The Impact of an Intervention to Improve Caregiver Contribution to Heart Failure Self-care on Caregiver Anxiety, Depression, Quality of Life, and Sleep

backgroundBetter caregiver contribution to self-care in heart failure is associated with better patient outcomes. however, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep.objectivethe aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. methods this is a secondary outcome analysis of the MOTIVATE-HF trial. patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). data were collected between June 2014 and october 2018. the article has been prepared following the consolidated standards of reporting Trials checklist. results a sample of 510 patient-caregiver dyads was enrolled. over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. conclusions motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings

Burden among informal caregivers of individuals with heart failure: A mixed methods study

AIMS: To develop a comprehensive understanding of caregiver burden and its predictors from a dyadic perspective. METHOD: A convergent mixed methods design was used. This study was conducted in three European countries, Italy, Spain, and the Netherlands. A sample of 229 HF patients and caregivers was enrolled between February 2017 and December 2018 from the internal medicine ward, outpatient clinic, and private cardiologist medical office. In total, 184 dyads completed validated scales to measure burden, and 50 caregivers participated in semi-structured interviews to better understand the caregiver experience. The Care Dependency Scale, Montreal Cognitive Assessment, and SF-8 Health Survey were used for data collection. Multiple regression analysis was conducted to identify the predictors and qualitative content analysis was performed on qualitative data. The results were merged using joint displays. RESULTS: Caregiver burden was predicted by the patient's worse cognitive impairment, lower physical quality of life, and a higher care dependency perceived by the caregivers. The qualitative and mixed analysis demonstrated that caregiver burden has a physical, emotional, and social nature. CONCLUSIONS: Caregiver burden can affect the capability of informal caregivers to support and care for their relatives with heart failure. Developing and evaluating individual and community-based strategies to address caregiver burden and enhance their quality of life are warranted

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Characteristics of Patients Who Do Not Respond to Motivational Interviewing for Heart Failure Self-care

Background Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients. Objective The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI. Methods This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change &lt;8 points) or MI responder (score change &gt;= 8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]). Results Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33-5.00], P = .005) and taking fewer medications (0.83 [0.74-0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25-14.95], P = .021) and higher baseline self-care management (1.06 [1.02-1.09], P &lt; .001), explaining 35% of the variance in HF self-care management. Conclusions Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions

Characteristics of patients who do not respond to motivational interviewing for heart failure self-care

Background Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients. Objective The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI. Methods This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change <8 points) or MI responder (score change ≥8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]). Results Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33–5.00], P = .005) and taking fewer medications (0.83 [0.74–0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25–14.95], P = .021) and higher baseline self-care management (1.06 [1.02–1.09], P < .001), explaining 35% of the variance in HF self-care management. Conclusions Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions

Influence of mutuality on quality of life in heart failure patient with inadequate self-care and caregiver dyads: an actor{\textendash}partner interdependence model analysis

Aims Mutuality, a positive quality of the relationship between patients and their informal caregivers characterized by love and affection, shared pleasurable activities, shared values, and reciprocity, influences several patient-caregiver outcomes in chronic-condition cases, but it remains unknown whether it influences the heart failure (HF) patient-caregiver dyad quality of life (QOL). The aim of this study was to evaluate the influence of mutuality and its four dimensions (love and affection, shared pleasurable activities, shared values, and reciprocity) on QOL in HF patient-caregiver dyads Methods and results Cross-sectional study: Using the actor-partner interdependence model, we examined how an individual's mutuality influenced his/her own QOL (actor effect) and his/her partner's QOL (partner effect). Mutuality and physical and mental QOL were measured with the Mutuality Scale and Short Form 12, respectively. A total of 494 HF patient-caregiver dyads were enrolled in the study. Mutuality showed strong evidence of caregiver partner effects on the HF patients' physical QOL (total score B = 2.503, P = 0.001; shared pleasurable activities B = 2.265, P &lt; 0.001; shared values B = 1.174, P = 0.420 and reciprocity B = 1.888, P = 0.001). For the mental QOL, mutuality and its four subscales had actor effects only on the patients' mental health (total mutuality B = 2.646, P = 0.003; love and affection B = 1.599, P = 0.360; shared pleasurable activities B = 2.599, P = 0.001; shared values B = 1.564, P = 0.001 and reciprocity B = 1.739, P = 0.020). In caregivers, mutuality had an actor effects on mental QOL (total score B = 1.548, P = 0.041 and reciprocity B = 1.526, P = 0.009). Conclusion Our results confirm the important role of mutuality in determining the physical and mental QOL in HF patient-caregiver dyads. Interventions aimed at improving the relationships within HF patient-caregiver dyads may have an impact on HF patients' and caregivers' QOL

