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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.

BackgroundLittle is known regarding the effects of index angiograms on health-related quality of life related to angiographic outcome, that is, positive or negative for coronary heart disease (CHD).MethodsA longitudinal, comparative design was used. Ninety-three patients underwent initial angiography and completed questionnaires (Cardiac-Quality of Life Index, Short Form-36 mental and physical, and Cardiac Attitudes Index) before, 1 week and 1 year after angiography. Data were evaluated with linear regression and analysis of variance.ResultsFifty-five patients were CHD positive (age 65.3 ± 10.7 years, 49% were female), and 38 patients were CHD negative (age 59.5 ± 12 years, 53% were female). Compared with CHD-positive patients over 1 year, CHD-negative patients reported lower scores on the Cardiac-Quality of Life Index (P < .008), Short Form-36 mental and physical measures (P = .004), and Cardiac Attitudes Index (P = .05).ConclusionCHD-negative patients experienced lower health-related quality of life and lower perceived control than CHD-positive patients. After an index angiogram, a negative finding may not be sufficient to relieve negative emotions.

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.

AimsTo describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure.BackgroundCare and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health.MethodsData for this descriptive cross-sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden.ResultsThe 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients' Physical Component Score of SF-36 (p

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.

The serious detrimental effects of smoking after heart transplantation (HTX) are well established, but data that demonstrate the effects on female HTX recipients are scarce. The purpose of this study was to describe tobacco use, exposure to second hand smoke (ESHS), and health perceptions of female HTX recipients and examine relationships between these variables of interest and demographic and clinical characteristics of women following HTX. Seventy-two women (mean age, 54.3+/-12.7 years; mean time since transplant, 5.5+/-4.5 years) were enrolled from a single HTX center. Demographic and clinical data, tobacco use, ESHS, and health perceptions were obtained through self-report and chart reviews. Tobacco use was verified by measurement of urine cotinine levels. Twenty-four women were nonsmokers before and after HTX. Eighteen (37.5%) of the 48 women who were former smokers before HTX had returned to tobacco abuse. Only 4 of the 18 accurately reported their smoking behaviors. Forty percent of nonsmokers reported ESHS. Tobacco use and ESHS were highest among African American women. Forty percent of the sample perceived their health status as fair-poor; the remaining 60% reported good-excellent health. In a multivariate analysis, current tobacco use (odds ratio [OR], 5.20; confidence interval [CI], 3.83-9.13) and ESHS (OR, 1.82; CI, 1.17-2.82) were independent predictors of lower health perceptions. Although a majority of the female recipients who used tobacco ceased smoking before HTX, a substantial proportion demonstrated recurrent tobacco use after HTX. Our findings suggest the need for aggressive screening and risk factor interventions to promote smoking cessation before and after HTX in this unique population of female HTX recipients.

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.

BackgroundChronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure.MethodsData for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire.ResultsSignificant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients.ConclusionCultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients.

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.

The advancements in surgical technique and perioperative care have significantly improved the survival of children with single ventricle (SV) congenital heart disease (CHD) over the past decade. The population who have undergone the Fontan operation are growing into adulthood and facing many unique challenges. Past research has focused on functional and neurodevelopmental outcomes with inferences made to health-related quality of life (HRQOL). With the population who have undergone the Fontan operation surviving into adulthood, little research has been directed toward the self-report of HRQOL in adolescents and young adults after surgical palliation. Questions still remain on how these patients will transition into adulthood and whether they will live normal productive lives. This article reviews the literature related to HRQOL in the SV subgroup of CHD. In addition, an overview of newly developed disease-specific HRQOL instruments is presented as well as limitations and future research in HRQOL of the SV Fontan population.

