Determinants of depressive symptoms in patients with heart failure based on the hopelessness theory of depression.

AIMS: Depressive symptoms are common in patients with heart failure (HF) and are associated with adverse outcomes in this group. This study examined depressive symptoms and associated determinants in patients with HF based on the hopelessness theory of depression. METHODS AND RESULTS: In this cross-sectional study, a total of 282 patients with HF were recruited from 3 cardiovascular units of a university hospital. Symptom burden, optimism, maladaptive cognitive emotion regulation strategies (MCERSs), hopelessness, and depressive symptoms were assessed using self-reported questionnaires. A path analysis model was established to evaluate the direct and indirect effects. The prevalence of depressive symptoms was 13.8% in the patients. Symptom burden had the greatest direct effect on depressive symptoms (ß = 0.406; P < 0.001), optimism affected depressive symptoms both directly and indirectly with hopelessness as the mediator (direct: ß = -0.360; P = 0.001; indirect: ß = -0.169; P < 0.001), and MCERSs only had an indirect effect on depressive symptoms with hopelessness as the mediator (ß = 0.035; P < 0.001). CONCLUSION: In patients with HF, symptom burden, decreased optimism, and hopelessness contribute to depressive symptoms directly. What is more, decreased optimism and MCERS lead to depressive symptoms indirectly via hopelessness. Accordingly, interventions aimed at decreasing symptom burden, enhancing optimism, and reducing the use of MCERSs, while declining hopelessness, may be conducive to relieving depressive symptoms in patients with HF.

DNA-Functionalized Porphyrinic Metal-Organic Framework-Based Drug Delivery System for Targeted Bimodal Cancer Therapy.

A DNA-functionalized porphyrinic MOF (porMOF) drug delivery system was successfully constructed. porMOF as a photosensitizer and drug delivery carrier can integrate photodynamic therapy (PDT) and chemotherapy. Via the strong coordination interaction between the zirconium cluster of porMOF and the terminal phosphate group of DNA, the stable modification of the DNA layer on the porMOF surface is achieved. Meanwhile, the introduction of C/G-rich base pairs into the DNA double-stranded structure provides more binding sites of chemotherapeutic drug doxorubicin (DOX). AS1411, an aptamer of nucleolin proteins that are overexpressed by cancer cells, is introduced in the double-stranded terminal, which can endow the nanosystem with the ability to selectively recognize cancer cells. C-rich sequences in DNA double strands form an i-motif structure under acidic conditions to promote the highly efficient release of DOX in cancer cells. In vitro and in vivo experiments demonstrate that the synergistic PDT/chemotherapy modality achieves highly efficient cancer cell killing and tumor ablation without undesirable side effects.

Dyadic Associations Between Burden and Depressive Symptoms Among Patients With Heart Failure and Their Caregivers: The Mediating Role of Perceived Stress.

BACKGROUND: Depressive symptoms are prevalent in patients with heart failure and their family caregivers. Given the interpersonal interactions between dyadic individuals with intimate relationship, it is essential to consider the dyads as a unit when exploring the factors associated with depressive symptoms in heart failure patient-caregiver dyads. OBJECTIVE: The aims of this study were to explore the dyadic effects of burden on depressive symptoms in heart failure patient-caregiver dyads and investigate whether perceived stress acts as a mediator in these relationships. METHODS: In this cross-sectional study, 237 heart failure patient-caregiver dyads were recruited from 3 hospitals in China between November 2018 and June 2019. Symptom burden, caregiving burden, perceived stress, and depressive symptoms were assessed using self-report questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were used to analyze the data. RESULTS: Patients' symptom burden had an actor effect on their own depressive symptoms and a partner effect on their caregivers' depressive symptoms. Similarly, caregivers' caregiving burden had an actor effect on their own depressive symptoms and a partner effect on patients' depressive symptoms. The actor effects between burden and depressive symptoms were partially mediated by their own perceived stress in heart failure patient-caregiver dyads. Furthermore, the partner effect between caregivers' caregiving burden and patients' depressive symptoms was completely mediated by patients' perceived stress. CONCLUSIONS: Patients' symptom burden and caregivers' caregiving burden aggravated their depressive symptoms by increasing their own perceived stress. Moreover, patients' symptom burden led to caregivers' depressive symptoms, and caregivers' caregiving burden contributed to patients' depressive symptoms through patients' perceived stress. These interdependent relationships suggest that dyadic interventions focused on reducing burden and perceived stress may be beneficial for relieving depressive symptoms in heart failure patient-caregiver dyads.

