Biomedical subjects

Cheryl Westlake

Publications and source records attributed to Cheryl Westlake.

8 recordsLinked to original sources

PubMed2006

Impact of obesity on quality of life and depression in patients with heart failure.

BACKGROUND: The effect of obesity on health related quality of life (HRQOL) and depression in a number of disease states is well documented, but its impact in heart failure (HF) patients remains speculative. We therefore examined the relationship between obesity, HRQOL, and depression in 358 patients with HF. METHODS AND RESULTS: Comparative analyses were conducted to determine if body mass index (BMI) was associated with HRQOL and depression in three groups of patients with HF-normal weight (BMI 18.5-24.9 kg/m2, n = 100), overweight (BMI 25-29.9 kg/m2, n = 141), and obese (BMI > or = 30 kg/m2, n = 117). Obese patients were younger than normal and overweight participants; all other demographic and clinical characteristics were similar. HRQOL and depression scores were significantly higher (worse) for obese patients. Body mass index was significantly correlated with all 3 scales of HRQOL (overall, r2 = .160; physical, r2 = .162; and mental, r2 = .217) as well as with depression (r2 = .166). CONCLUSION: Obese patients with HF are more likely to have poorer HRQOL, physical health, emotional well-being and depressive symptoms. Poorer HRQOL is predictive of worse outcomes in patients with HF; however, given the apparent obesity paradox in HF, further investigation of the impact of obesity in HF is urgently required.

Body Mass Index↗

PubMed2006

Developing a Web-based education and counseling program for heart failure patients.

This paper describes a 2-phase method utilized to develop and evaluate the feasibility of a Web-based program targeted to the specific learning needs of elderly patients with heart failure. In the first phase, informational resources specific to the needs of elderly patients were identified using aspects of participant-focused research. Data from 69 patients were obtained through a structured interview and later reviewed with health care providers and patient representatives. Items deemed important by the patients and health care providers were incorporated into the Internet-based program that was drafted for the study. The second phase of the process entailed obtaining data to support the acceptability and feasibility of the intervention by providing 12 patient volunteers access to the Internet-based program that was developed. After 2 weeks, the authors contacted the volunteers and asked them about their experiences with accessing and navigating the Web page. The authors found that elderly persons with limited computer skills can and will use Web resources to obtain information when given adequate instructions on how to access the Web pages.

Aged↗

PubMed2005

Depression in patients with heart failure.

BACKGROUND: Psychologic comorbidities, particularly depression, often accompany heart failure and add to the complexity of clinical management. We conducted a study to describe the prevalence of depression, the differences between patients with minimal versus mild to severe depression, and the correlates of depression in patients with heart failure. METHODS AND RESULTS: Data were collected from 200 patients with symptoms of heart failure resulting from systolic dysfunction. Psychologic assessment included depression, perceived control, neuroticism, educational needs, and social support/network. Patients were, on average, 57.0 (+/-12.1) years old, male (168, 84.0%), and in New York Heart Association (NYHA) class II or III (n=140, 70.0%) with a mean ejection fraction of 25.5+/-6.4%. They had an average maximal oxygen uptake of 15.8 (+/-4.6) mL x kg x min and 6-minute walk distance of 1345.0 (+/-302.1) feet. Minimal depression was described by 105 (52.5%) patients, mild by 62 (31%), moderate by 30 (15%), and severe by 3 (1.5%). The significant differences between patients with minimal depression compared to mild to severe depression were NYHA class (chi2=14.05, P=.003), maximal oxygen uptake (t=2.62, P=.010), 6-minute walk distance (t=4.22, P < .001), beta-blocker therapy (chi2=15.21, P < .001), perceived control (t=7.93, P < .001), and neuroticism (t=-8.85, P < .001). CONCLUSIONS: More than half the patients studied did not report experiencing significant depression. In those who did, both physical and psychosocial variables accounted for 48.6% of the variance. These findings warrant further research and indicate a need to test interventions aimed at enhancing perceived control, reducing neuroticism, and meeting educational needs to reduce depression in patients with heart failure.

Aged↗

PubMed2003

Perceived control reduces emotional stress in patients with heart failure.

We studied patients with heart failure (HF) to determine if perceived control reduces emotional distress (i.e., anxiety, depression and hostility) in chronic, debilitating cardiac illness and whether the demographic, clinical and psychologic characteristics of patients with high and low perceived control differed. Psychological assessment of 222 patients with heart failure included an evaluation of perceived control using the Control Attitudes Scale, as well as anxiety, depression and hostility using the Multiple Affect Adjective Checklist. Using multivariate analysis to control for differences in demographic and clinical characteristics, we found that patients with high perceived control had significantly greater 6-minute walk distances and less emotional distress than patients with low perceived control. Interventions designed to increase perceived control may be an important aspect of HF care, but require testing in randomized trials.

Anxiety↗

PubMed2002

Emotional well-being of heart failure patients and their caregivers.

