Synthesis of Long COVID Symptoms: An Evidence-Based Standardized Mapping Study With the Omaha System.

Background: In COVID-19 survivors, symptom burden is a significant and multifaceted personal and societal challenge. The Omaha system is a standardized terminology used by researchers and clinicians for documentation and analysis of meaningful data for whole-person health. Given the urgent need for a standardized symptom checklist specific to the long COVID population, the purpose of the present study was to identify long COVID symptoms from the published literature (native symptoms) and map those to the Omaha system signs/symptoms terms. Methods: The long COVID symptoms identified from 13 literatures were mapped to the Omaha system signs/symptoms, using an expert consensus approach. The criteria for mapping were that the long COVID signs/symptoms had to contain either a one-to-one match (exact meaning of the native terms and the signs/symptoms) or a partial match (similar but not exact meaning). Results: The synthesis of the 217 native symptoms of long COVID and mapping analysis to the Omaha problems and signs/symptoms level resulted in a combined, deduplicated, and standardized list of 74 signs/symptoms for 23 problems. Of these, 72 (97.3%) of native signs/symptoms were a full match at the problem level, and 67 (90.5%) of native signs/symptoms were a full or partial match at the sign/symptoms level. Conclusions: The present study is the first step in identifying a standardized evidence-based symptom checklist for long COVID patients. This checklist may be used in practice and research for assessment, tracking, and intervention planning as well as longitudinal analysis of symptom resolution and intervention effectiveness.

Cardiovascular and cerebral vascular health in females with postacute sequelae of COVID-19.

Many individuals who had coronavirus disease 2019 (COVID-19) develop detrimental persistent symptoms, a condition known as postacute sequelae of COVID-19 (PASC). Despite the elevated risk of cardiovascular disease following COVID-19, limited studies have examined vascular function in PASC with equivocal results reported. Moreover, the role of PASC symptom burden on vascular health has not been examined. We tested the hypothesis that peripheral and cerebral vascular function would be blunted and central arterial stiffness would be elevated in patients with PASC compared with age-matched controls. Furthermore, we hypothesized that impairments in vascular health would be greater in those with higher PASC symptom burden. Resting blood pressure (BP; brachial and central), brachial artery flow-mediated dilation (FMD), forearm reactive hyperemia, carotid-femoral pulse wave velocity (PWV), and cerebral vasodilator function were measured in 12 females with PASC and 11 age-matched female controls without PASC. The severity of persistent symptoms in those with PASC was reported on a scale of 1-10 (higher score: greater severity). Brachial BP (e.g., systolic BP, 126 ± 19 vs.109 ± 8 mmHg; P = 0.010), central BP (P < 0.050), and PWV (7.1 ± 1.2 vs. 6.0 ± 0.8 m/s; P = 0.015) were higher in PASC group compared with controls. However, FMD, reactive hyperemia, and cerebral vasodilator function were not different between groups (P > 0.050 for all). Total symptom burden was not correlated with any measure of cardiovascular health (P > 0.050 for all). Collectively, these findings indicate that BP and central arterial stiffness are elevated in females with PASC, whereas peripheral and cerebral vascular function appear to be unaffected, effects that appear independent of symptom burden.NEW & NOTEWORTHY We demonstrate for the first time that resting blood pressure (BP) and central arterial stiffness are higher in females with PASC compared with controls. In contrast, peripheral and cerebral vascular functions appear unaffected. Moreover, there was no relationship between total PASC symptom burden and measures of BP, arterial stiffness, or vascular function. Collectively, these findings suggest that females with PASC could be at greater risk of developing hypertension, which appears independent of symptom burden.

The Relationships Among Health Literacy, Illness Perception, and Diabetes Self-Care in Korean-Speaking Immigrants With Diabetes.