The effects of weight management on heart failure: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Weight management is an important part of disease management in patients with heart failure. However, the effectiveness of reported weight management interventions is inconclusive. AIMS: The aim of this systematic review and meta-analysis was to assess the effects of weight management on functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure. METHODS: PubMed, Web of Science, Embase, and the Cochrane Library were searched on April 3, 2022. This study was registered with PROSPERO (CRD42021283817). Eligible studies assessed functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure. Two researchers independently screened the articles, extracted data, and evaluated the risk bias of each study. Dichotomous variables were presented as OR with a 95% confidence interval (CI). The data were analyzed using a fixed effect or random effect model, and heterogeneity was determined using I2 statistics. All statistical analyses were conducted using RevMan 5.3. RESULTS: Among 4279 studies screened, seven randomized controlled trials were included in this study. The results showed that weight management significantly improved functional status (OR = 0.15, 95% CI [0.07, 0.35], I2 = 52%) and reduced the risk of all-cause mortality (OR = 0.54, 95% CI [0.34, 0.85], I2 = 0%), but had no significant effect on heart failure-related hospitalizations (OR = 0.72, 95% CI [0.20, 2.66]). LINKING EVIDENCE TO ACTION: Weight management has effects on improved functional status and reduced all-cause mortality in patients with heart failure. It is necessary to strengthen the weight management interventions of patients with heart failure to improve patients' functional status and reduce all-cause mortality.

Relationship Between Physical Symptoms and Loneliness in Patients with Heart Failure: The Serial Mediating Roles of Activities of Daily Living and Social Isolation.

OBJECTIVES: This study aimed to examine the multiple mediation effects of activities of daily living and social isolation on the relationship between physical symptoms and loneliness in patients with heart failure. DESIGN: We adopted a cross-sectional descriptive survey. SETTING AND PARTICIPANTS: A total of 303 patients with heart failure were recruited at 2 general hospitals in China from November 2019 to December 2020. METHODS: Information on loneliness was assessed using the Loneliness Scale of the University of California at Los Angeles (version 3), physical symptoms were evaluated using the Symptom Status Questionnaire-Heart Failure, the Activity of Daily Living Scale was used to evaluate activities of daily living, the Lubben Social Network Scale was used to measure social isolation. The serial mediation model was examined using PROCESS macro in SPSS. RESULTS: Of the 303 patients, 66.7% experienced mild loneliness and 21.8% experienced moderate or severe loneliness. Multiple mediation analysis showed that physical symptoms had a direct effect on loneliness (effect = 0.210; 95% confidence interval (CI) 0.099-0.320) and the link between physical symptoms and loneliness through 3 indirect pathways: (1) activities of daily living (effect = 0.043; 95% CI 0.006‒0.086), accounting for 20.48% of the total effect; (2) social isolation (effect = 0.060; 95% CI 0.005‒0.120), accounting for 28.57% of the total effect; and (3) activities of daily living and social isolation in series (effect = 0.049; 95% CI 0.024‒0.081), accounting for 23.33% of the total effect. The total mediating effect was 72.38%. CONCLUSIONS AND IMPLICATIONS: Activities of daily living and social isolation sequentially mediated the relationship between physical symptoms and loneliness in patients with heart failure. Therefore, attention to reducing activities of daily living limitations and social isolation may be beneficial to reducing loneliness, apart from alleviating physical symptoms.

Psychosocial factors associated with career success among nurses: A latent profile analysis.

