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3.
J Cardiovasc Nurs ; 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33306621

RESUMO

BACKGROUND: Patients with a left ventricular assist device are a unique and growing population who deserve their own valid, reliable instrument for health-related quality of life. OBJECTIVE: We developed and tested the Health-Related Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire. METHODS: In a prospective, descriptive study, patients from 7 sites completed the QOLVAD and comparator questionnaires. Construct validity was tested using confirmatory factor analysis. Convergent validity was tested using correlations of QOLVAD scores to well-established measures of subjective health status, depression, anxiety, and meaning/faith. Reliability and test-retest reliability were quantified. RESULTS: Patients (n = 213) were 58.7 ± 13.9 years old; 81.0% were male, 73.7% were White, and 48.0% had bridge to transplant. Questionnaires were completed at a median time of 44 weeks post ventricular assist device. The 5 QOLVAD domains had acceptable construct validity (root mean square error of approximation = 0.064, comparative and Tucker-Lewis fit indices > 0.90, weighted root mean square residual = 0.95). The total score and domain-specific scores were significantly correlated with the instruments to which they were compared. Internal consistency reliability was acceptable for all subscales (α = .79-.83) except the cognitive domain (α = .66). Unidimensional reliability for the total score was acceptable (α = .93), as was factor determinacy for multidimensional reliability (0.95). Total test-retest reliability was 0.875 (P < .001). CONCLUSION: Our analysis provided initial support for validity and reliability of the QOLVAD for total score, physical, emotional, social, and meaning/spiritual domains. The QOLVAD has potential in research and clinical settings to guide decision making and referrals; further studies are needed.

4.
Nurs Womens Health ; 24(6): 413-420, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33157071

RESUMO

OBJECTIVE: To explore use of fertility awareness-based methods (FABMs) and factors that influence their use. DESIGN: Secondary data analysis of the National Survey of Family Growth, 2015 to 2017. SETTING: Surveys were conducted in the homes of a national sample of women in the civilian, noninstitutionalized population of the United States. PARTICIPANTS: A subset of women (N = 423) ages 19 to 49 years who sought advice about becoming pregnant. INTERVENTION/MEASUREMENTS: Descriptive statistics and multivariate logistic regression were used to describe sample characteristics and to examine predictors for FABM use. RESULTS: The sample was primarily married (70%), non-Hispanic women age 35 years or older (M = 37.4 years, SD = 7.3). Most were college educated (n = 253, 74.4%), were employed (n = 317, 74.9%), and had health insurance (n = 392, 92.7%). Only 113 women (27%) used one of three FABMs. The most frequent FABM was calendar rhythm (n = 103, 24.6%). Few used temperature/cervical mucus (n = 33, 7.9%) or Standard Days/Cycle Beads (n = 25, 6%). Catholic religion and age were not significant factors in FABM use. There was no significant difference among women with and without college degrees in FABM use: χ2(1, N = 423) = .27, p = .60. The model containing all predictors was not statistically significant: χ2(6, N = 423) = 5.686, p < .459; this indicates that the model was unable to distinguish differences in predictors between respondents who had or had not used an FABM. The model explained 1.7% (Cox and Snell R2) and 2.5% (Nagelkerke R2) of the variance in FABM use. CONCLUSION: The most effective FABM (temperature/cervical mucus) was used infrequently among women who sought advice to achieve pregnancy. Although the effects were insignificant in predicting which women used an FABM, descriptive findings on FABM use were clinically informative. Considering the cost, emotional strain, and potential complications of infertility treatment, clinicians should consider initially recommending a fertility awareness-based method to women seeking advice about achieving pregnancy.

8.
Heart Lung ; 49(5): 488-494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32434702

RESUMO

BACKGROUND: Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable. OBJECTIVES: Identify distinct profiles of dyspnea burden and identify predictors of dyspnea symptom profile. METHODS: A secondary analysis of data from five studies completed at Oregon Health and Science University was conducted. The Heart Failure Somatic Perception Scale was used to measure dyspnea burden. Latent class mixture modeling identified distinct profiles of dyspnea burden in a sample of HF patients (n = 449). Backwards stepwise multinomial logistic regression identified predictors of latent profile membership. RESULTS: Four profiles of dyspnea burden were identified: no dyspnea/not bothered by dyspnea, mild dyspnea, moderate exertional dyspnea, and moderate exertional dyspnea with orthopnea and PND. Higher age was associated with greater likelihood of not being bothered by dyspnea than having moderate exertional dyspnea with orthopnea and PND. Higher NYHA class, anxiety, and depression were associated with greater likelihood of greater dyspnea burden. CONCLUSIONS: Burden of dyspnea is highly variable among HF patients. Clinicians should account for the nuances of dyspnea and the activities that induce dyspnea when assessing HF patients.

