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  • 1
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    Abstract 4606: Appetite Ratings on Single-item Visual Analog Scale Identify Patients with Heart Failure at Risk for Malnutrition
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background : Patients with heart failure (HF) are at risk for malnutrition due to multiple factors. A simple, clinically feasible tool to identify risk for malnutrition is needed. Visual analog scales have been used in studies on appetite but it is unknown whether an appetite scale can be used to identify patients with HF at risk for malnutrition. Purpose : To determine whether differences in kcal and protein intake could be identified in patients with HF grouped by their appetite rating. Method : A total of 137 patients (63% male, 60 ± 12 years, 56% NYHA class III/IV, ejection fraction (39 ± 14%) were recruited from outpatient HF clinics in the Midwest and South. Patients provided detailed 4-day food diaries that were reviewed by a registered dietitian to verify serving sizes and preparation methods and to obtain missing information. Patients were also asked to rate their appetite over the 4 days of diet recording on a 10 mm visual analog with anchors of “no appetite” and “extremely good appetite” Diaries were analyzed by Nutrition Data Systems software. Three series of between-group comparisons of kcal and protein (total and referenced to kg body weight) were made by t-tests using 4 mm (below midpoint), 5 mm (mid-point), and 6 mm (above mid-point) cut-points. Results : Significant differences in kcal and protein intake were identified between groups using the 6 mm cut point. A total of 36% of the patients had low appetite ratings ( 〈 6mm). Patients with low appetite ratings consumed 20% fewer total kcals (1555 vs. 1936 kcal, p = .001) and 23% fewer kcal/kg (18 vs. 22 kcal, p = .005) than those with high ratings. The low appetite group also consumed 24% less protein than the high appetite group (62 g vs. 82 g, p = .001). The .71 g/kg protein intake of the low appetite group was below the recommended .8 g/kg protein intake for adults. In contrast, the .91 g/kg protein intake of the high appetite group was above the recommended level. Conclusion : Patients with lower appetite ratings had kcal and protein intakes below recommended levels while those with high appetite ratings had adequate intake. These results provide evidence that rating appetite on a visual analog scale may be a simple tool that could be used clinically to identify patients with HF at risk for malnutrition. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_920-a
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 2
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    Depressive symptoms and inflammatory biomarkers in patients with heart failure
    Oxford University Press (OUP) ; 2014
    In:  European Journal of Cardiovascular Nursing Vol. 13, No. 5 ( 2014-10), p. 444-450
    Details
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 13, No. 5 ( 2014-10), p. 444-450
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    URL: Article
    DOI: 10.1177/1474515113507508
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2014
    detail.hit.zdb_id: 2099328-6
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  • 3
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    Depressive symptoms in patients with heart failure negatively affect family caregiver outcomes and quality of life
    Oxford University Press (OUP) ; 2016
    In:  European Journal of Cardiovascular Nursing Vol. 15, No. 1 ( 2016-02), p. 30-38
    Details
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 15, No. 1 ( 2016-02), p. 30-38
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    URL: Article
    DOI: 10.1177/1474515114535329
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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  • 4
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    Dietary sodium restriction below 2 g per day predicted shorter event-free survival in patients with mild heart failure
    Oxford University Press (OUP) ; 2014
    In:  European Journal of Cardiovascular Nursing Vol. 13, No. 6 ( 2014-12), p. 541-548
    Details
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 13, No. 6 ( 2014-12), p. 541-548
    Abstract: Despite a growing recognition that a strict low sodium diet may not be warranted in compensated heart failure (HF) patients, the link between sodium restriction below 2 g/day and health outcomes is unknown in patients at different levels of HF severity. Purpose: The purpose of this study was to compare differences in event-free survival among patients with 〈 2 g/day, 2–3 g/day, or 〉 3 g/day sodium intake stratified by New York Heart Association (NYHA) class. Method: A total of 244 patients with HF completed a four-day food diary to measure daily sodium intake. All-cause hospitalization or death for a median of 365 follow-up days and covariates on age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, the presence of ankle edema, and prescribed medications were determined by patient interview and medical record review. Hierarchical Cox hazard regression was used to address the purpose. Results: In NYHA class I/II ( n=134), patients with 〈 2 g/day sodium intake had a 3.7-times higher risk ( p=0.025), while patients with 〉 3 g/day sodium intake had a 0.4-times lower risk ( p=0.047) for hospitalization or death than those with 2–3 g/day sodium intake after controlling for covariates. In NYHA class III/IV ( n=110), 〉 3 g/day sodium intake predicted shorter event-free survival ( p=0.044), whereas there was no difference in survival curves between patients with 〈 2 g/day and those with 2–3 g/day sodium intake. Conclusion: Sodium restriction below 2 g/day is not warranted in mild HF patients, whereas excessive sodium intake above 3 g/day may be harmful in moderate to severe HF patients.
