How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed-methods study.

AIMS: Patients with chronic heart failure (CHF) struggle to follow self-care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self-care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives. METHODS AND RESULTS: We used a sequential exploratory mixed-methods design to investigate the interaction between symptoms and BoT in CHF patients. CONCLUSIONS: If symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self-care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience

Effects of the HEART camp intervention on adherence to exercise in patients with heart failure

Background: Patients with heart failure (HF) have poor adherence to the recommended guidelines of30 minutes of moderate intensity exercise five days per week. The importance of adherence to exercise is underscored by recent data showing that lack ofadherence to recommended exercise leads toincreased risk for mortality and HF readmission. Thepurpose of this randomized controlled trial was toevaluate the effect of the HEART Camp (HC) protocol (multi-component intervention) on long-term adherence to exercise. Hypothesis: Subjects in theHEART Camp (HC) intervention group will have better adherence to exercise than the enhanced usual care (EUC) group over time (6, 12 and 18 months). Methods: A prospective randomized two-group (HC and EUC) repeated measures experimental design was used. Both groups received access to theexercise facility and 9 exercise training sessions in a 3-week run-in period. Group educational sessions and an exercise coach provided the interventioncomponents (knowl-edge, attitudes, self-efficacy, behavioral self-management skills and social support). Adherence (defined as 80% of therecommended 150 minutes of exercise) was mea-sured by an exercise diary with heart rate monitor validation of self-report. Results: The sample consisted of 191 subjects with a mean age of 60.9 + 11.4 years; 53.9% were male; EF was 39.9 + 13.1%; 54.5% were NYHA Class II and 36.6% were Class III; 53.4% were Caucasian and 45.5% were African-American. Chi-square analysis of adherence data showed no significant group differences at 6 months (P=.443). Both 12 and 18-month adherence in the HC group (42 and 35.2% respectively) were significantly higher (P \u3c.05) than the EUC group (27.8 and 19.3% respectively). See Fig. 1. An analysis of potential moderators of the intervention showed no significance for age, gender, race, marital status, or NYHA Class. Moderator effects were found for BMI with the HC intervention showing efficacy across thelevels of BMI while higher BMI in the EUC had lower adherence levels. The HC intervention improved adherence in subjects with higher EF while adherence in the EUC group was worse with higher EF Conclusions: The multi-component HC interventionsignificantly improved exercise adherence at 12 and 18 months. Providing subjects with access and 9 sessions of training improved short-term adherencein the EUC group

Validity and Reliability of the Quality of Life with a Left Ventricular Assist Device (QOLVAD) Questionnaire.

Purpose: A valid and reliable quality of life (QOL) measure designed for left ventricular assist device (LVAD) patients has not been established. We report second stage preliminary psychometrics for the QOLVAD Questionnaire. Methods: Prospective, cross-sectional study at 7 sites. QOLVAD construct validity (overall, physical, emotional, social, cognitive and meaning/spiritual QOL) was tested using confirmatory factor analysis. Convergent validity was tested using correlations between QOLVAD scores and well-established measures of subjective health status (KCCQ12), depressive symptoms (PHQ9) anxiety (PROMIS), meaning/peace and faith (FACIT). Reliability was quantified using Cronbach\u27s alpha (for domain scores) and factor determinacy score (multidimensional reliability). Test re-test reliability was quantified using correlations and Bland-Altman tests (enrollment vs. 1 week later). Results: There were 186 LVAD patients in the overall sample: 58.5±13.8 years; 82.7% male, 77.3% white, 50% bridge to transplant. Surveys were completed at median time (25th, 75th percentile) of 44 weeks (17.5±115.5) post-VAD. The five domains of the QOLVAD had good construct validity (RMSEA = 0.07, Comparative and Tucker Lewis fit indices = 0.90, weighted and standardized root mean square residual = 1.348 and 0.09, respectively). QOLVAD scores were standardized to range from 0-100 with higher values indicating better QOL. The overall and domain specific scores were significant correlated with the various other tools to which they were compared (Table). Additionally, with the exception of the cognitive domain (α=0.60), reliability was high among all areas (range 0.79 to 0.93) as was test re-test reliability (range 0.71 to 0.94; p\u3c0.001 for all). Conclusion: While a subsequent version will focus on strengthening reliability of the cognitive domain, the existing QOLVAD is a valid, reliable measure of overall QOL with an LVAD and of physical, emotional, social and meaning/spiritual domains