Diabetes self-care is explained as an illness-related coping behavior. Health literacy is an important predictor in self-care behaviors. However, little is known about their association with illness perception in Korean immigrants with diabetes. This study aimed to examine the relationships among health literacy, illness perception, and diabetes self-care in Korean-speaking immigrants with diabetes. This cross-sectional study was conducted in 2020. A convenience sample of 52 Korean adults with diabetes in Dallas-Fort Worth areas completed a survey. Data were analyzed using SPSS (version 25) with statistical significance at α < .05. The mean of health literacy was high (11.1, SD = 1.1, ranges 0-12). There were no statistically significant associations between health literacy, illness perception, and diabetes self-care. Language barriers are considered a literacy issue, but health literacy and limited English proficiency must be approached differently by health care providers.

Heart Failure and Disability in Community-Dwelling Older Adults in the United States-1999 to 2018: Data From National Health and Nutrition Examination Survey.

To examine the associations of heart failure (HF) with five domains of disability while controlling for covariates. Subjects with HF and aged ≥ 50 years were selected from the 1999 to 2018 National Health and Nutrition Examination Survey data. Five domains of disability were measured with 19 physical tasks. Logistic regression with adjustment for covariates was conducted. The prevalence of HF in 27,185 adults aged ≥ 50 years was 6.37%. After controlling for demographics and smoking, logistic regression showed that HF was associated with 2.8 to 3.4 times increased odds of all domains of disability compared to adults without HF, but with additional adjustments of covariates, the association was attenuated indicating the mediating effects of covariates. The future study may examine the mediating effects of covariates when intervening difficulties with lower extremity mobility and activities of daily living while considering in community-dwelling older adults with HF.

Association between Caffeine Intake and All-Cause and Cause-Specific Mortality: An Analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2014 Database.

Sixty-four percent of adults in America drink coffee daily, and caffeine is the main reason people tend to drink coffee habitually. Few studies have examined the association between caffeine and all-cause and cause-specific mortality. The objective of this study was to examine the association between caffeine and all-cause and cause-specific mortality using the National Health and Nutrition Examination Survey (NHANES) 1999-2014 database. The multivariate Cox proportional hazards regression model was used to examine 23,878 individuals 20 years and older. Daily caffeine intake was measured once at baseline. A total of 2206 deaths occurred, including 394 cardiovascular (CVD) deaths and 525 cancer deaths. Compared to those with a caffeine intake of <100 mg/day, the hazard ratios (HRs) for CVD mortality were significantly lower in the participants with a caffeine intake of 100-200 mg/day (HR, 0.63; 95% confidence interval [CI], 0.45-0.88), and those with a caffeine intake of >200 mg/day (HR, 0.67; 95% CI, 0.50-0.88) after adjusting for potential confounders. The HRs for all-cause mortality were significantly lower in the participants with a caffeine intake of 100-200 mg/day (HR, 0.78; 95% CI, 0.67-0.91), and those with a caffeine intake of >200 mg/day (HR, 0.68; 95% CI, 0.60-0.78). Subgroup analyses showed that caffeine may have different effects on all-cause mortality among different age and body mass index (BMI) groups. In conclusion, higher caffeine intake was associated with lower all-cause and CVD mortality.

Impaired Exercise Tolerance in Heart Failure: Role of Skeletal Muscle Morphology and Function.

PURPOSE OF REVIEW: To discuss the impact of deleterious changes in skeletal muscle morphology and function on exercise intolerance in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as the utility of exercise training and the potential of novel treatment strategies to preserve or improve skeletal muscle morphology and function. RECENT FINDINGS: Both HFrEF and HFpEF patients exhibit a reduction in percent of type I (oxidative) muscle fibers and oxidative enzymes coupled with abnormal mitochondrial respiration. These skeletal muscle abnormalities contribute to impaired oxidative metabolism with an earlier shift towards glycolytic metabolism during exercise that is strongly associated with exercise intolerance. In both HFrEF and HFpEF patients, peripheral "non-cardiac" factors are important determinants of the improvement in exercise tolerance following aerobic exercise training. Adjunctive strategies that include nutritional supplementation with amino acids and/or anabolic drugs to stimulate anabolic molecular pathways in skeletal muscle show great promise for improving exercise tolerance and treating heart failure-associated sarcopenia, but these efforts remain early in their evolution, with no immediate clinical applications. There is consistent evidence that heart failure is associated with multiple skeletal muscle abnormalities which impair oxygen uptake and utilization and contribute greatly to exercise intolerance. Exercise training induces favorable adaptations in skeletal muscle morphology and function that contribute to improvements in exercise tolerance in patients with HFrEF. The contribution of skeletal muscle adaptations to improved exercise tolerance following exercise training in HFpEF remains unknown and warrants further investigation.