9.
Artigo em Inglês | MEDLINE | ID: mdl-32295183

RESUMO

A growing body of evidence supports the fact that optimal health-related quality of life is largely dependent on patient competence in symptom perception. However, many studies have reported poor symptom perception in patients with heart failure. In China, there has been no previous research on assessing the symptom perception ability of patients with heart failure. This study aimed to describe how Chinese patients with heart failure perceive their symptoms, as well as to explore their influencing factors. A theory-based, descriptive, correlational cross-sectional design was used in this study. Data on symptom perception and factors related to symptom perception were collected via structured interviews and medical records. A convenience sample of 208 hospitalized patients was enrolled. The degree of symptom perception in this study was at a high level. The results showed that the level of depression, the New York Heart Association functional class, the left ventricular ejection fraction, and educational background were identified as independent factors of symptom perception in Chinese patients with heart failure. The degree of symptom perception of patients with heart failure was affected by personal, psychological, and physiological factors. Health policy and healthcare providers should pay more attention and deepen the understanding to Chinese patients with heart failure to provide better healthcare.


Assuntos
Insuficiência Cardíaca , Qualidade de Vida , Autoimagem , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Depressão , Feminino , Nível de Saúde , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda
10.
Am J Ther ; 27(3): e235-e242, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30299270

RESUMO

BACKGROUND: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents. METHODS: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 250 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 83 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from the 8024 patients. RESULTS: Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality, which was only significant in the non-NH subgroup (P for interaction, 0.026). CONCLUSIONS: We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found no evidence that this association is different in NH residents with HF versus non-NH patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.

11.
Eur J Cardiovasc Nurs ; 18(6): 484-491, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31027443

RESUMO

BACKGROUND: The Heart Failure Somatic Perception Scale (HFSPS) is a four-factor instrument used to assess how bothersome are 18 physical signs and symptoms of heart failure. To date, construct validity and reliability of the HFSPS have been evaluated in only one American study and never in a European population. AIM: To evaluate psychometric properties (validity and reliability) of the HFSPS in a European heart failure population. METHODS: This was an Italian multicentre study in which the HFSPS factorial structure was assessed using confirmatory factor analysis. Criterion related validity of the HFSPS was evaluated by correlating its factor scores with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using Pearson's r. The HFSPS internal consistency reliability was evaluated using the factor score determinacy coefficient, Cronbach's α and model-based internal consistency index. RESULTS: Most of the participants (n=321) were male (56.6%), with a mean age of 71.48 years (SD, 12.75) and in New York Heart Association class II (61.8%). The confirmatory factor analysis, testing the original HFSPS four-factor structure (dyspnoea, chest discomfort, early and subtle, and oedema), resulted in the following supportive fit indices: χ2 (126, N=321)=337.612, p<0.001, comparative fit index =0.920, Tucker-Lewis index =0.903, root mean square error of approximation =0.072 and standardized root mean square residual =0.045. With regard to the criterion related validity, all the correlations with the KCCQ were statistically significant. The HFSPS reliability resulted in factor score determinacy coefficients ⩾ 0.87 and Cronbach's α ⩾ 0.75, with the exception of the two-item chest discomfort subscale; the model-based reliability coefficient was 0.914. CONCLUSION: The validity and reliability of the HFSPS were supportive in this European sample. The HFSPS can be used to assess how bothersome heart failure signs and symptoms are in order to improve their management.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Sintomas Inexplicáveis , Adulto , Idoso , Análise Fatorial , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Avaliação de Sintomas
12.
J Cardiovasc Nurs ; 34(2): 174-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30489416

RESUMO

BACKGROUND: We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF), particularly in response to left ventricular assist device (LVAD) implantation. OBJECTIVE: The aim of this study was to quantify the degree to which symptoms and biomarkers change in parallel from before implantation through the first 6 months after LVAD implantation in advanced HF. METHODS: This was a prospective cohort study of 101 patients receiving an LVAD for the management of advanced HF. Data on symptoms (dyspnea, early and subtle symptoms [HF Somatic Perception Scale], pain severity [Brief Pain Inventory], wake disturbance [Epworth Sleepiness Scale], depression [Patient Health Questionnaire], and anxiety [Brief Symptom Inventory]) and peripheral biomarkers of myocardial stretch, systemic inflammation, and hypervolumetric mechanical stress were measured before implantation with a commercially available LVAD and again at 30, 90, and 180 days after LVAD implantation. Latent growth curve and parallel process modeling were used to describe changes in symptoms and biomarkers and the degree to which they change in parallel in response to LVAD implantation. RESULTS: In response to LVAD implantation, changes in myocardial stretch were closely associated with changes in early and subtle physical symptoms as well as depression, and changes in hypervolumetric stress were closely associated with changes in pain severity and wake disturbances. Changes in systemic inflammation were not closely associated with changes in physical or affective symptoms in response to LVAD implantation. CONCLUSIONS: These findings provide new insights into the many ways in which symptoms and biomarkers provide concordant or discordant information about LVAD response.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Adulto , Sintomas Afetivos , Idoso , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Avaliação de Sintomas
13.
Heart Lung ; 47(6): 565-575, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30314637

