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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.

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.

PURPOSE:A 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. METHODS:Data 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. RESULTS:Women 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. CONCLUSION:Women 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: Treatment-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 RESULTS: A 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. CONCLUSION: The 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.

BACKGROUND:Heart 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. METHODS:The emotional well-being of 103 patient-caregiver dyads was assessed using the mental health subscale of the SF-12. RESULTS:Patients 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 <.05). In a multivariate model, patient's age, gender, and caregivers' emotional well-being accounted for 54% of the variance in patients' emotional well-being. CONCLUSION:We found that the emotional well-being of caregivers is associated with the emotional well-being of HF patients. Our findings suggest the need to focus on supporting caregivers and providing them with the strategies they need to support their loved ones with HF.

PURPOSE: The aim of this study was to examine the relationship between acculturation, medication adherence, lifestyle behaviors (e.g., physical activity, nutrition, weight control), and blood pressure control among hypertensive Arab Americans. DESIGN: The study utilized a cross-sectional descriptive design. A convenience sample of 126 participants completed questionnaires and had measures of blood pressure, weight, and height. Forty-six participants were hypertensive and were included in the analysis. RESULTS: Only 29.2% of participants reported high medication adherence. High medication adherence was associated with lower diastolic blood pressure, eating a healthy diet, and following lifestyle modifications. Acculturation was significantly associated with physical activity and body mass index. CONCLUSION: Our study found that acculturated participants were more adherent to medications and physical activity and had better blood pressure control. Further studies are needed to explore how acculturation improves adherence and what factors contribute to better adherence in order to design culturally sensitive interventions.

Purpose of reviewThis article examines interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure.Recent findingsEight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of four to six sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n=4), depressive symptoms (n=1), stress mastery (n=1), caregiver confidence and preparedness (n=1), and caregiver mastery (n=1).SummaryCompared with dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with heart failure. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of heart failure caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance heart failure caregiver support and education., Funding Agencies|National Heart, Lung, and Blood Institute [1R01HL093466-05]; Swedish Research Council for Medicine and Health; Swedish Research Council for Health, Working Life and Welfare

Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre-post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up (Mbase = 12.5 ± 5.51, Mfollow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults' knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.

PurposeThe aim of this study was to examine the relationship between acculturation, medication adherence, lifestyle behaviors (e.g., physical activity, nutrition, weight control), and blood pressure control among hypertensive Arab Americans.DesignThe study utilized a cross-sectional descriptive design. A convenience sample of 126 participants completed questionnaires and had measures of blood pressure, weight, and height. Forty-six participants were hypertensive and were included in the analysis.ResultsOnly 29.2% of participants reported high medication adherence. High medication adherence was associated with lower diastolic blood pressure, eating a healthy diet, and following lifestyle modifications. Acculturation was significantly associated with physical activity and body mass index.ConclusionOur study found that acculturated participants were more adherent to medications and physical activity and had better blood pressure control. Further studies are needed to explore how acculturation improves adherence and what factors contribute to better adherence in order to design culturally sensitive interventions.

Music interventions are effectively used to reduce anxiety in patients on maintenance hemodialysis (HD). The purpose of this review was to identify the methodological quality and examine the effectiveness of music interventions on anxiety in patients requiring maintenance HD. Articles were searched through 10 electronic databases, and relevant articles were systematically reviewed. Seven studies were analyzed for this study, and the combined seven studies revealed a medium effect size (pooled standardized mean differences [SMD] = 0.76; 95% CI: 0.55, 0.98). This study found that music interventions effectively reduce anxiety in patients on maintenance HD.

The purpose of the current study was to present a framework to determine potential usability of health websites by older adults. Review of the literature showed paucity of nursing theory related to the use of technology and usability, particularly in older adults. The Roy Adaptation Model, a widely used nursing theory, was chosen to provide framework for the new model. Technology constructs from the Technology Acceptance Model and United Theory of Acceptance and Use of Technology and behavioral control construct from the Theory of Planned Behavior were integrated into the construction of the derived model. The Use of Technology for Adaptation by Older Adults and/or Those With Limited Literacy (U.S.A.B.I.L.I.T.Y.) Model was constructed from the integration of diverse theoretical/conceptual perspectives. The four determinants of usability in the conceptual model include (a) efficiency, (b) learnability, (c) perceived user experience, and (d) perceived control. Because of the lack of well-validated survey questionnaires to measure these determinants, a U.S.A.B.I.L.I.T.Y. Survey was developed. A panel of experts evaluated face and content validity of the new instrument. Internal consistency of the new instrument was 0.96. Usability is key to accepting technology. The derived U.S.A.B.I.L.I.T.Y. framework could serve as a guide for nurses in formative evaluation of technology.

BackgroundHispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC).MethodsProject Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back.ResultsParticipants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC.ConclusionThe intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function

BackgroundOlder adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy.ObjectiveThe objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management.MethodsWe conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis.ResultsThe participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology m

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.

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 Ar

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.