AIM: In this study, a person-centred approach was used to analyse career success profiles and explore the associated psychosocial factors among nurses. DESIGN: A cross-sectional study was conducted from 15 April to 15 October 2019. METHODS: A total of 1155 registered Chinese nurses were recruited from two general hospitals using convenience sampling. Participants completed a printed questionnaire, including the Maslach Burnout Inventory, Stress of Conscience Questionnaire, Practice Environment Scale, and Career Success Scale. Latent profile analysis and multinomial logistic regression were performed. The data were analysed with Mplus 8.3 and SPSS version 26.0. RESULTS: Three latent profiles of career success were identified: high, moderate and low. Nurses with lower educational levels, more years of work experience, lower emotional exhaustion, higher personal achievement, lower stress of conscience and higher participation in hospital affairs were more likely to have higher career success than the other profiles. CONCLUSIONS: Burnout, stress of conscience, practice environment, educational level and years of work experience were associated with career success among nurses. Targeting interventions may help enhance nurses' career success. Future research should combine subjective and objective indicators (salary, title and so on) to assess career success and explore other determinants for formulating interventions to enhance nurses' career success. IMPACT: The heterogeneity and psychosocial factors associated with nurses' career success provide valuable evidence for the formulation of individualized interventions. Nursing managers should understand the importance of career success, develop interventions to reduce nurses' burnout and stress of conscience, and improve the practice environment to enhance their career success. NO PATIENT OR PUBLIC CONTRIBUTIONS: This study was designed to examine the psychosocial factors associated with nurses' career success. The study was not conducted using suggestions from the patient groups or the public.

Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure.

Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (ß = .222, p = .011) and physical symptoms (ß = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (ß = -.241, p < .01) and family functioning (ß = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.

Fear of movement and its associated psychosocial factors in heart failure patients: a cross-sectional study.

AIMS: Fear of movement is a significant obstacle to daily activities, which may lead to adverse outcomes in patients with heart failure. This study aimed to examine the prevalence of fear of movement and to identify psychosocial factors associated with fear of movement in heart failure patients. METHODS AND RESULTS: In this cross-sectional study, a total of 305 heart failure patients were recruited from three cardiovascular units of a university hospital. Self-reported questionnaires were used to measure fear of movement, cardiac anxiety, depressive symptoms, subjective social status, education, monthly income, and employment status. The results showed that 178 (58.4%) patients were accompanied with fear of movement. Hierarchical linear regression analysis showed that scores for cardiac anxiety (ß = 0.254, P < 0.001) and depressive symptoms (ß = 0.308, P < 0.001), as well as being employed (ß = 0.186, P < 0.001) were positively associated with fear of movement score, while the score for subjective social status (ß = -0.101, P = 0.038) was negatively associated with fear of movement score. The four independent variables accounted for 30.3% of the variance in fear of movement. CONCLUSIONS: Fear of movement is common in patients with heart failure. Cardiac anxiety, depressive symptoms, subjective social status, and employment status were associated with patients' fear of movement. This indicates that measures should be taken to screen and manage patients' fear of movement. Furthermore, alleviating cardiac anxiety and depressive symptoms may be important to consider in relieving fear of movement in heart failure patients, especially for those who are employed and with low subjective social status.

Mitolysosome exocytosis, a mitophagy-independent mitochondrial quality control in flunarizine-induced parkinsonism-like symptoms.

Mitochondrial quality control plays an important role in maintaining mitochondrial homeostasis and function. Disruption of mitochondrial quality control degrades brain function. We found that flunarizine (FNZ), a drug whose chronic use causes parkinsonism, led to a parkinsonism-like motor dysfunction in mice. FNZ induced mitochondrial dysfunction and decreased mitochondrial mass specifically in the brain. FNZ decreased mitochondrial content in both neurons and astrocytes, without affecting the number of nigral dopaminergic neurons. In human neural progenitor cells, FNZ also induced mitochondrial depletion. Mechanistically, independent of ATG5- or RAB9-mediated mitophagy, mitochondria were engulfed by lysosomes, followed by a vesicle-associated membrane protein 2- and syntaxin-4-dependent extracellular secretion. A genome-wide CRISPR knockout screen identified genes required for FNZ-induced mitochondrial elimination. These results reveal not only a previously unidentified lysosome-associated exocytosis process of mitochondrial quality control that may participate in the FNZ-induced parkinsonism but also a drug-based method for generating mitochondria-depleted mammal cells.

