Examining the Relationship Between Modifiable Risk Factors and Levels of Functioning Among Appalachian Patients With Heart Failure

Background: Heart failure is becoming more prevalent in the United States due to our aging population. More than 10% of people over the age of 70 have heart failure. Risk factors include coronary artery disease (CAD), which includes myocardial infarction and angina. Hypertension precedes heart failure in 75% of cases. Risk factors for CAD include obesity, high glycemic intake, high dietary sodium intake, sedentary lifestyle, and cigarette smoking. In West Virginia, the heart failure death rate is 32.6 per 100,000 population, accounting for 3% of all deaths. The highest rates of hospitalization for heart failure in the nation are found in Appalachia yet a gap exists in the literature on how modifiable risk factors are related to the well-being of people living in this region.;Aims: The aims of this study were to determine the relationship between nutrition, obesity, physical activity, and smoking on physical, social, and emotional well-being among Appalachian patients with heart failure.;Methods: A cross-sectional, descriptive, correlational study using a convenience sample of 115 patients from a nursing home, two outpatient clinics, and a tertiary-care hospital was conducted to examine the relationship between modifiable risk factors and well-being as measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Modifiable risk factors were measured using (1) the American Heart Association Life\u27s Simple 7 Questionnaire to assess nutrition habits, (2) BMI as a measure of obesity, (3) the Duke Activity Status Index (DASI) for physical activity, and (4) the Global Adult Tobacco Survey (GATS) to determine smoking status. Bivariate and descriptive analyses were performed and nonparametric analogs were used to examine the relationship between predictor and outcome variables. One-way analysis of variance (ANOVA) tests were used to further analyze risk factors in relation to levels of well-being.;Results: A majority of participants in this study were older, white, obese or overweight, and of lower socioeconomic status and had New York Heart Association (NYHA) class III or IV disease. Statistically significant findings included higher levels of physical activity being related to enhanced levels of physical, social, and emotional well-being. Nutritional status was found to be significantly related to higher levels of social well-being.;Conclusion: Knowledge of modifiable risk factors and their relationship to the well-being of individuals with heart failure in Appalachia is necessary to develop appropriate secondary prevention measures aimed at reducing or eliminating these risk factors. Physical activity programs may have the greatest impact on physical, social, and emotional well-being in this study population. Identifying resources in rural areas of Appalachia is necessary to promote behavior modification to reduce modifiable risks to ultimately minimize disease progression

Study Protocol of Coaching End-of-Life Palliative Care for Advanced Heart Failure Patients and Their family Caregivers in Rural Appalachia: A Randomized Controlled Trial

Background Heart failure (HF) afflicts 6.5 million Americans with devastating consequences to patients and their family caregivers. Families are rarely prepared for worsening HF and are not informed about end-of-life and palliative care (EOLPC) conservative comfort options especially during the end stage. West Virginia (WV) has the highest rate of HF deaths in the U.S. where 14% of the population over 65 years have HF. Thus, there is a need to investigate a new family EOLPC intervention (FamPALcare), where nurses coach family-managed advanced HF care at home. Methods This study uses a randomized controlled trial (RCT) design stratified by gender to determine any differences in the FamPALcare HF patients and their family caregiver outcomes versus standard care group outcomes (N = 72). Aim 1 is to test the FamPALcare nursing care intervention with patients and family members managing home supportive EOLPC for advanced HF. Aim 2 is to assess implementation of the FamPALcare intervention and research procedures for subsequent clinical trials. Intervention group will receive routine standard care, plus 5-weekly FamPALcare intervention delivered by community-based nurses. The intervention sessions involve coaching patients and family caregivers in advanced HF home care and supporting EOLPC discussions based on patients’ preferences. Data are collected at baseline, 3, and 6 months. Recruitment is from sites affiliated with a large regional hospital in WV and community centers across the state. Discussion The outcomes of this clinical trial will result in new knowledge on coaching techniques for EOLPC and approaches to palliative and end-of-life rural home care. The HF population in WV will benefit from a reduction in suffering from the most common advanced HF symptoms, selecting their preferred EOLPC care options, determining their advance directives, and increasing skills and resources for advanced HF home care. The study will provide a long-term collaboration with rural community leaders, and collection of data on the implementation and research procedures for a subsequent large multi-site clinical trial of the FamPALcare intervention. Multidisciplinary students have opportunity to engage in the research process. Trial registration ClinicalTrials.gov NCT04153890, Registered on 4 November 201