA showed the system's effectiveness for patients with CHF. However, WANDA experienced a considerable amount of missing data due to system misuse, nonuse, and failure. Missing data is highly undesirable as automated alarms may fail to notify healthcare professionals of potentially dangerous patient conditions. In this study, we exploit machine learning techniques including projection adjustment by contribution estimation regression (PACE), Bayesian methods, and voting feature interval (VFI) algorithms to predict both non-binomial and binomial data. The experimental results show that the aforementioned algorithms are superior to other methods with high accuracy and recall. This approach also shows an improved ability to predict missing data when training on entire populations, as opposed to training unique classifiers for each individual.

Congestive heart failure (CHF) is a cardiovascular disorder that affects approximately 4.6 million Americans and is a leading cause of death in the United States. Current research shows that strategies to promote early recognition and treatment of symptoms and enhance self-care management behaviors reduce unnecessary hospitalizations. However, mechanisms to monitor patients' health status and behaviors are limited by constraints imposed by the patient's geography, infirmity, or resources. Remote monitoring supports a more dynamic connection between healthcare providers and patients, improves health promotion and patient care through monitoring of health data, communicates health reminders, and makes provisions for patient feedback. This paper will describe two versions of Weight and Activity with Blood Pressure Monitoring System (WANDA [22]) that leverages sensor technology and wireless communication to monitor health status of patients with CHF. The WANDA system is built on a three-tier architecture consisting of sensors, a web server, and back-end database tiers. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation in a real-time automated fashion and allows health professionals to offer surveillance, advice, and continuity of care and triggers early implementation of strategies to enhance adherence behaviors. The small study has enabled patients to reduce or maintain the number of readings which are out of the acceptable range. For diastolic, systolic, and heart rate values, the t-test results show that the WANDA study is effective for patients with CHF. © 2010 ACM.

ObjectiveThis study sought to compare the prevalence of anxiety, depression, and hostility among 3 clinically diverse elderly cardiac patient cohorts and a reference group of healthy elders.MethodsThis was a multicenter, comparative study. A total of 1167 individuals participated: 260 healthy elders, and 907 elderly cardiac patients who were at least 3 months past a hospitalization (478 heart-failure patients, 298 postmyocardial infarction patients, and 131 postcoronary artery bypass graft patients). Symptoms of anxiety, depression, and hostility were measured using the Multiple Affect Adjective Checklist.ResultsThe prevalence of anxiety, depression, and hostility was higher in patients in each of the cardiac patient groups than in the group of healthy elders. Almost three quarters of patients with heart failure reported experiencing symptoms of depression, and the heart-failure group manifested the greatest percentage of patients with depressive symptoms.ConclusionsThe high levels of emotional distress common in cardiac patients are not a function of aging, because healthy elders exhibit low levels of anxiety, depression, and hostility.

Reported treatment adherence rates of patients with end stage renal disease (ESRD) have been extremely varied due to lack of reliable and valid measurement tools. This study was conducted to develop and test an instrument to measure treatment adherence to hemodialysis (HD) attendance, medications, fluid restrictions, and diet prescription among patients with ESRD. This article describes the methodological approach used to develop and test the psychometric properties (such as reliability and validity) of the 46-item ESRD-Adherence Questionnaire (ESRD-AQ) in a cohort of patients receiving maintenance HD at dialysis centers in Los Angeles County. The ESRD-AQ is the first self-report instrument to address all components of adherence behaviors of patients with ESRD. The findings support that the instrument is reliable and valid and is easy to administer. Future studies are needed in a larger sample to determine whether additional modifications are needed.

Heart failure is a leading cause of death in the United States, with around 5 million Americans currently suffering from congestive heart failure. The WANDA B. wireless health technology leverages sensor technology and wireless communication to monitor heart failure patient activity and to provide tailored guidance. Patients who have cardiovascular system disorders can measure their weight, blood pressure, activity levels, and other vital signs in a real-time automated fashion. The system was developed in conjunction with the UCLA Nursing School and the UCLA Wireless Health Institute for use on actual patients. It is currently in use with real patients in a clinical trial. © 2010 IEEE.