The relationship between mutuality and contributions to self-care in family caregivers of patients with heart failure: multiple mediating effects of resilience and self-efficacy.

AIMS: Previous studies have indicated a positive association between mutuality and caregiver contributions to heart failure self-care (CC-HFSC). However, little is known about the underlying mechanisms in the relationship. This study aimed to determine whether resilience and self-efficacy play multiple mediating roles in the association between mutuality and CC-HFSC. METHODS AND RESULTS: In this cross-sectional, correlational study, a self-reported survey was conducted in 259 patient-caregiver dyads recruited from two hospitals in China using a convenience sampling method. Better mutuality (r = 0.27, P < 0.01), resilience (r = 0.23, P < 0.01), and self-efficacy (r = 0.34, P < 0.01) were correlated with greater CC-HFSC maintenance. Better mutuality (r = 0.29, P < 0.01), resilience (r = 0.20, P < 0.01), and self-efficacy (r = 0.35, P < 0.01) were correlated with greater CC-HFSC management. In multiple mediation models, self-efficacy independently [effect = 0.061, 95% confidence interval (CI) (0.024-0.119)] and resilience and self-efficacy serially [effect = 0.017, 95% CI (0.007-0.036)] mediated the association between mutuality and CC-HFSC maintenance. Meanwhile, self-efficacy independently [effect = 0.058, 95% CI (0.020-0.113)] and resilience and self-efficacy serially [effect = 0.018, 95% CI (0.007-0.038)] mediated the association between mutuality and CC-HFSC management. CONCLUSIONS: Resilience and self-efficacy were multiple mediators in the association between mutuality and CC-HFSC. Interventions targeting the facilitation of mutuality, and then increasing resilience and self-efficacy may be beneficial for improving CC-HFSC.

Experiences of Disease Adaptation in Patients With Heart Failure: A Qualitative Study.

This study aimed to explore the experiences of adaptation in heart failure (HF) patients according to the Roy adaptation model. A qualitative study was conducted between December 2020 and March 2021 in China. A total of 21 patients with HF were recruited at of two general hospitals. Semi structured face-to-face interviews were conducted with each participant. NVivo 11 was used to encode the transcription and thematic analysis was preformed to analyze the transcripts. Eleven minor themes emerged from the data, namely unbalanced nutrition, inappropriate activities, unrestricted liquid intake, excessive sodium intake, worrying about the future, negative emotions, poor spiritual aspect, unable to fulfill social roles, forced to stop work, interpersonal alienation, and less communication with friends or family. Most participants with HF experienced poor disease adaptation. The themes that emerged offer a new perspective on the experiences of disease adaptation in patients with HF.

Association between sleep and quality of life in heart failure patient-caregiver dyads and mediation of fatigue: An actor-partner interdependence mediation model.

AIMS: Quality of life is essential to heart failure patients and their family caregivers. This study aimed to examine the mediating role of fatigue in the association between sleep and quality of life in heart failure patient-caregiver dyads. DESIGN: A cross-sectional descriptive study was conducted from November 2017 to August 2018. METHODS: A total of 269 heart failure patient-caregiver dyads at two hospitals in China were included. The Chinese version of the Pittsburgh Sleep Quality Index, the Chalder Fatigue Scale and the 12-item Short-Form Health Survey were used to collect data on heart failure patients and their family caregivers. The structural equation model was employed in the dyadic analysis based on the actor-partner interdependence mediation model. RESULTS: Regarding the actor effects, poor sleep was negatively associated with physical and mental quality of life in heart failure patients and their family caregivers, respectively, and the relationship was mediated by their fatigue. Regarding the partner effects, caregivers' fatigue was positively associated with patients' physical quality of life and mediated the association between caregivers' sleep and patients' physical quality of life. CONCLUSIONS: Heart failure patients and their family caregivers experience reduced quality of life when they have poor sleep and fatigue, and caregivers' fatigue is related to patients' improved physical quality of life. Hence, dyadic interventions targeting to improving sleep and fatigue may be beneficial to their quality of life. IMPACT: This study highlights the importance of routinely measuring and managing sleep and fatigue for heart failure patients and their family caregivers. Effective dyadic-based interventions that maintain equal attention to family caregivers should be considered by healthcare providers to maximize the improvement of patients' quality of life.