Aim: This paper describes the trajectory during 1 year of four patient‐reported outcomes (PROs), namely, sleep, depressive symptoms, health‐related quality of life (HrQoL), and well‐being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs. Methods and results: Data analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF‐Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well‐being. Across the entire 1‐year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well‐being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co‐morbidity, and poor physical activity to one. Conclusion: In total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well‐being at least once during a 1‐year period. This underscores the need for continuous monitoring and follow‐up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory. [ABSTRACT FROM AUTHOR]

Aims: To describe sources of health information and health‐seeking behaviours of adults (aged ≥18) living in medically underserved communities in the Philippines. Design: This is a secondary, quantitative analysis from a cross‐sectional parent study. Participants completed a 10‐item, self‐report survey on their sources of health information, healthcare providers sought for health and wellness and health‐seeking behaviours when ill. Responses were evaluated across two age groups (<60 vs. ≥60 years) and genders using generalized linear mixed models. Results: Surveys were completed by 1202 participants in rural settings (64.6% female, mean age 49.5 ± 17.6). Friends and/or family were their key source of health information (59.6%), followed by traditional media (37%) and healthcare professionals (12.2%). For health promotion, participants went to healthcare professionals (60.9%), informal healthcare providers (17.2%) or others (7.2%). When ill, they visited a healthcare professional 69.1% of the time, self‐medicated (43.9%), prayed (39.5%) or sought treatment from a rural health clinic (31.5%). We also found differences in health‐seeking behaviours based on age and gender. Conclusions: Our findings highlight the need to organize programs that explicitly deliver accurate health information and adequate care for wellness and illness. Study findings emphasize the importance of integrating family, friends, media and healthcare professionals, including public health nurses, to deliver evidence‐based health information, health promotion and sufficient treatment to medically underserved Filipinos. Implications: New knowledge provides valuable information to healthcare providers, including public health nurses, in addressing health disparities among medically underserved Filipinos. Impact: This study addresses the current knowledge gap in a medically vulnerable population. Healthcare professionals are not the primary sources of health information. Approximately one‐third of participants do not seek them for health promotion or treatment even when ill, exacerbating health inequities. More work is necessary to support initiatives in low‐ and middle‐income countries such as the Philippines to reduce health disparities. Reporting Method: We adhered to the reporting guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cross‐sectional studies. Patient or Public Contribution: There was no patient or public contribution as our study design and methodology do not make this necessary. [ABSTRACT FROM AUTHOR]

BackgroundThe effect of obesity on health related quality of life (HRQOL) and depression in a number of disease states is well documented, but its impact in heart failure (HF) patients remains speculative. We therefore examined the relationship between obesity, HRQOL, and depression in 358 patients with HF.Methods and resultsComparative analyses were conducted to determine if body mass index (BMI) was associated with HRQOL and depression in three groups of patients with HF-normal weight (BMI 18.5-24.9 kg/m2, n = 100), overweight (BMI 25-29.9 kg/m2, n = 141), and obese (BMI > or = 30 kg/m2, n = 117). Obese patients were younger than normal and overweight participants; all other demographic and clinical characteristics were similar. HRQOL and depression scores were significantly higher (worse) for obese patients. Body mass index was significantly correlated with all 3 scales of HRQOL (overall, r2 = .160; physical, r2 = .162; and mental, r2 = .217) as well as with depression (r2 = .166).ConclusionObese patients with HF are more likely to have poorer HRQOL, physical health, emotional well-being and depressive symptoms. Poorer HRQOL is predictive of worse outcomes in patients with HF; however, given the apparent obesity paradox in HF, further investigation of the impact of obesity in HF is urgently required.

Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure (HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese (body mass index > or =27 kg/m(2)) patients with advanced HF who were randomized to exercise (n = 48) and control (n = 51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3 +/- 10.1 years and predominantly male (75%), Caucasian (57%), and married (55%). Most patients were in New York Heart Association class III or IV (67%), with a mean ejection fraction of 25%. Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group (-6.37 +/- 11.7 vs -0.33 +/- 9.3 kg, p = 0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months (r = 0.331, p = 0.006), as well as decreased depression (r = -0.315, p = 0.01) and hostility (r = -0.355, p = 0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group (0.63 +/- 0.94 vs 1.07 +/- 0.95, p