L'unit\ue0 di degenza infermieristica: studio descrittivo sull'assistenza erogata

Le patologie croniche necessitano di un'assistenza continuativa, la quale attualmente non \ue8 completamente garantita dal sistema sanitario italiano poich\ue9 pi\uf9 orientato alla gestione dell'acuzie. Nella Regione Lazio (Palombara Sabina) \ue8 presente un'Unit\ue0 di Degenza Infermieristica, la cui assistenza \ue8 rivolta ai pazienti cronici. L'obiettivo del presente studio \ue8 stato quello di descrivere l'assistenza erogata dall'Unit\ue0 di Degenza Infermieristica. Un disegno di studio descrittivo-comparativo \ue8 stato utilizzato. Il campione era composto dai 290 pazienti ricoverati nel periodo 2014-2015. Sono state analizzate le seguenti variabili: socio-demografiche, motivo del ricovero, diagnosi e interventi infermieristici, diagnosi e interventi medici, indice di Barthel, degenza media, tasso di mortalit\ue0 e di trasferimento presso un ospedale per acuti. I risultati hanno mostrato un'et\ue0 media del campione di 78 \ub1 11,4 anni. Il bisogno di ricevere assistenza infermieristica di medio-alta intensit\ue0 (14,5%) \ue8 emerso come il motivo pi\uf9 frequente di ricovero. Le diagnosi infermieristiche maggiormente formulate sono state quelle di deficit della cura di s\ue9 nell'igiene personale (78,3%) e compromissione della mobilit\ue0 (74,8%). Invece, la cardiopatia ipertensiva (32,4%) \ue8 stata la diagnosi medica pi\uf9 riscontrata. La degenza media \ue8 stata di 19 giorni, con una mortalit\ue0 del 2,1% e un tasso di trasferimento del 9%. Si \ue8 riscontrato, alla dimissione, un generale miglioramento dei livelli di dipendenza dei pazienti rispetto all'ingresso (p < 0,001). L'Unit\ue0 di Degenza Infermieristica sembra strategica per l'assistenza ai soggetti anziani con patologie croniche, anche multiple, in alcune fasi della loro malattia. I dati analizzati sembrano indicare la capacit\ue0 dell'Unit\ue0 di Degenza Infermieristica di contribuire alla riduzione dei ricoveri ospedalieri e di generare esiti favorevoli sensibili alle cure infermieristiche

Dyad gender and relationship quality influence heart failure self-care

Caregivers promote heart failure self-care, yet little is known about how relationship quality and dyad gender influences self-care. The purpose of this study was to evauluate the contribution of dyad gender and relationship quality on heart failure self-care. The study was a secondary analysis from a heart failure self-care intervention. Dyad gender was categorized by patient-caregiver gender as Male-Male (M + M), Female-Female (F + F), Female-Male (Fp + Mc), and Male-Female (Mp + Fc). The Self-Care of Heart Failure Index v.6.2 measured self-care. The Mutuality Scale assessed relationship quality. Univariate linear regression identified determinants of patient self-care maintenance and self-efficacy. The sample (n = 503) was 48% Mp + Fc, 27% F + F, 15% Fp + Mc, and 10% M + M. Better caregiver mutuality in M + M dyads was associated with lower self-care maintenance (b = −7.45, 95% CI [−13.80, −1.11]) and self-efficacy (b = −18.07, 95% CI [−29.11, −7.04]). Better patient mutuality was associated with higher self-efficacy for M + M dyads (b = 12.63, 95% CI [2.18, 23.09]). Mutuality and dyad gender appear important for self-care. Consider the role of gender in the dyad in behavioral interventions