The influence of depression and anxiety symptoms on health-related quality of life in patients with atrial fibrillation and atrial flutter.

BACKGROUND: The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. OBJECTIVES: The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. METHODS: In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. RESULTS: Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R² = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R² = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R² = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. CONCLUSION: In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.

Pathophysiological relationships between heart failure and depression and anxiety.

Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.

Gender differences in the predictors of depression among patients with heart failure.

BACKGROUND: Depression is common in patients with heart failure. The prevalence of depression is known to differ in male and female patients with heart failure, but little is known about whether these patients differ in predictors of depression. The purposes of this study were to: (1) determine whether the prevalence of depression in patients with heart failure differed by gender: (2) examine if predictors of depression differed by patient gender. METHODS: In this cross-sectional observational study, 147 patients with a primary diagnosis of heart failure completed five self-report questionnaires: demographic and clinical characteristic questionnaire, Mishel Uncertainty in Illness Scale, Beck Depression Inventory-II, Social Support Scale and Minnesota Living with Heart Failure Questionnaire. Data were analyzed with logistic regression. RESULTS: The majority of subjects were male (54.4%), with a mean age of 71.04 ± 13.29 years and mean ejection fraction of 46.42 ± 17.02%. About two-thirds of male patients (65%) and of female patients (65.7%) had significant depressive symptoms (Beck Depression Inventory-II score ≥14). More female than male patients had moderate or severe depressive symptoms. Stratified analyses revealed that significant independent predictors of depressive symptoms among males were being unemployed (odds ratio=.09, 95% confidence intervals=.02- .54), lower ejection fraction (odds ratio=.96, 95% confidence intervals=.92-1.00), and worse quality of life (odds ratio=1.09, 95% confidence intervals=1.05-1.14); among females, predictors were uncertainty (odds ratio=1.09, 95% confidence intervals=1.04-1.32) and worse quality of life (odds ratio=1.17, 95% confidence intervals=1.08-1.48). CONCLUSIONS: Different variables predicted the presence of significant depressive symptoms in male and female patients with heart failure, but quality of life was an important factor in predicting depression in both genders.

Current status of spirituality in cardiac rehabilitation programs: a review of literature.

PURPOSE: Strong spiritual experiences in life are a protective, positive, prognostic factor in cardiovascular diseases. However, spirituality is often neglected in cardiac rehabilitation (CR) programs. The purpose of this article was to review studies that investigated spirituality in CR programs. METHODS: The electronic databases PubMed, CINHAL, PsycINFO, and Cochrane Library of Systematic Reviews were searched for studies that measured spirituality in a CR population. The search included studies with and without spiritual interventions in CR settings. RESULTS: Five quantitative studies and 1 qualitative study that enrolled a total of 1636 patients in phase 2 CR programs were reviewed. The spiritual interventions found were relaxation responses and spiritual classes. Two studies showed preliminary evidence that supports the further exploration of spiritual interventions in CR programs. CONCLUSIONS: Evidence supporting the use of spiritual interventions for medical and psychological outcomes in CR programs is very limited because of a lack of controlled clinical trials. However, the descriptive and observational studies provide some empirical support to further explore spiritual interventions in CR programs, with the goal of enhancing the psychosocial and emotional status of CR participants. Further rigorous research design and procedures are needed to establish the contribution of spirituality in CR programs for cardiac patients.

Effects of interventions on depression in heart failure: a systematic review.

OBJECTIVE: We sought to conduct a systematic review to evaluate the effects of interventions on depression in adults with heart failure (HF). METHODS: Published, peer-reviewed, English-language, prospective interventional studies were identified in a search of Medline, CINAHL, PsychINFO, and the Cochrane Libraries of Systematic Reviews and Clinical Trials from 1996 through August 2011 and relevant bibliographies. Eligible studies included patients with New York Heart Association functional class II and III HF with experimental or quasiexperimental designs and preintervention and postintervention measures of depression. Ineligible studies were nonpharmacologic with a sample size <50, and drug studies without a comparison group. RESULTS: Twenty-three experimental and quasiexperimental studies that enrolled a total of 3564 persons with HF contributed evidence about 6 types of interventions: selective serotonin reuptake inhibitors (SSRIs), an erythropoiesis-stimulating agent, exercise, disease management programs, complementary and alternative medicine (CAM), and a multimodal intervention of cognitive behavioral therapy and exercise. Studies with SSRIs examined effects of sertraline, paroxetine, and citalopram. The CAM interventions included tai chi, progressive muscle relaxation therapy, and mindfulness-based stress reduction. CONCLUSIONS: Evidence is strong that pharmacology and CAM may improve depression. Moderate evidence supports the use of exercise. A strong body of evidence indicates that disease management programs do not improve depression. This review does not support the development of guidelines for treatment of depression in persons with HF because evidence is insufficient and, at times, contradictory.

Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study.

AIM: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors. BACKGROUND: The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences. METHODS: Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005. RESULTS: In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale. CONCLUSION: The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.

Quality of life and psychological status of patients with implantable cardioverter defibrillators.