Maintaining regular, long-term physical activity is critical to achieve favorable effects of heart transplantation. Yet, at present, little is known about the physical activity patterns of transplant recipients, especially women. The study was conducted to (1) describe levels and types of physical activity using actigraphy and self-report, (2) determine the association between physical activity and sociodemographic variables, and (3) assess the relationship between physical activity, quality of life (QOL), and relevant health indicators (hypertension, hyperlipidemia, and obesity) among female heart transplant recipients. Twenty-seven women (average age, 57 +/- 13 years, primarily Caucasian [82%], retired [89%], married [67%], average time since transplant 2.1 +/- 1.3 years) from a single heart transplant facility were asked to report amount and types of physical activity and overall QOL and wear an actigraph for 1 week to measure physical activity level. Physical activity levels by actigraphy averaged 280,320 +/- 52,416 counts for the week (range, 206,784-354,144); self-reported physical activity level on a 0 to 10 scale was 4.3 +/- 0.37 (range, 0-7). The actigraph and self-reported measures were significantly correlated (r = 0.661, P = .000). It was found that women were more likely to engage in household tasks and family activities than occupational activities or sports. Significant differences in physical activity (F = 6.319, P = .006) were observed in participants who reported fair (n = 13), good (n = 9), and very good (n = 5) overall QOL. The only demographic factor associated with physical activity was age; younger women were more active than older women (r = -0.472, P = .013). A negative correlation was found between levels of physical activity and presence of hypertension, hyperlipidemia, and obesity. It was found that a majority of female transplant recipients remains sedentary. Given the association between physical activity and overall QOL and relevant health indicators, measures to enhance physical activity need to be developed and tested; these strategies may be beneficial in improving overall outcomes.

BackgroundMeasuring adherence to exercise is important to clinicians and researchers because inadequate adherence can adversely affect the effectiveness of an exercise program and cloud the relationship between exercise and clinical outcomes. Hence, assessment strategies for adherence to exercise, as with assessment strategies for other outcomes, must have demonstrated validity if they are to be employed with confidence. We conducted this study to determine the validity of pedometers as a measure of exercise adherence to a home-based walking program in heart failure patients.Methods and resultsExercise adherence was measured using pedometers in 38 patients (74% men) age 54.1 +/- 11.7 years who participated in a 12-month home-based walking program. A comparison of functional status as measured by the 6-minute walk distance and peak oxygen uptake (VO2 max) at 6 months into the exercise training program was made between 2 groups of participants who were thought to represent adherers and nonadherers: participants who demonstrated > or = 10% change in pedometer scores (n = 20) and those who showed no change in pedometer scores (n = 18) from baseline to 6 months. Patients who showed improvements in their pedometer scores over 6 months had better functional status at 6 months (6-minute walk distance 1718 +/- 46 versus 1012 +/- 25 meters, F = 5.699, P = .022; VO 2 max 17 +/- 0.7 versus 10 +/- 0.5 units, F = 7.162, P = .011) when compared with patients whose pedometers reflected minimal change in distance walked (ie, < or = 10%).ConclusionPedometers are inexpensive and readily available to both clinicians and researchers. The results of this study suggest that they may be a valid indicator of exercise adherence in heart failure patients who participate in a home-based walking program.

BackgroundAssessment of physical and mental health has become one of the ultimate tests of health-related quality of life (HRQOL) for patients with advanced heart failure. Little is known, however, about the comparative effects of surgical or medical treatment on the HRQOL of these chronically ill patients over time.MethodsWe examined 77 patients (74% of whom were male), aged 56.1 +/- 12.7 years who were referred for heart transplant evaluation at a single heart failure center to describe the effects of time and treatment status on changes in HRQOL scores (physical and mental health and depression) using the Short Form-12 and the Beck Depression Inventory at 2 time points during their illness trajectory. The 2 evaluations on average were 2 years apart (mean 24.5 +/- 2.8 months). All patients were evaluated at baseline, and 3 groups were identified at the time of the 2-year follow-up: transplant recipients (n = 17), transplant candidates (n = 13), and medically stable patients considered too well to receive a transplant (n = 47). Nonparametric statistics were used to analyze group differences in HRQOL scores. The significance level was set at a P value less than .05.ResultsDemographic and HRQOL scores were not significantly different among the 3 groups at baseline. During follow-up, physical health and depression scores significantly improved over time in all patients, but changes in mental health were minimal. Group comparisons showed that although all patients continued to have low HRQOL scores at the time of follow-up evaluation, medically stable patients had higher mental health scores and less depressive symptoms than their counterparts.ConclusionOur results support the need for ongoing HRQOL assessment with an emphasis on timely recognition and treatment of psychologic distress throughout the heart failure illness trajectory. Heart transplant recipients and candidates equally need special attention and follow-up because they both seem to have emotional and psychologic repercussions.