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    URL: Article
    DOI: 10.1177/1474515113517574
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2014
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  • 5
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    Abstract 4609: Evidence of Need for a More Comprehensive Approach to Dietary Self-Management for Patients with Heart Failure and Diabetes
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background: Type 2 diabetes (DM) is a common comorbidity in patients with heart failure (HF). Nutritional management is a key strategy in achieving blood glucose control and decreasing the risk of microvascular complications. The ability of patients with HF to nutritionally self-manage multiple comorbidities is unknown. Purpose: To compare nutritional intake of a group of patients with HF and DM with a group without DM. Methods: A total of 174 patients (66 with DM, age 60± 12 yrs, 35% female, 57% NYHA class III/IV) recruited from HF clinics completed detailed 4-day food diaries that were reviewed by a registered dietitian. Nutrition Data System software was used to determine carbohydrate (total and subtype), protein, fat, cholesterol, and sodium intake. Fasting blood glucose was obtained on a subset of 123 patients. Between-group comparisons were made using independent sample t-tests. Results: Patients with DM consumed a lower percentage of calories from carbohydrate (44% vs. 49%, p=.003) and a greater percentage of calories from protein (19% vs. 16%, p 〈 .001) and fat (38% vs. 35%, p=.049) compared to patients without DM. With respect to carbohydrate subtypes, patients with DM consumed 30% less sucrose (29g vs. 42g, p 〈 .001) and 39% less fructose (14g vs. 23g, p 〈 .001) than patients without DM, but a similar amount of starch (93g vs. 95g). There were no differences in sodium (3472mg vs. 3209mg), cholesterol (321mg vs. 285mg) or saturated fat (12% vs. 11% of kcal) intake between groups with and without DM. A total of 60% of patients with DM had fasting blood glucose levels 〉 120mg/dl and 40% had a fasting levels 〉 140mg/dl. Conclusions: Patients with HF and DM primarily limited dietary sugar intake, with only moderate success. Nutritional management of HF has focused on the single nutrient sodium with limited success; these data suggest that teaching for DM may be similarly focused on the single nutrient sugar. This indicates that new, more comprehensive, approaches are needed to help patients meet the challenge of nutritionally managing multiple comorbidities. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_921
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 6
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    Abstract 13862: Testing of a Health-related Quality of Life Model
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: In patients with heart failure (IHF), health-related quality of life (HRQOL) is as important as longer survival. Deaths are inevitable for all human beings, but clinicians may help patients with HF to maintain or improve HRQOL until almost at the end of their lives. Psychological and physical symptoms can impact HRQOL through different pathways, and behavioral factors can indirectly impact HRQOL, but the relationships have not been tested in prior theoretical models. Hypothesis: Sociodemographic (i.e., age), biological/physiological (i.e., comorbidity), psycho-social (i.e., depressive symptoms and social support), physical (i.e., physical symptoms and functional status), and behavioral factors (i.e., dietary adherence) in Heo-Moser model will be associated with HRQOL directly and indirectly in patients with HF through different pathways. Methods: This is a secondary analysis of baseline data from two observational studies in which baseline data were collected using the same instruments (N = 358 patients with HF, mean age: 60.4 years). Structural equation modeling (SEM) was used to test the hypothesis. Results: In the SEM, the analysis showed desirable model fit: Chi-square = 7.710, p = .260, RMSEA = .028 (95% confidence interval = 0.00, 0.078), CFI = 0.998, TLI = 0.989, and SRMR = 0.023. Age, depressive symptoms, physical symptoms, and functional status were directly associated with HRQOL. Age, comorbidity, depressive symptoms, social support, dietary adherence, and physical symptoms were indirectly associated with HRQOL through different pathways (Figure 1). Conclusions: All the factors in the model were directly and/or indirectly associated with HRQOL through different pathways. The pathways of physical symptoms, depressive symptoms, and dietary adherence differed. This model can be used to develop interventions targeting improvement in HRQOL in patients with chronic diseases.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13862
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Abstract 2092: Heart Failure Patients with Diabetes Have More Comorbidities and Self Care Problems