RESUMO

BACKGROUND: We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF). OBJECTIVES: The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF. METHODS: This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage. Linear modeling was used to compare relationships among biomarkers and physical symptoms between cohorts. RESULTS: Worse myocardial stress, systemic inflammation and endothelial dysfunction were associated with worse physical symptoms in moderate HF (n=48), but less physical symptom burden in advanced HF (n=48). CONCLUSIONS: Where patients are in the HF trajectory needs to be taken into consideration when exploring biological underpinnings of physical HF symptoms.


Assuntos
Biomarcadores/sangue , Insuficiência Cardíaca/sangue , Adulto , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
J Cardiovasc Nurs ; 33(2): 160-167, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28731914

RESUMO

BACKGROUND: Overnight observation is the standard of care for uncomplicated elective percutaneous coronary intervention (PCI). However, same-day discharge (SDD) is reportedly safe using predetermined criteria and patient risk categories. Characteristics of patients with SDD have not yet been described. OBJECTIVE: The purpose of this study was to describe the phenotype of patients appropriate for SDD after PCI without predetermined criteria and patient risk categories. METHODS: Analysis of PCI registry data was conducted on patients (n = 2174) who underwent elective and nonelective PCI between January 2012 and June 2014. Preliminary analysis included descriptive statistics, t tests, and χ tests. All variables were analyzed using random forest plot to determine importance of predictors of SDD followed by confirmatory logistic regression. RESULTS: Random forest plot indicated 6 predictors of SDD. Confirmatory logistic regression using a model with all 6 predictors indicated that the model was able to distinguish between patients with SDD and overnight observation after PCI and was statistically significant (χ(7.12, N = 2174) = 511.12, P < .005). Strongest predictors of SDD were stable angina (odds ratio, 5.93 [95% confidence interval, 1.316-26.712]; P = .020) followed by non-ST elevation myocardial infarction/high-risk unstable angina (odds ratio, 1.66 [95% confidence interval, 1.239-2.225]; P = .001). Readmission within 24 hours of SDD after PCI was low at 0.91%. CONCLUSIONS: Age, access site, complexity, and number of lesions stented did not preclude SDD. A broader range of patients, particularly patients in higher risk categories (non-ST elevation myocardial infarction and unstable angina), are candidates for SDD.


Assuntos
Doença da Artéria Coronariana/cirurgia , Tempo de Internação , Alta do Paciente , Intervenção Coronária Percutânea , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco
17.
J Cardiovasc Nurs ; 32(2): 140-147, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26696036

RESUMO

BACKGROUND: Symptoms are known to predict survival among patients with heart failure (HF), but discrepancies exist between patients' and health providers' perceptions of HF symptom burden. OBJECTIVE: The purpose of this study is to quantify the internal consistency, validity, and prognostic value of patient perception of a broad range of HF symptoms using an HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v. 3. METHODS: Factor analysis of the HF Somatic Perception Scale was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire. Divergent validity was examined using the Self-care of HF Index self-care management score. One-year survival based on HF Somatic Perception Scale scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics, and lab values. RESULTS: The sample was 63% male, 85% white, 67% functionally compromised (New York Heart Association class III-IV) with a mean (SD) age of 63 (12.8) years. Internal consistency of the HF Somatic Perception Scale was α = .90. Convergent (r = -0.54, P < .0001) and divergent (r = 0.18, P > .05) validities were supported. Controlling for Seattle HF scores, HF Somatic Perception Scale was a significant predictor of 1-year survival, with those most symptomatic having worse survival (hazard ratio, 1.012; 95% confidence interval, 1.001-1.024; P = .038). CONCLUSIONS: Perception of HF symptom burden as measured by the HF Somatic Perception Scale is a significant predictor of survival, contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms, may be useful in evaluating therapeutic outcomes and predicting event-free survival.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Sintomas Inexplicáveis , Avaliação de Sintomas , Adulto , Idoso , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Psicometria , Reprodutibilidade dos Testes , Estudos Retrospectivos , Taxa de Sobrevida
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