BackgroundThe physical demands and psychological stressors of caregiving negatively impact the emotional well-being of spouses in many chronically ill populations such as patients with Alzheimer's disease and end-stage renal failure. Heart failure (HF) is a chronic illness with a poor prognosis that is increasing in prevalence and incidence, yet little is know about its effect on the family, particularly the spouse.ObjectiveWe conducted this study to describe the emotional well-being of spouses of patients with HF, to identify factors associated with spouses' decreased emotional well-being, and to compare emotional well-being between spouses with higher and lower levels of perceived control. We proposed a model that included age, sex, employment status, perceived control, and caregiver burden to explain the emotional well-being of spouses.MethodsData were collected from 69 spouses of patients with advanced HF (mean age 54 years and predominantly female) using 2 subscales of the SF-36, control attitudes scale-family version and caregiver appraisal tool. Descriptive statistics, Pearson correlations, and stepwise multiple regression were used to analyze data.ResultsThe model explained 40% of the variance in the emotional well-being of spouses (P = 0.001). Perceived control (P = 0.001) and age (P = 0.046) were associated with emotional well-being. In spouses with higher levels of control, emotional well-being was significantly higher than in spouses with lower levels of control (P = 0.003). Older spouses had higher levels of emotional well-being compared with younger spouses (P = 0.01).ConclusionsHealth care professionals must assess the level of control perceived by spouses of patients with advanced HF and provide information and counseling directed toward increasing their sense of control. Younger spouses are particularly at risk for decreased emotional well-being and may require special intervention.

BackgroundThe attributes of fatigue after orthotopic heart transplantation (OHT) are poorly understood. We conducted this study to assess the prevalence, severity and correlates of fatigue among female OHT survivors.MethodsFifty women (age 54.7 +/- 13.0 years) from a single heart transplant center, who underwent OHT 5.1 +/- 4.4 (mean +/- SD) years earlier, completed a battery of questionnaires including the Profile of Mood States-fatigue sub-scale to assess levels of fatigue, the Beck Depression Inventory to measure depression, and the Short Form-36 to measure functional status and mental health. Demographic and clinical data were obtained from self-reports and medical chart reviews.ResultsWomen reported mean scores of 15.7 +/- 6.8 (range 3 to 27), 13.2 +/- 8.2 (range 0 to 38), 37.2 +/- 10.8 (range 22 to 62) and 41.5 +/- 11.2 (range 17 to 60) for fatigue, depression, functional status and mental health, respectively. Univariate analyses revealed that sociodemographic and clinical variables (e.g., age, employment status, anemia, renal insufficiency) were significantly related to fatigue (p < 0.001). Likewise, depression, functional status and mental health were also significantly related to fatigue (p < 0.001). In a multivariate model, age (adjusted R(2) = 0.23, p < 0.001), anemia (adjusted R(2) = 0.39, p < 0.001), functional status (adjusted R(2) = 0.60, p < 0.001) and depression (adjusted R(2) = 0.69, p < 0.001) were significant predictors of fatigue. The model explained 69% of the variance in fatigue (p < 0.001).ConclusionsFatigue is common in women after OHT and is associated with both physiologic and psychologic factors. Clinicians should evaluate all female recipients for symptoms of fatigue, especially those with anemia, renal insufficiency, poor functional status and depression. Other potential mediators of fatigue, such as the denervated donor heart and type of immunosuppressive regimen, may also play a role and require further study.

BackgroundThe purpose of this study was 2-fold: (1) to describe and compare the quality of life (QOL) and psychologic well-being of 2 groups of women matched for age and functional status (6-minute walk distance), including those who had received a heart transplant and those who were candidates on a transplant waiting list; and (2) to identify correlates of QOL in female heart transplant recipients.MethodsData were collected from 50 female recipients (mean age 54.7 +/- 13.0 years) and 50 female candidates (mean age 56.8 +/- 12.2 years) from a major heart transplant facility using the Minnesota Living with Heart Failure Questionnaire, the Beck Depression Inventory and the Control Attitude Scale.ResultsThe overall QOL scores were 28.0 +/- 26.4 and 56.3 +/- 26.1 for recipients and candidates, respectively (p < 0.01), with lower scores denoting higher QOL. The mean physical health (11.3 +/- 11.2 vs 19.9 +/- 12.1, p < 0.01) and emotional health (7.5 +/- 8.2 vs 12.8 +/- 7.8, p < 0.001) scores were also lower (reflecting higher physical and emotional health) for recipients as compared with candidates. Likewise, recipients reported significantly (p < 0.001) lower depressive moods (23.2 +/- 8.2 vs 45.8 +/- 16.3) and higher perceived control (10.9 +/- 4.3 vs 8.6 +/- 1.9) compared with candidates. Functional status, depression and perceived control were significant correlates of QOL among female recipients and accounted for 49% variance in overall QOL.ConclusionsAlthough overall QOL of was better among female heart transplant recipients than candidates, both groups of women reported poor QOL. Clinicians need to identify potential resources and interventions to improve QOL both before and after heart transplant surgery.