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background : Approximately 30 – 47% of heart failure (HF) patients have diabetes mellitus (DM) which is associated with increased risk for rehospitalization and death. Little data exist on psychological factors, physical symptoms, and comorbidities that could affect self care and outcomes in this population. Purpose : To compare HF patients with and without diabetes on demographic, clinical and psychosocial factors associated with self-care and outcomes. Methods : Participants (N = 212, 61 ±11 years old, 62% male, 25% African-American, 62% NYHA functional class III/IV, 37% with DM) from a larger study on nutrition and Body Mass Index (BMI) in HF completed clinical assessments, interviews and questionnaires. Variables and measures were: comorbidities; psychosocial factors of anxiety (Brief Symptom Inventory), depressive symptoms (Beck Depression Inventory-II), and social support (Perceived Social Support Scale); frequency and severity of HF symptoms (Symptom Status Questionnaire); and outcomes of functional status (Duke Activity Status Index; DASI ) and quality of life (MLHFQ). Hospitalizations after 12 months were obtained from medical record review and patient/family interview in a subset. Data were analyzed by t-tests, Chi-Square and nonparametric statistics. Results : Patients with DM were older (63 ± 9 vs 60±12 years, p=.02), had higher BMI (32 ± 6.4 vs 29.4 ± 6.7 kg/m 2 , p=.003), and a greater proportion had coronary artery disease, stroke, and renal dysfunction (p=.01) than those without DM. Thirty-seven percent were receiving insulin therapy. Although no differences in psychosocial factors were found, those with DM reported greater symptom severity (13.7 ±6.7 vs 10.7 ± 6.9 p=.003), and exhibited lower DASI scores (11.4 ± 10.8 vs 15.8 ± 13, p=.001), and MLHFQ scores (45.1 ± 22 vs 38.5 ± 23, p=.04) as well as more total hospitalizations at 12 months (1.5 ± 2.8 vs .55 ± 1.1 p=.04, n=122) than those without DM. Conclusion : HF patients with concomitant DM are at risk for more complex self care regimens due to increased comorbidities and symptom severity, and reduced functional status and quality of life with increased hospitalizations. These data may be useful in designing a comorbidity model of self management interventions to improve outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_668
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 8
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    Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure
    Oxford University Press (OUP) ; 2013
    In:  European Journal of Cardiovascular Nursing Vol. 12, No. 5 ( 2013-10), p. 454-460
    Details
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 12, No. 5 ( 2013-10), p. 454-460
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    URL: Article
    DOI: 10.1177/1474515112470996
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2013
    detail.hit.zdb_id: 2099328-6
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  • 9
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    Factors associated with perceived control and the relationship to quality of life in patients with heart failure
    Oxford University Press (OUP) ; 2015
    In:  European Journal of Cardiovascular Nursing Vol. 14, No. 2 ( 2015-04), p. 137-144
    Details
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 14, No. 2 ( 2015-04), p. 137-144
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    URL: Article
    DOI: 10.1177/1474515113519931
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2015
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  • 10
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    Refusal to participate in heart failure studies: do age and gender matter?
    Wiley ; 2016
    In:  Journal of Clinical Nursing Vol. 25, No. 7-8 ( 2016-04), p. 983-991
    Details
    In: Journal of Clinical Nursing, Wiley, Vol. 25, No. 7-8 ( 2016-04), p. 983-991
    Abstract: The objective of this retrospective study was to evaluate reasons heart failure patients decline study participation, to inform interventions to improve enrollment. Background Failure to enrol older heart failure patients (age  〉  65) and women in studies may lead to sampling bias, threatening study validity. Design This study was a retrospective analysis of refusal data from four heart failure studies that enrolled 788 patients in four states. Methods Chi‐Square and a pooled t‐test were computed to analyse refusal data (n = 300) obtained from heart failure patients who were invited to participate in one of the four studies but declined. Results Refusal reasons from 300 patients (66% men, mean age 65·33) included: not interested ( n  = 163), too busy ( n  = 64), travel burden ( n  = 50), too sick ( n  = 38), family problems ( n  = 14), too much commitment ( n  = 13) and privacy concerns ( n  = 4). Chi‐Square analyses showed no differences in frequency of reasons ( p   〉  0·05) between men and women. Patients who refused were older, on average, than study participants. Conclusions Some reasons were patient‐dependent; others were study‐dependent. With ‘not interested’ as the most common reason, cited by over 50% of patients who declined, recruitment measures should be targeted at stimulating patients’ interest. Additional efforts may be needed to recruit older participants. However, reasons for refusal were consistent regardless of gender. Relevance to clinical practice Heart failure researchers should proactively approach a greater proportion of women and patients over age 65. With no gender differences in type of reasons for refusal, similar recruitment strategies can be used for men and women. However, enrolment of a representative proportion of women in heart failure studies has proven elusive and may require significant effort from researchers. Employing strategies to stimulate interest in studies is essential for recruiting heart failure patients, who overwhelmingly cited lack of interest as the top reason for refusal.
    Type of Medium: Online Resource
    ISSN: 0962-1067 , 1365-2702
    URL: Issue
    URL: Article
    DOI: 10.1111/jocn.2016.25.issue-7pt8
    DOI: 10.1111/jocn.13135
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2006661-2
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