Comparison of Wearable Trackers' Ability to Estimate Sleep.

Tracking physical activity and sleep patterns using wearable trackers has become a current trend. However, little information exists about the comparability of wearable trackers measuring sleep. This study examined the comparability of wearable trackers for estimating sleep measurement with a sleep diary (SD) for three full nights. A convenience sample of 78 adults were recruited in this research with a mean age of 27.6 ± 11.0 years. Comparisons between wearable trackers and sleep outcomes were analyzed using the mean absolute percentage errors, Pearson correlations, Bland⁻Altman Plots, and equivalent testing. Trackers that showed the greatest equivalence with the SD for total sleep time were the Jawbone UP3 and Fitbit Charge Heart Rate (effect size = 0.09 and 0.23, respectively). The greatest equivalence with the SD for time in bed was seen with the SenseWear Armband, Garmin Vivosmart, and Jawbone UP3 (effect size = 0.09, 0.16, and 0.07, respectively). Some of the wearable trackers resulted in closer approximations to self-reported sleep outcomes than a previously sleep research-grade device, these trackers offer a lower-cost alternative to tracking sleep in healthy populations.

Systematic review of symptom clusters in cardiovascular disease.

BACKGROUND: Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients' experiences with heart disease. AIMS: To summarize the state of the science in symptom cluster research for patients with acute coronary syndrome, myocardial infarction, coronary artery bypass surgery, and heart failure through systematic review and to provide direction for the translation of symptom cluster research into the clinical setting. METHODS: Databases were searched for articles from January 2000 through to May 2015 using MESH terms "symptoms, symptom clusters, acute coronary syndrome (ACS), myocardial infarction (MI), coronary heart disease (CHD), ischemic heart disease (IHD), heart failure (HF), coronary artery bypass surgery (CABS), cluster analyses, and latent classes." The search was limited to human studies, English language articles, and original articles investigating symptom clusters in individuals with heart disease. Fifteen studies meeting the criteria were included. RESULTS: For patients with ACS and MI, younger persons were more likely to experience clusters with the most symptoms. Older adults were more likely to experience clusters with the lowest number of symptoms and more diffuse and milder symptom clusters that are less reflective of classic ACS presentations. For HF patients, symptom clusters frequently included physical and emotional/cognitive components; edema clustered in only three studies. Symptom expression was congruent across geographical regions and cultures. CONCLUSIONS: The findings demonstrated similarities in symptom clusters during ACS, MI, and HF, despite multiple methods and analyses. These results may help clinicians to prepare at-risk patients for proper treatment-seeking and symptom self-management behaviors.

Selecting symptom instruments for cardiovascular populations.

The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.

Use of the Late-Life Function and Disability Instrument for Measuring Physical Functioning in Patients With Heart Failure.

BACKGROUND AND PURPOSE: We evaluated the psychometric properties of the functioning component of the Late-Life Function and Disability Instrument (LLFDI) in individuals with heart failure (HF). METHODS: Factor analyses were used (N = 151) to assess the dimensionality and structure of the basic and advanced lower extremity function subscales. Rasch model scores were compared to the raw means of the items. RESULTS: Rasch scores correlated with the raw means of the items at r = .96, indicating raw means are comparable to the more complicated Rasch analysis in estimating physical functioning using the basic and advanced subscales. CONCLUSIONS: The lower extremity physical functioning subscales of the LLFDI have potential as a clinical assessment tool to identify HF patients who are at high risk for functional limitations.

A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure.

Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η(2)) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η(2) = .015) and functional status (η(2) = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η(2) = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention's underlying physiological effect is needed.

Examining Characteristics of Hospitalizations in Heart Failure Patients: Results from the 2009 All-payer Data.

