Depression, Anxiety, and Resilience: The Association of Emotions With Self-care in Patients With Heart Failure.

BACKGROUND: Engaging in self-care behaviors improves outcomes in patients with heart failure. Identifying psychological factors that affect self-care behaviors and the role of resilience may inform interventions that improve outcomes. OBJECTIVES: The study objective was to determine the relationships among depression, anxiety, resilience, and self-care, including whether resilience mediates or moderates the effects of depression and anxiety on self-care. METHODS: Pearson correlation coefficients were computed to estimate the relationships of depression, anxiety, and resilience with self-care behaviors. Mediating and moderating effects of resilience on the relationships of depression and anxiety with self-care were evaluated using multiple linear regression. RESULTS: Depression and anxiety were associated with lower self-care. Higher resilience was associated with lower depression and anxiety, but resilience did not mediate or moderate the relationship of depression and anxiety with self-care. CONCLUSIONS: Interventions that foster resilience may improve outcomes by reducing anxiety and depression in patients with heart failure.

The Effects of Nonconventional Exercise on Functional Capacity and Quality of Life in Patients With Heart Failure: A Systematic Review.

BACKGROUND: Patients with heart failure (HF) experience decreased functional capacity (FC) and poor quality of life (QOL). Exercise and cardiac rehabilitation programs are an integral part of managing HF because they have been shown to provide a multitude of benefits including improved FC and QOL. In recent years, nonconventional exercise interventions have offered a promising approach for promoting physical activity in patients with HF, thus leading to improved FC and QOL. PURPOSE: This review aimed to assess the effects of either supervised or unsupervised, nonconventional exercise interventions on FC and QOL in patients with HF. METHODS: A literature search using PubMed, Web of Science, Cochrane Library, and Science Direct for relevant studies was conducted. Experimental studies that examined nonconventional exercise interventions in adults with HF were eligible for inclusion. Two reviewers independently selected the studies, assessed the quality of the studies, and then narratively synthesized each study. RESULTS: The authors identified 14 studies that included 879 patients with HF. Most studies were ranked moderate to high quality where 13 studies found significantly improved FC and 10 found significantly improved QOL after nonconventional exercises. CONCLUSIONS: This review provides preliminary evidence that patients with HF may benefit from alternative forms of exercise to improve FC and QOL. Walking was the most frequent exercise, but other nonconventional exercises such as aquatic exercise, dance, resistance training, stretching, Tai Chi, and yoga are also promising interventions that may improve FC and QOL in patients with HF. CLINICAL IMPLICATIONS: Nonconventional exercise can be a convenient and alternative method of exercise versus traditional cardiac rehabilitation, thereby providing new opportunities that can lead to improved FC and QOL.

Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions: A Systematic Review.

BACKGROUND: Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality. OBJECTIVE: This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease. METHODS: Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions. RESULTS: Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity. CONCLUSIONS: Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.

Psychological distress, forced awakening, and morning blood pressure surge.

BACKGROUND: Morning blood pressure surge (MBPS) has been recognized as an independent predictor of cardiovascular disease events. Psychological distress, including anxiety, depression, and perceived stress, and behavioral risk factors, such as poor sleep quality, have been associated with increased MBPS. Elevations in sympathetic activity induced by forced awakening may also contribute to further increases in MBPS. Yet, no examination of the interrelationships among psychological distress, sleep quality, awakening mode (natural vs. forced awakenings), and MBPS has been undertaken. OBJECTIVE: This pilot study aimed: (1) to examine if MBPS differs by awakening mode and (2) to investigate whether psychological distress is associated with MBPS difference between natural and forced awakenings, independent of sleep quality. METHODS: Thirty-two healthy adults were included in this cross-sectional study. Blood pressure was measured using a beat-to-beat blood pressure monitor over two nights, consisting of one night of natural awakening and one night of forced awakening. Psychological distress and sleep quality were assessed using questionnaires. We conducted paired t-tests (aim 1) and multiple linear regressions (aim 2). RESULTS: MBPS was significantly greater during forced awakening compared with natural awakening. In addition, the MBPS difference between natural and forced awakenings was significantly greater in participants with higher anxiety levels, independent of sleep quality. CONCLUSION: We found that augmentation of MBPS by forced awakening was significantly greater in individuals who reported higher anxiety levels. Additional research is needed to examine the potential impacts of forced awakening and anxiety on MBPS in a larger sample of individuals at risk for cardiovascular disease.

The impact of forced awakening on morning blood pressure surge.