PurposeTo describe respiratory symptoms and pulmonary function among long-term survivors of non-small cell lung cancer (NSCLC), and their relationship to quality of life (QOL).MethodsCross-sectional survey of disease-free, 5-year minimum survivors of NSCLC (n = 142; 54% women; average age, 71 years); the majority (74%) had received a lobectomy. Analysis included frequency of self-reported respiratory symptoms (cough, phlegm, wheezing, breathlessness) as measured by the American Thoracic Society questionnaire, pulmonary function findings from hand-held spirometry, and QOL (Short Form-36).ResultsTwo thirds of survivors reported at least one respiratory symptom (mean, 1.3; SD, 1.2): 25% cough, 28% phlegm, 31% wheezing, and 39% dyspnea. Twenty-one percent reported that they spent most of the day in bed in the past 12 months because of respiratory symptoms. Average FEV(1) percentage predicted was 68% (SD, 23); 21% had < 50% predicted FEV(1). Based on spirometry results, 36% had a moderate/severe obstructive and/or restrictive ventilatory disorder. Survivors exposed to second-hand smoke (28%) were more than three times as likely to report respiratory symptoms. Respiratory symptom burden contributed to diminished QOL in several domains.ConclusionsThe majority of these survivors experienced respiratory symptoms, and more than one third reported dyspnea, including one of five patients with seriously diminished pulmonary function. Symptom burden, rather than ventilatory impairment, contributed to diminished QOL. Further study is needed to determine the patterns and effective management of posttreatment respiratory symptoms on survivors of lung cancer.

PurposeA descriptive, exploratory study was conducted to examine perceptions and meanings assigned to the experience of end-stage heart failure and transplant surgery in female recipients.MethodsData was collected from 33 female heart transplant recipients from a heart transplant clinic using quantitative and qualitative methods. Women completed the Life Attitudes Profile and Multiple Affect Adjective Checklist and participated in a semi-structured interview.ResultsWomen on average had a meaning score of 30.64 +/- 8.32 (range, 10-43) and a life purpose score of 40.12 +/- 13.78 (range, 17-63). The participants reported high levels of anxiety, depression, and hostility. Women expressed feelings of fear and lack of control related to their heart disease and transplant; however, they also described optimism, faith, acceptance, altruism, self-transcendence, self-fulfillment, and changing life goals as strong motivators for recovery.ConclusionWomen experience emotional distress as much as and beyond 5 years after heart transplantation. Their sense of meaning and life purpose is relatively high and is positively informed by several motivating factors that serve as coping resources throughout the recovery process.

BACKGROUND:The role of hope on mood states and quality of life (QOL) in heart transplant recipients has not been examined previously. This exploratory study was done to describe levels of hope, mood states and QOL; examine relationships between these variables and demographic characteristics; and identify predictors of QOL in female heart transplant recipients. METHODS:Fifty women from a single heart transplant clinic were asked to complete the Herth Hope Index (HHI), Multiple Affect Adjective Checklist (MAACL) and SF-12 (which produces a physical component summary [PCS] and a mental component summary [MCS]). Descriptive statistics, Pearson correlations, and stepwise multiple regression were used to analyze the data. The level of statistical significance was set at 0.05. RESULTS:Patients on average were 54.7 +/- 13.0 years of age and had undergone heart transplantation 5.2 +/- 4.4 years prior to study participation. Patients reported experiencing moderately low hope, and moderately high anxiety, depression and hostility. They also exhibited low levels of QOL as reflected in their low PCS and MCS scores. There was a strong positive association between hope, mood states and MCS (p = 0.001). In a multiple regression model, age, hope and depression accounted for 69% of the variance in the MCS. CONCLUSIONS:The study supports the strong association between hope, mood states and the MCS of QOL in female heart transplant recipients. Hope was an independent predictor of mood states and QOL. This finding suggests that interventions directed at fostering hope among heart transplant recipients may be the key to improving their QOL.