BACKGROUND: Heart failure (HF) dramatically affects the lives of both patients and their caregivers, yet limited research exists examining the relationship between emotional well-being of HF patients and their caregivers. Therefore, we conducted a study to (1) describe and compare the emotional well-being of HF patients and their caregivers, (2) determine if gender differences exist in emotional well-being of patients and caregivers, and (3) identify factors associated with emotional well-being of HF patients. METHODS: The emotional well-being of 103 patient-caregiver dyads was assessed using the mental health subscale of the SF-12. RESULTS: Patients were 57.6 +/- 12.1 years, predominantly Caucasian (76.7%) and male (67.0%). Caregivers were 59.5 +/- 17.6 years, predominantly females (70.9%) and spouses of patients with HF (82.6%). Patients had significantly lower (poorer) emotional well-being scores than caregivers. Both gender and age were associated with patients' emotional well-being; male and younger participants had higher (better) scores than female and older patients (P <.05). In a multivariate model, patient's age, gender, and caregivers' emotional well-being accounted for 54% of the variance in patients' emotional well-being. CONCLUSION: We found that the emotional well-being of caregivers is associated with the emotional well-being of HF patients. Our findings suggest the need to focus on supporting caregivers and providing them with the strategies they need to support their loved ones with HF.

Adolescent↗

PubMedDate not supplied

Two-year follow-up of quality of life in patients referred for heart transplant.

BACKGROUND: Assessment of physical and mental health has become one of the ultimate tests of health-related quality of life (HRQOL) for patients with advanced heart failure. Little is known, however, about the comparative effects of surgical or medical treatment on the HRQOL of these chronically ill patients over time. METHODS: We examined 77 patients (74% of whom were male), aged 56.1 +/- 12.7 years who were referred for heart transplant evaluation at a single heart failure center to describe the effects of time and treatment status on changes in HRQOL scores (physical and mental health and depression) using the Short Form-12 and the Beck Depression Inventory at 2 time points during their illness trajectory. The 2 evaluations on average were 2 years apart (mean 24.5 +/- 2.8 months). All patients were evaluated at baseline, and 3 groups were identified at the time of the 2-year follow-up: transplant recipients (n = 17), transplant candidates (n = 13), and medically stable patients considered too well to receive a transplant (n = 47). Nonparametric statistics were used to analyze group differences in HRQOL scores. The significance level was set at a P value less than .05. RESULTS: Demographic and HRQOL scores were not significantly different among the 3 groups at baseline. During follow-up, physical health and depression scores significantly improved over time in all patients, but changes in mental health were minimal. Group comparisons showed that although all patients continued to have low HRQOL scores at the time of follow-up evaluation, medically stable patients had higher mental health scores and less depressive symptoms than their counterparts. CONCLUSION: Our results support the need for ongoing HRQOL assessment with an emphasis on timely recognition and treatment of psychologic distress throughout the heart failure illness trajectory. Heart transplant recipients and candidates equally need special attention and follow-up because they both seem to have emotional and psychologic repercussions.

Adult↗

PubMedDate not supplied

Correlates of health-related quality of life in patients with heart failure.

BACKGROUND: The purpose of this study was to explore health-related quality of life (HRQOL) in patients with advanced heart failure undergoing heart transplantation evaluation. The overall aim of the study was to determine whether patients' demographic characteristics, functional status, neuroticism, social network, social support, spirituality, and time since symptom onset are related to the physical and mental components of a patient's HRQOL. METHODS: A descriptive, correlational design was used. Patients (N = 61) were recruited from 2 university-affiliated, outpatient, heart failure programs. Data were collected from chart review, a 6-minute walk, and patient-completed instruments. HRQOL, including physical and mental health components, was assessed with use of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: Demographic characteristics, functional status, neuroticism, social network, social support, spirituality, and time since symptom onset explained 26% of the variability in the physical health component of HRQOL and 44% of the variability in the mental health component of HRQOL in patients with advanced heart failure. In analyzing the data for the most parsimonious model, New York Heart Association classification, 6-minute walk distance, and neuroticism explained 49% of the variability in the mental health component of HRQOL. CONCLUSIONS: New York Heart Association classification, 6-minute walk distance, and neuroticism are related to the mental health component of HRQOL and can be easily included in the assessment of patients with heart failure who are undergoing heart transplantation evaluation. The findings of the current study require replication but may be used to identify patients with heart failure who are potentially at risk for reduced HRQOL.

Activities of Daily Living↗

PubMedDate not supplied

Compliance behaviors of elderly patients with advanced heart failure.

Although compliance behaviors of heart failure (HF) patients have become the focus of increasing scrutiny in the last decade, the prevalence of noncompliance among elderly patients with HF is poorly understood. We conducted this study to describe and compare the compliance behaviors of elderly patients (> or = 65 years) and younger patients (< 65 years) with HF on 6 prescribed activities: medical appointments, medications, diet, exercise, smoking cessation, and alcohol abstinence. Data from a sample of 140 older (50%) and younger (50%) HF patients matched for genderand disease severity were collected with the HF Compliance Questionnaire and analyzed via descriptive statistics, chi-square, paired t-tests, and Pearson correlations. We found that elderly patients were more compliant with diet (77% vs 65%, p = .001) and exercise (67% vs 55%, p = .021) than were their younger counterparts. There was no difference in the other health care behaviors. Of the 70 elderly patients, 51% reported some degree of difficulty complying with exercise while 37%, 24%, and 23% had difficulty following diet, keeping follow-up appointments, and taking medications, respectively. A smaller percentage of elders continued to smoke (9%) and drink alcohol (18%). Patients were asked why they had difficulty following their health care regimens; responses varied by prescribed activity. Lastly, we found inverse relationships between perceived difficulty following and compliance with all of the 6 behaviors measured (p < .001); as difficulty increased, compliance decreased. Strategies to help older patients minimize perceived difficulties associated with health care regimens may improve compliance and long-term morbidity and mortality from HF. Assumptions about older age being related to noncompliance appear invalid in patients with HF.

Age Factors↗