Sedentary behavior and health outcomes in patients with heart failure: a systematic review and meta-analysis.

A better understanding of the association between sedentary behavior and heart failure is essential for the development of interventions to improve patients' outcomes. Therefore, a systematic review was conducted to determine the association between sedentary behavior and all-cause mortality, health-related quality of life, and depression in heart failure patients. We searched Web of Science, PubMed, Embase, and Cochrane Library and articles in references on 7 May 2021. The search results were limited to articles on heart failure patients over the age of 18, observational studies investigating the association between sedentary behavior and heart failure, and studies reporting one or more outcomes of interest. Two reviewers independently screened the literature and extracted data. Strengthening the Reporting of Observational Studies in Epidemiology was used to assess the quality of articles. Nine observational studies were included, of which, four were of high quality. Four cohort studies indicated that sedentary behavior was significantly associated with increased all-cause mortality (hazard ratio: 1.97; 95% confidence interval: 1.60 to 2.44; I2 = 38.9%). In addition, subgroup analysis based on geographical regions was conducted (hazard ratio: 1.82; 95% confidence interval: 1.46 to 2.29; I2 = 0%). Sedentary behavior was associated with worse health-related quality of life in patients with heart failure, and the regression coefficients ranged from 0.004 to 0.033 (95% confidence interval: 0.0004 to 0.055). Although sedentary behavior was associated with increased all-cause mortality and worse quality of life in patients with heart failure, further studies are needed to determine whether this association is causal.

The multiple mediating effects of social connectedness and self-care confidence on the relationship between subjective social status and emotional well-being in patients with heart failure: a cross-sectional study.

BACKGROUND: Previous studies have shown that subjective social status (SSS) was positively associated with well-being in various populations. However, little is known about the relationship considering the underlying mechanism in patients with heart failure (HF). AIMS: The aim was to study the effects of social connectedness and self-care confidence on the relationship between SSS and well-being in patients with HF according to the Reserve Capacity Model. METHODS AND RESULTS: We recruited 296 patients from a general hospital using convenience sampling. SSS, social connectedness, self-care confidence, and well-being were assessed using self-reported questionnaires. A multiple mediation model was examined using the PROCESS macro in SPSS.Higher levels of SSS (r = 0.18, P < 0.01), social connectedness (r = 0.21, P < 0.01), and self-care confidence (r = 0.20, P < 0.01) were positively correlated with better emotional well-being, but not with physical well-being. The multiple mediation analysis revealed that the relationship between SSS and emotional well-being was mediated by social connectedness (effect: 0.061, 95% CI [0.014, 0.148]) and self-care confidence (effect: 0.110, 95% CI [0.006, 0.249]) separately, and together in serial (effect: 0.008, 95% CI [0.001, 0.028]). CONCLUSIONS: Social connectedness and self-care confidence are multiple mediators of the relationship between SSS and emotional well-being. Interventions targeting to strengthening social connectedness and self-care confidence may improve emotional well-being directly. In addition, emotional well-being may be improved by enhancing SSS indirectly in patients with HF.

The Heterogeneity of Physical and Anxiety Symptoms and Quality of Life Among Patients With Heart Failure: A Latent Class Analysis.