BackgroundThere is limited research to support the effect of exercise adherence on clinical outcomes in patients with heart failure (HF). This secondary analysis was conducted on the intervention arm of an exercise training study in patients with HF to assess whether adherence and the dose of treatment exposure were associated with clinical outcomes, functional performance (maximum oxygen consumption [VO2], anaerobic threshold, and workload), and quality of life (QOL).MethodsSeventy-one patients (average age, 54 +/- 12.5 years; male, 66%; Caucasian, 66%; married, 61%; New York Heart Association class II-III, 97.2%; and average ejection fraction, 26.4% +/- 6.5%) were included in the current study. Patients with an increase >/= 18% in the amount of exercise from baseline to 6 months, as measured by pedometers, were categorized as adherers (n = 38); patients who had no change or an increase in the amount of exercise of

BackgroundLow health literacy compromises patient safety, quality health care, and desired health outcomes. Specifically, low health literacy is associated with decreased knowledge of one's medical condition, poor medication recall, nonadherence to treatment plans, poor self-care behaviors, compromised physical and mental health, greater risk of hospitalization, and increased mortality.MethodsThe health literacy literature was reviewed for: definitions, scope, risk factors, assessment, impact on health outcomes (cardiovascular disease and heart failure), and interventions. Implications for future research and for clinical practice to address health literacy in heart failure patients were summarized.ResultsGeneral health literacy principles should be applied to patients with heart failure, similar to others with chronic conditions. Clinicians treating patients with heart failure should address health literacy using five steps: recognize the consequences of low health literacy, screen patients at risk, document literacy levels and learning preferences, and integrate effective strategies to enhance patients' understanding into practice.ConclusionAlthough the literature specifically addressing low health literacy in patients with heart failure is limited, it is consistent with the larger body of health literacy evidence. Timely recognition of low health literacy combined with tailored interventions should be integrated into clinical practice.

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67+/-11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain>or=4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P=0.02), psychological (depression: P=0.002; anxiety: P=0.001), social (P

BackgroundConsiderable evidence confirms the high prevalence of anxiety and depression in the patients with heart failure (HF). However, little is known about the relationship of race/ethnicity to psychosocial variables in this population. The purpose of this study was to examine and compare the incidence of anxiety and depression in a cohort of non-Hispanic blacks, Hispanics, and non-Hispanic whites with advanced systolic HF.Methods and resultsTwo-hundred forty-one patients (7% non-Hispanic blacks, 22.8% Hispanics, 60.7% non-Hispanic whites) mean age 56.7+/-13.0 years, male (70%), married (81%), retired (75%), New York Heart Association (NYHA) Class III (53.9%), and mean ejection fraction 31.2+/-5.4%) from a single heart transplant facility were asked to complete a series of questionnaires to assess anxiety, depression, perceived control, social support, and financial stability. Non-Hispanic blacks had higher levels of anxiety (P=.048) and depression (P=.026) compared with Hispanics; a similar trend was noted when comparing non-Hispanic blacks and non-Hispanic whites, but these differences were not statistically significant. Perceived control was highest among Hispanics and lowest among non-Hispanic whites (P=.046). In a multivariate model race/ethnicity, perceived control, and social support accounted for 30% of the variance in anxiety while race/ethnicity, NYHA Class, perceived control, and social support accounted for 41% of the variance in depression.ConclusionsOur findings reveal that non-Hispanic blacks are more likely to be anxious and depressed than their counterparts. Because patient perceptions of control and social support are related to dysphorias known to influence morbidity and mortality, clinicians should regularly assess patients' concerns and assist in accessing appropriate services and treatments tailored to individual needs. Non-Hispanic blacks warrant increased scrutiny.