BACKGROUND: Implantable cardioverter defibrillators reduce mortality in patients at high risk for sudden cardiac death and in patients with heart failure. Patients with defibrillators often experience psychological distress and poor quality of life, which can potentiate pathological processes that increase the risk for sudden cardiac death. To achieve the full benefits of the defibrillators, patients must maintain their psychological status and quality of life. OBJECTIVES: To review the research on psychological status and quality of life of patients with implantable cardioverter defibrillators and suggest nursing interventions to improve the patients' health. METHOD: Searches of PubMed were used to find articles on depression, anxiety, and quality of life in patients with implantable cardioverter defibrillators. RESULTS: Poor quality of life is associated with anxiety and depression in patients with implantable cardioverter defibrillators. Discharges of the devices have adverse consequences for patients' psychological status and quality of life. Younger patients are at highest risk for psychological distress and poor quality of life after implantation. Longitudinal research would facilitate determining the course of the changes in psychological status and quality of life during the time patients have the defibrillators. More intensive intervention may be necessary for the most vulnerable recipients: patients who are young, have experienced shocks, and are in psychological distress. CONCLUSIONS: Poor quality of life and depression are common in patients with implantable cardioverter defibrillators. Nursing interventions to reduce psychological distress and improve quality of life may reduce morbidity and mortality in these patients. Additional research is needed to determine effective interventions.

The influence of age, gender, and race on the prevalence of depression in heart failure patients.

OBJECTIVES: The goal of this study was to determine the prevalence of depression in an out-patient heart failure (HF) population; its relationship to quality of life (QOL); and the impact of gender, race, and age. BACKGROUND: Most studies of depression in HF have evaluated hospitalized patients (a small percentage of the population) and have ignored the influence of various patient characteristics. Although reported depression rates among hospitalized patients range from 13% to 77.5%, out-patient studies have been small, have reported rates of 13% to 42%, and have not adequately accounted for the impact of age, race, or gender. METHODS: A total of 155 patients with stable New York Heart Association functional class II, III, and IV HF and an ejection fraction <40% were given questionnaires to assess QOL and depression. These included the Medical Outcomes Study Short Form, the Minnesota Living with Heart Failure questionnaire, and the Beck Depression Inventory (BDI). Depression was defined as a score on the BDI of > or =10. RESULTS: A total of 48% of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring QOL. However, they did not differ in ejection fraction or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers. CONCLUSIONS: Depression is common in patients with HF, with age, gender, and race influencing its prevalence in ways similar to those observed in the general population. These data suggest that pharmacologic or non-pharmacologic treatment of depression might improve the QOL of HF patients.

Health risk behaviors in smoking and non-smoking young women.

PURPOSE: To compare the health, health risk behaviors and stress levels of college female smokers and non-smokers. DATA SOURCES: Forty-one college women, ages 18-21 years, participated in an interview and completed a health survey and the Derogatis Stress Profile. CONCLUSIONS: The smokers perceived themselves to be more overweight (Chi square, p = < .001). Smokers used more marijuana (Chi square, p = < .003) and had higher scores on depression [t (39) = 2.29, p = .028], hostility [t (39) = 2.562, p = .014] and perceived quality of health [t (39) = 2.72, p = .01]. In the interview, smokers identified social situations involving alcohol as the time they would most likely smoke. Smokers did not smoke when ill and all were interested in quitting. The non-smoking women support smoking cessation for their peers. IMPLICATIONS FOR PRACTICE: College alcohol and substance use prevention and treatment programs should address tobacco cessation. The majority of college women are not smokers and could be resources to encourage smoking cessation among their peers. Smoking cessation at this age has dramatic implications for future health.

Depression in patients with heart failure: physiologic effects, incidence, and relation to mortality.

Heart failure affects 4.8 million people in the United States. Patients depressed after myocardial infarction have increased morbidity and mortality. Only a few studies have investigated the effects of depression in patients with heart failure. The incidence of depression in heart failure ranges from 13% to 77.5%. Men with heart failure are more likely to become depressed than the general population. Depression incidence is higher in hospitalized patients with heart failure than in stabilized outpatients. In patients with heart failure, depression is associated with mortality. Physiologic changes, which occur in depressed patients, have been implicated as possibly contributing to the increased mortality. Nurses have a major role in the management of patients with heart failure and can be pivotal in the detection and treatment of depression in these patients. Reduction in depression is likely to decrease morality in patients with heart failure.

A review of nursing research on blood pressure.

PURPOSE: To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research. ORGANIZING CONSTRUCT: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement. METHODS: This 10-year literature review 1990-1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article. FINDINGS: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurements of BP under multiple conditions increased, but measurement within conditions did not. CONCLUSIONS: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.

Tobacco dependence curricula in acute care nurse practitioner education.

BACKGROUND: Tobacco dependence is the leading preventable cause of death in the United States, yet healthcare professionals are not adequately educated on how to help patients break the deadly cycle of tobacco dependence. OBJECTIVE: To assess the content and extent of tobacco education in the curricula of acute care nurse practitioner programs in the United States. METHODS: A survey with 13 multiple-choice items was distributed to the coordinators of 72 acute care nurse practitioner programs. The survey was replicated and modifiedfrom previous research on tobacco dependence curricula in undergraduate medical education. RESULTS: Fifty programs (83%) responded to the survey. Overall, during an entire course of study, 70% of the respondents reported that only between 1 and 3 hours of content on tobacco dependence was covered. Seventy-eight percent reported that students were not required to teach smoking-cessation techniques to patients, and 94% did not provide opportunities for students to be certified as smoking-cessation counselors. Sixty percent reported that the national guidelines for smoking cessation were not used as a curriculum reference for tobacco content. CONCLUSIONS: The majority of acute care nurse practitioner programs include brief tobacco education. More in-depth coverage is required to reduce tobacco dependence. Acute care nurse practitioners are in a prime position to intervene with tobacco dependence, especially when patients are recovering from life-threatening events. National recommendations for core tobacco curricula and inclusion of tobacco questions on board examinations should be developed and implemented.