BACKGROUND: Patients with heart failure (HF) experience a severe burden of symptoms and reduced quality of life (QoL). However, little is known about the heterogeneity of these symptoms and the association with QoL. OBJECTIVES: The aims of this study were to conduct a latent class analysis on co-occurring physical and anxiety symptoms and to determine whether the underlying subgroups differ regarding the QoL among patients with HF. METHODS: The authors of this cross-sectional study recruited 329 patients with HF from 2 hospitals. Patients' symptoms and QoL were self-reported, and data were analyzed using latent class analysis, χ 2 test, analysis of variance, and hierarchical linear regression analysis. RESULTS: Three latent classes (all low, all high, and high physical-partial anxiety) were identified based on the occurrence of patients' physical and anxiety symptoms. Patients with a lower body mass index, a worse New York Heart Association class, and a longer disease duration were more likely to belong to the all-high class. Hierarchical linear regression analysis showed that distinct subgroups (all low vs all high: ß = -0.299, P < .001; all low vs high physical-partial anxiety: ß = -0.228, P < .001) were significantly associated with the physical summary component score for QoL. Likewise, distinct subgroups (all low vs all high: ß = -0.509, P < .001; all low vs high physical-partial anxiety: ß = -0.128, P = .012) were significantly associated with the mental summary component score for QoL. CONCLUSIONS: Patients with HF showed heterogeneity in physical and anxiety symptoms; the subgroup with severe symptoms exhibited a poor QoL. The associations between symptom subgroups and QoL require targeted symptom-based interventions.

Effects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials - Reprint.

BACKGROUND: Self-management intervention is an important component of disease management in patients with heart failure. It can improve heart failure knowledge, quality of life, and heart failure-related hospitalizations of heart failure patients. However, studies on the effect of two self-management interventions tasks have reported conflicting results. OBJECTIVE: This study conducted an up-to-date systematic review of the literature to evaluate the effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalizations in patients with heart failure. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched PubMed, Embase, Web of Science, Cochrane Library, and the references of articles in 14th December 2019. METHODS: The study characteristics included: authors, year, country, sample size, mean age of patients with heart failure, duration of intervention, recruitment and intervention delivery, interventions based on self-efficacy theory, cognitive behavioral therapy, disease management, self-care education. The risk of bias for each study was assessed independently by two investigators based on the Cochrane Handbook. This study used Revman to analyze different research outcomes. The fixed-effect model was used in the absence of significant heterogeneity or low heterogeneity, and if the heterogeneity was high, the random effect model was used. RESULTS: A total of 4977 publications were retrieved in this study. After eliminating duplicates and screening for titles and abstracts, 209 articles were retrieved for full-text evaluation. Finally, a total sample size analyzed across 15 randomized controlled trials was 2630 participants. This study showed that self-management interventions significantly improved heart failure knowledge (0.61, 95% confidence interval (CI) 0.27-0.95, p = 0.0004), quality of life (0.20, 95% CI 0.02-0.38, p = 0.03), and heart failure-related hospitalization (OR 0.40, 95% CI 0.29 to 0.55, p<0.00001) in patients with heart failure. CONCLUSIONS: This study reveals the beneficial effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalization in patients with heart failure. Therefore, high quality randomized controlled designs are needed to explore the optimal self-management interventions for patients with heart failure. Tweetable abstract: This study reveals self-management interventions can improve heart failure knowledge, quality of life, and reduced heart failure-related hospitalization.