BackgroundAlthough evidence exists to support the presence of pain in advanced stages of heart failure (HF), the pain experience in the early phases of this progressive disease is poorly documented, and therefore, poorly understood. The current study was conducted to: 1) examine the prevalence of pain in cohort of patients with chronic HF (New York Heart Association class I-IV); and 2) determine the relationship between pain and QOL.Methods and resultsData were obtained from 300 patients (mean age 54.2+/-12.7 years; 72% male; 65% Caucasians; time since HF diagnosis 4.6+/-4.8 years). Two-thirds of the patients (67%) reported some degree of pain; the prevalence of pain increased as functional class worsened (p

BackgroundProgress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF).Methods and resultsFrom March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634). In our study, the HF patients were older (P < .000), reported lower levels of general health (P = .018), had more co-morbidities (P < .000), were more likely to have a history of cancer (P = .035), and suffered more chest pain and fewer headaches (P = .026, P = .03, respectively) than their non-HF cohorts. When controlling for age, co-morbidity and cancer disorders, HF and non-HF patients did not differ in pain severity, interference, distress or locations. Of the patients currently experiencing pain, 67.3% of HF patients and 68.4% of non-HF patients rated their pain as moderate or severe (pain >or=4 on a 0 to 10 scale).ConclusionsAlthough HF has not been identified as a painful condition, this study suggests the burden of pain is significant for both HF and non-HF ambulatory care patients.

Despite advances in healthcare, heart failure patients continue to experience complications that could have been prevented or treated. This occurs because the only way that a therapeutic or preventive regimen can be effective, assuming that the patient's condition has been accurately diagnosed and appropriately treated, is if the patient implements self-care behaviors and adheres to the treatment regimen. However, it is widely accepted that this does not occur in many or even most instances. This article provides an overview of the current evidence related to adherence and self-care behaviors among heart failure patients and describes the state of the science on interventions developed and tested to enhance self-care maintenance in this population. Our review of literature shows that effective interventions integrate strategies that motivate, empower, and encourage patients to make informed decisions and assume responsibility for self-care. Gaps in current evidence support the need for additional research on ways to improve adherence and self-care for patients who are at an increased risk of poor adherence, including those with cognitive and functional impairments and low health literacy.

This study was conducted to determine the prevalence of fatigue and identify its demographic, clinical, and psychological correlates in 150 heart failure (HF) patients (73% men, 66% Caucasian, mean age 55.0 years, mean ejection fraction 26.7%+/-11%), from a single HF center, using the Profile of Mood States-Fatigue Subscale, the Minnesota Living With Heart Failure Questionnaire, and the Beck Depression Inventory. Sociodemographic and clinical data were obtained through self-report and chart abstraction. High levels of fatigue were reported in 50.4% of men and 51.2% of women. In a multivariate model, maximal workload, physical health, emotional health, and depression explained 51% of the variance in fatigue (P

BackgroundThe aim of this study was to determine the effects of a home-based exercise program on clinical outcomes. Exercise training improves exercise capacity in patients with heart failure (HF) but the long-term effects on clinical outcomes remain unknown.MethodsWe randomized 173 patients with systolic HF to control (n = 87) or home-based exercise (n = 86). The primary end point was a composite of all-cause hospitalizations, emergency department admissions, urgent transplantation, and death at 12 months. Functional performance (as assessed by cardiopulmonary exercise testing and the 6-minute walk test), quality of life, and psychological states were measured at baseline, 3 months, and 6 months.ResultsThere was no significant difference between experimental and control groups in the combined clinical end point at 12 months and in functional status, quality of life, or psychological states over 6 months. Patients in the exercise group had a lower incidence of multiple (2 or more) hospitalizations compared with the control group: 12.8% versus 26.6%, respectively (P = .018).ConclusionsA home-based walking program that incorporated aerobic and resistance exercise did not result in improved clinical outcomes at 1-year follow-up in this cohort of patients with systolic HF. However, the exercise program resulted in reduced rehospitalization rates.