Heart failure (HF) is one of the most common chronic and disabling illnesses, resulting in high morbidity and mortality. Readmission rate, one key indicator of healthcare quality and healthcare utilization, is prevalent in HF patients. Inconsistent evidences exist about the impact of rural health disparities on HF patients' readmissions. The purpose of this explorative study was to examine the characteristics of hospitalized HF patients and factors related to readmissions in 2009. The results showed all-cause readmission rates were 13.6%, 23.6%, and 31.6% at 30-, 90- and 180-days respectively. The factors related readmissions included age, income, discharge/transfer status from index hospitalization, and comorbidity. Findings from this analysis suggested additional studies using multiple data sources are needed to have a comprehensive understanding of risk factors related HF patients' healthcare utilization.

Predictors of cognitive/affective and somatic depression in heart failure patients.

The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.

Predictors of modifications in instrumental activities of daily living in persons with heart failure.

OBJECTIVES: The objective of this study was to identify factors related to disability in heart failure (HF) patients using a modified version of the model of disability proposed by Nagi. The hypothesized relationships among pathology (severity of HF and comorbidity), impairment (dyspnea, fatigue, muscle strength), functional limitation (functional capacity), and disability (modification in instrumental activities of daily living [IADLs]) were assessed as well as the influence of age and sex on pathways to disability. METHODS AND RESULTS: Using a cross-sectional design, a convenience sample of 48 men and 53 women (mean age, 59.5 years) with New York Heart Association class II-IV was recruited at a HF clinic. Path analyses via Amos revealed that 71% of the variance in modifications in IADLs was explained by the significant predictors of dyspnea (B = .67), functional capacity (B = -.25), and age (B = .19). Dyspnea and comorbidity also had indirect effects on modification in IADLs through functional capacity. Age also had an indirect effect on modification in activities of daily living through functional capacity, and sex had an indirect effect through dyspnea and functional capacity. CONCLUSION: Patients with HF may benefit from interventions targeted at reducing dyspnea with daily activities and improving functional capacity to prevent disability.

Predictors of motor tasks essential for daily activities among persons with heart failure.

BACKGROUND: To engage in daily activities, persons must be able to perform basic motor tasks, such as walking around the house, climbing up stairs, standing up from the sofa, and so forth. For patients with heart failure (HF), activity intolerance, symptoms of HF, muscle strength, and balance contribute to the "ability" to perform daily activities. Many patients with HF reported that they are able to perform motor tasks, but they modify how they do the tasks. The purpose of the study was to identify factors that predict modification in motor tasks essential to daily activities. METHODS AND RESULTS: Forty-eight men and 54 women aged more than 18 years (mean 59.6 years) were recruited from an outpatient HF clinic. By using hierarchic multiple regression, 90% of the variance in modifications in motor tasks (Late Life Function and Disability Instrument-Function component) was explained, and significant predictors were dyspnea with motor tasks (beta = 0.87), age (beta = 0.12), and gender (beta = 0.11). Older women had significantly greater modifications in these tasks than men. CONCLUSION: Modifications of motor tasks may provide information on those at high risk of developing disability and assist clinicians to identify interventions to improve dyspnea and prevent or reverse decline.

Spirituality and well being among elders: differences between elders with heart failure and those without heart failure.

Heart failure is a chronic debilitating disease that affects all aspects of a person's life, including physical, mental and spiritual dimensions. The associations among these dimensions, and the relationship to overall health status, have not been clearly identified. The purpose of this quantitative, descriptive study was to explore differences between spirituality, depressive symptoms, and quality of life among elders with and without heart failure. A total of 44 elders with heart failure and 40 non-heart failure elders completed several questionnaires including: The Daily Spiritual Experiences Scale (DSES), Spirituality Index of Well-Being (SIWB), Center for Epidemiologic Studies Depression Scale (CES-D), and SF-12 Health Survey. There were significant differences in the groups on gender and ethnicity; thus these variables were controlled in the analyses related to the dependent variables. After controlling for gender and ethnicity, there were significant differences in the physical component of quality of life and spiritual well-being. The heart failure patients had significantly lower physical quality of life but more spiritual well-being than the non-heart failure patients. There were no significant differences in daily spiritual experiences, mental component of quality of life, and depressive symptoms between the two groups.