BACKGROUND: Poor sleep quality can cause an increase in morning blood pressure surge (MBPS), an independent risk factor of cardiovascular disease (CVD) events. Awakening induced by external factors such as alarm clocks, may also contribute to increased MBPS. OBJECTIVES: To (1) compare the MBPS and sleep quality parameters between natural and forced awakenings and (2) examine the potential impact of forced awakening on MBPS, independent of sleep quality. METHODS: Thirty-two healthy adults participated in this pilot study, which included one night of natural awakening and one night of forced awakening (i.e., sleep was interrupted by an alarm after five hours). Objective and self-reported sleep quality parameters were measured using a multisensory wristband and sleep diaries, respectively, and beat-to-beat blood pressure variability was assessed using a continuous blood pressure monitor. Analyses included a paired t-test (objective 1) and linear mixed models (objective 2). RESULTS: Participants predominantly consisted of young, healthy, and highly educated Asian adults. During the night of sleep with forced awakening, significantly higher MBPS, lower objective wakefulness after sleep onset, and lower self-reported sleep latency were observed, compared to the night with natural awakening. Forced awakening was significantly associated with increased MBPS after controlling for age, sex, mean arterial pressure, and sleep quality. CONCLUSIONS: Forced awakening may significantly increase MBPS, consequently heightening the risk of CVD events. Study findings should be validated in a larger sample. Further research is also warranted to examine the impact of forced awakening on MBPS in individuals with CVD.

Sleep and blood pressure variability: A systematic literature review.

BACKGROUND: Blood pressure variability (BPV) is a prognostic marker of cardiovascular disease (CVD). Sleep is recognized as a significant risk factor for CVD; however, little is known about the relationship between sleep characteristics and BPV. OBJECTIVE: In this systematic review, we aimed to (1) describe methods used to measure BPV and sleep and (2) describe the current evidence in the literature on the association between sleep and BPV. METHODS: A systematic search was conducted using the search terms "sleep" AND ("blood pressure variability" OR "ambulatory blood pressure monitor") in CINAHL, PubMed, Web of Science, and PsycINFO databases. RESULTS: Twenty-two studies were included in this systematic review. Sleep was measured using various methods, including polysomnography, actigraphy, sleep diaries, and questionnaires, while BPV was measured over various time intervals using different monitoring devices such as a beat-to-beat blood pressure (BP) monitoring device, a 24-h ambulatory BP monitor, or an automatic upper arm BP monitor. The studies demonstrated mixed results on the associations between sleep parameters (sleep quality, architecture, and duration) and increased BPV. CONCLUSIONS: Although the mechanisms that explain the relationship between sleep and BPV are still unclear, accumulating evidence suggests potential associations between increased BPV with poor sleep quality and longer sleep duration. Given the recent development of sleep and BP monitoring technologies, further research is warranted to assess sleep and BPV under free-living conditions. Such studies will advance our understanding of complex interactions between sleep and CVD risk.

Using video education to improve outcomes in heart failure.

BACKGROUND: Heart Failure (HF) guidelines recommend HF self-care education. An optimal method of educating HF patients does not currently exist. OBJECTIVES: To evaluate the effectiveness of supplementing usual HF education with video education and evaluate patients' satisfaction with video education. METHODS: A mixed methods design was used. A convenience sample of 70 patients was recruited from an academic medical center. Participants completed the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index before and after receiving video education, to measure HF knowledge, self-efficacy, and self-care respectively. Video usage and satisfaction with video education data were collected. All-cause 30-day readmissions data were compared to a historical group. RESULTS: HF knowledge and self-care maintenance scores increased significantly. Self-efficacy, self-care management and all-cause 30-day readmissions did not significantly improve. Most HF patients were highly satisfied. CONCLUSION: Supplementing usual HF education with VE was associated with improved HF knowledge and self-care maintenance.

Like Mother, Like Child: The Influences of Maternal Attitudes and Behaviors on Weight-Related Health Behaviors in Their Children.

BACKGROUND: Childhood obesity has become a global health issue, yet little is known about the influence of maternal factors on children's weight-related health behaviors (dietary habits and physical activity), especially in China. The purpose of this study was to examine the influence of maternal factors on children's eating behaviors and physical activity in Chinese preschool-age children. METHOD: A cross-sectional study was utilized to describe weight-related health behaviors among preschool-aged children and identify maternal factors that are associated with children's weight-related health behaviors in China. Mothers completed questionnaires regarding family eating and activity habits, child feeding practices, and maternal self-efficacy regarding their child's health-related health behaviors. RESULTS: A total of 222 mother-child dyads participated in this study. Maternal health-related behavior and attitudes regarding feeding practices and self-efficacy were associated with children's health-related behaviors, including eating behaviors and physical and sedentary activities. The influence of maternal behaviors and attitudes were domain specific. DISCUSSION: Improvement of children's health behaviors, promoting a healthy lifestyle of the mother and self-efficacy, and providing health home environment for the child are critical in obesity prevention. IMPLICATIONS FOR PRACTICE: Because children's health is critical to the health of the nation and to global development, understanding the factors related to children's health-related behaviors is an important first step toward development of tailored, culturally sensitive interventions for promoting a healthy lifestyle and preventing obesity.