BACKGROUND: Lung cancer survivors are at an increased risk for recurrence and the development of secondary tumors and other comorbid conditions. However, little is known about lung cancer survivors' risk behaviors and the effect of these behaviors on overall health perceptions. OBJECTIVE: The purpose of this study was to describe the prevalence of health risk behaviors among non-small cell lung cancer survivors and their relationship perception to overall health. METHODS: One hundred forty-two survivors of non-small cell lung cancer with a minimum of 5 years disease free completed a battery of questionnaires to assess perception of health status and self-reported risk behaviors (smoking, exposure to secondhand smoke, alcohol use) and weight before and after diagnosis. Urinary cotinine level was used to verify smoking status, and actual height and weight were obtained to determine overweight status (body mass index, >/=25). Descriptive statistics and logistic regression were used to analyze the data. RESULTS: Seventy percent of participants reported their health as good to excellent. Although 81% quit smoking after diagnosis, 13.4% continued to smoke and 28% reported exposure to secondhand smoke. Approximately half the sample (58%) drank alcohol (16.3% quit after diagnosis) and was overweight (51%). A strong agreement between current smoking and exposure to secondhand smoke was observed. In a multivariate analysis, smoking (odds ratio [OR], 7.02; CI, 2.45 to 20.13), exposure to secondhand smoke (OR, 5.37; CI, 2.42 to 11.95), alcohol use (OR, 9.04; CI, 3.28 to 24.92), and overweight (OR, 8.51; CI, 3.44 to 21.10) were independent predictors of perceived poor health status. CONCLUSION: Although most lung cancer survivors have made healthy lifestyle changes, a substantial proportion has not. Our findings suggest the need for multiple risk factor interventions to decrease risk behaviors and improve overall health after a cancer diagnosis.

BackgroundTreatment-seeking delays for heart failure (HF) symptoms are significantly high. However, earlier studies did not closely examine race as a characteristic that could potentially influence delay times. The purpose of this study was (1) to describe racial differences in treatment-seeking delays for HF symptoms and (2) to identify racial differences in hospital readmission rates, functional status, and total length of stay.Methods and resultsA retrospective chart review of all patients admitted with HF at a Veterans Administration facility was conducted. The study sample consisted of 753 patients: 456 Caucasians (60.6%), 220 African Americans (29.2%), 41 Asians (5.4%), and 36 Hispanics (4.8%). The average prehospital delay time was 2.9 +/- 0.7 days. Mean delay times were significantly longer for African Americans than for Caucasians, Asians, and Hispanics (P =.019). African Americans also had significantly higher readmission rates (P =.001) and lower functional status (higher New York Heart Association functional class) (P =.034). There were no significant racial differences in total length of stay for HF admissions.ConclusionThe current study supports that racial differences exist in treatment-seeking behaviors for HF symptoms, hospital readmission rates, and functional status. A better understanding of treatment-seeking behaviors of HF patients with different racial characteristics may be key to early recognition and prevention of complications in this high-risk population; it may be beneficial in identifying patients at risk for treatment delays and potentially poorer outcomes.

BackgroundHeart failure (HF) dramatically affects the lives of both patients and their caregivers, yet limited research exists examining the relationship between emotional well-being of HF patients and their caregivers. Therefore, we conducted a study to (1) describe and compare the emotional well-being of HF patients and their caregivers, (2) determine if gender differences exist in emotional well-being of patients and caregivers, and (3) identify factors associated with emotional well-being of HF patients.MethodsThe emotional well-being of 103 patient-caregiver dyads was assessed using the mental health subscale of the SF-12.ResultsPatients were 57.6 +/- 12.1 years, predominantly Caucasian (76.7%) and male (67.0%). Caregivers were 59.5 +/- 17.6 years, predominantly females (70.9%) and spouses of patients with HF (82.6%). Patients had significantly lower (poorer) emotional well-being scores than caregivers. Both gender and age were associated with patients' emotional well-being; male and younger participants had higher (better) scores than female and older patients (P