Effects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Self-management intervention is an important component of disease management in patients with heart failure. It can improve heart failure knowledge, quality of life, and heart failure-related hospitalizations of heart failure patients. However, studies on the effect of two self-management interventions tasks have reported conflicting results. OBJECTIVE: This study conducted an up-to-date systematic review of the literature to evaluate the effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalizations in patients with heart failure. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched PubMed, Embase, Web of Science, Cochrane Library, and the references of articles in 14th December 2019. METHODS: The study characteristics included: authors, year, country, sample size, mean age of patients with heart failure, duration of intervention, recruitment and intervention delivery, interventions based on self-efficacy theory, cognitive behavioral therapy, disease management, self-care education. The risk of bias for each study was assessed independently by two investigators based on the Cochrane Handbook. This study used Revman to analyze different research outcomes. The fixed-effect model was used in the absence of significant heterogeneity or low heterogeneity, and if the heterogeneity was high, the random effect model was used. RESULTS: A total of 4977 publications were retrieved in this study. After eliminating duplicates and screening for titles and abstracts, 209 articles were retrieved for full-text evaluation. Finally, a total sample size analyzed across 15 randomized controlled trials was 2630 participants. This study showed that self-management interventions significantly improved heart failure knowledge (0.61, 95% confidence interval (CI) 0.27-0.95, p = 0.0004), quality of life (0.20, 95% CI 0.02-0.38, p = 0.03), and heart failure-related hospitalization (OR 0.40, 95% CI 0.29 to 0.55, p<0.00001) in patients with heart failure. CONCLUSIONS: This study reveals the beneficial effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalization in patients with heart failure. Therefore, high quality randomized controlled designs are needed to explore the optimal self-management interventions for patients with heart failure. Tweetable abstract: This study reveals self-management interventions can improve heart failure knowledge, quality of life, and reduced heart failure-related hospitalization.

Nonpharmacological Interventions for Depressive Symptoms in End-Stage Renal Disease: A Systematic Review.

Depressive symptoms are common in patients with end-stage renal disease, which can affect treatment and prognosis. We aimed to evaluate the effects of nonpharmacological interventions for depressive symptoms in end-stage renal disease. Eligible studies were identified using PubMed, Web of Science, the Cochrane Library, Embase, and PsycNET (up to March 2019). We identified 24 studies including 1,376 patients. We found that psychological intervention (-0.60, 95% confidence interval [CI] = [-0.87, -0.33]), exercise (-1.13, 95% CI = [-1.56, -0.69]), and manual acupressure (-0.26, 95% CI = [-0.50, 0.03]) were associated with a significant effect on depressive symptoms. However, few studies reported adverse events, and conclusions about safety should be drawn cautiously. While the available data show that nonpharmacological interventions are potential strategies to alleviate depressive symptoms of patients with end-stage renal disease, recommendation of the most efficacious interventions for this population will require future randomized controlled trials with large-scale, long-term intervention.

Exercise interventions on patients with end-stage renal disease: a systematic review.

OBJECTIVE:: This study aimed to conduct an up-to-date systematic review of the literature to evaluate the effects of exercise on fatigue, anxiety, depression, physical activity, and quality of life (QOL) in patients with end-stage renal disease. DATA SOURCES:: We searched PubMed (October 2018), Embase (from 1966 to October 2018), Web of Science (from 1900 to October 2018), The Cochrane Library (October 2018), and references of papers. METHODS:: This study includes randomized controlled trials that analyzed the combined effects of exercise intervention on patients with end-stage renal disease. Two reviewers independently screened the retrieved records, extracted data, and assessed the risk of bias for inclusion in the study. The effects of exercise intervention were conducted in the meta-analysis using RevMan 5.3 software. RESULTS:: A total of 614 participants were included in 13 randomized controlled studies. The study revealed that exercise can improve fatigue, anxiety, depression, physical activity, and QOL. The effect value results were as follows: (1) fatigue, -0.97 (95% confidence interval (CI) -1.32 to -0.62, P < 0.00001); (2) anxiety, -0.78 (95% CI -1.17 to -0.39, P < 0.0001); (3) depression, -0.85 (95% CI -1.13 to -0.56, P < 0.00001) (4) physical activity, 38.15 (95% CI 21.20 to 55.10, P < 0.0001); (5) QOL, the physical component of the 36-item Short-Form Health Survey (SF-36), 4.73 (95% CI 1.92 to 7.54, P = 0.0010); and (6) the mental component of the SF-36, 3.42 (95% CI 0.27 to 6.56, P = 0.03). CONCLUSION:: Exercise intervention is more effective in fatigue, anxiety, depression, physical activity, and QOL. However, large-scale randomized controlled trials are needed to confirm the appropriate types of exercise and optimal time for patients with end-stage renal disease.