Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients.

BACKGROUND: Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation. METHODS: ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 +/- 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group x Time effects,chi(2)for percentage with clinically significant anxiety and depression at each time point, and logistic regression. RESULTS: All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P < 0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups. CONCLUSIONS: A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant.

Nutrient intake in heart failure patients.

BACKGROUND AND RESEARCH OBJECTIVE: Approximately 50% of heart failure (HF) patients are thought to be malnourished, and macronutrient and micronutrient deficiencies may potentially aggravate HF symptoms. Thus, concerns have been raised about the overall nutrient composition of diets in HF populations. The purpose of this study was to examine the macronutrient and micronutrient intake by caloric adequacy among community-dwelling adults with HF. PARTICIPANTS AND METHODS: A secondary analysis of baseline data of participants in an HF lifestyle intervention study was conducted. Participants (n = 45) were predominantly male (55.6%), white, and non-Hispanic (64.4%); had a mean age of 61 years (SD, 11 years) and mean body mass index of 31.2 kg/m (SD, 7.3 kg/m); were of New York Heart Association functional classes II and III (77.8%); and had a mean ejection fraction of 31.9% (SD, 13.2%); and 69% had a college or higher level of education. The Block Food Habits Questionnaire was used to assess the intake of macronutrients and micronutrients. Analysis included descriptive statistics and Mann-Whitney U tests. RESULTS AND CONCLUSIONS: Individuals reporting inadequate daily caloric intake reported a lower intake of macronutrients and micronutrients as well as other differences in dietary patterns compared with individuals reporting adequate daily caloric intake. More than half of the individuals reporting adequate caloric intake did not meet the recommended dietary allowance for magnesium and vitamin E. Interventions aimed at increasing overall intake and nutrient density are suggested. Further research is needed to better understand the relationship between dietary factors and outcomes in HF.

Implantable cardioverter defibrillator storm: nursing care issues for patients and families.

Implantable cardioverter defibrillators (ICDs) are being used for primary and secondary prevention of life-threatening cardiac arrhythmias, and evidence suggests that increased use is likely in the future. ICD storm, the delivery of two or more shocks within 24 hours, occurs in 10% to 20% of patients who have ICDs and can have long-lasting psychological and physical consequences. An understanding of the factors associated with ICD storm, relevant assessment, and patient and family teaching and counseling can help clinicians to better meet the needs of patients who have experienced ICD storm.

Family education and support interventions in heart failure: a pilot study.

BACKGROUND: Self-management of dietary sodium restriction by persons with heart failure (HF) is difficult and usually occurs within the home setting and within a family context. OBJECTIVE: To compare a patient and family education (EDUC) intervention with a combined education and family partnership intervention (EDUC + FPI) for effects on improving dietary sodium self-management in persons with HF. METHODS: Patients with HF and a family member (FM) were randomized to EDUC (n = 29 dyads) or EDUC + FPI (n = 32 dyads). Participants with HF were primarily White males with a mean age of 61 years (+/-12). The FMs were primarily women and spouses and had a mean age of 54 years (+/-17). Self-reported dietary sodium (Diet NA) intake and 24-hr urinary sodium (Urine NA) were measured at baseline (BL) and 3 months (3M) after intervention. Data were analyzed with descriptive statistics, generalized least squares regression, paired t test, and chi-square test. RESULTS: Groups did not differ by age, gender, or clinical variables; however, family functioning (Family APGAR) scores were slightly higher in the EDUC + FPI group at BL. Both groups decreased Diet NA and Urine NA from BL to 3M; the EDUC + FPI group showed greater decrease in Urine NA and had a greater percentage of those who decreased Urine NA by at least 15% (p = .04). Regression analysis to predict Urine NA revealed a significant Group x Time interaction (p = .03) when accounting for time-varying measures of body mass index (p = .001). DISCUSSION: A family-focused intervention may be useful in reducing dietary sodium intake in persons with HF. The Urine NA results support the importance of incorporating family-focused education and support interventions into HF care.