Biomedical subjects

Debra K Moser

Publications and source records attributed to Debra K Moser.

At least 19 recordsLinked to original sources

PubMed2006

Gender differences in the effects of physical and emotional symptoms on health-related quality of life in patients with heart failure.

BACKGROUND: Physical and emotional symptoms are common in heart failure. These symptoms are theorized to affect health-related quality of life (HRQOL), but their impact is likely mediated by variables not yet explored. Moreover, gender may affect these relationships. AIM: To determine gender differences in the effects of physical and emotional symptom status on HRQOL. METHODS AND RESULTS: Data from 51 men and 47 women with heart failure were analyzed using regression analyses. There were no gender differences in physical or emotional symptom status, or HRQOL, but there were differences in the dynamic relationships among the variables. In bivariate analyses, physical and emotional symptom status was related to HRQOL in both men and women. However, in women, physical symptom status was related to HRQOL, while in men depression affected HRQOL in multivariate analyses (p<.001, r(2)=.27; p<.001, r(2)=.40, respectively). Functional status measured by the New York Heart Association functional class mediated the effects of anxiety and depression on HRQOL only in women. CONCLUSION: There were gender differences in the dynamic relationships among variables related to HRQOL. These results demonstrate the need for individualized, comprehensive evaluation of patient's HRQOL and symptom status in order to appropriately target interventions.

Activities of Daily Living↗

PubMed2006

Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council.

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.

Acute Disease↗

PubMed2006

Daily variability in dyspnea, edema and body weight in heart failure patients.

BACKGROUND: Heart failure (HF) and heart failure exacerbations are associated with distressing physical signs and symptoms that include dyspnea, peripheral edema and weight gain. There are no prior investigations that describe the daily fluctuations of these. PURPOSE: The purpose of this investigation was to characterize daily dyspnea, edema and body weight in patients with HF for 1 month. METHODS: This analysis used a descriptive correlational design. Data were collected daily for 30 days from a cohort of heart failure subjects (n=48). Daily mean values and associations between self-reported dyspnea, edema and body weight were determined. RESULTS: The sample included 48 participants with a mean age of 48+/-15 years. Slightly more than half were male (54%) and a majority were married (54%). On average, subjects with HF reported moderate daily levels of self-reported dyspnea and perceived edema. The average daily association between self-reported dyspnea and edema was a positive, significant relationship (p<0.001). There were fewer significant positive associations between self-reported dyspnea and body weight and self-reported edema and body weight. CONCLUSIONS: In this cohort, heart failure patients were able to monitor symptoms daily, detect fluctuations and may be able to modify self-care activities and therapeutic regimen based on these ratings.

Body Weight↗

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

Usefulness of a home-based exercise program for overweight and obese patients with advanced heart failure.

Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure (HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese (body mass index > or =27 kg/m(2)) patients with advanced HF who were randomized to exercise (n = 48) and control (n = 51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3 +/- 10.1 years and predominantly male (75%), Caucasian (57%), and married (55%). Most patients were in New York Heart Association class III or IV (67%), with a mean ejection fraction of 25%. Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group (-6.37 +/- 11.7 vs -0.33 +/- 9.3 kg, p = 0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months (r = 0.331, p = 0.006), as well as decreased depression (r = -0.315, p = 0.01) and hostility (r = -0.355, p = 0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group (0.63 +/- 0.94 vs 1.07 +/- 0.95, p <0.05). In conclusion, the findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with advanced HF.

Adolescent↗

PubMed2006

Nonpharmacologic care by heart failure experts.

BACKGROUND: Nonpharmacologic clinical management practices have not been studied widely in heart failure (HF). The purpose of this survey was to describe the practices of self-identified experts in HF to identify: topics with uniformity of practice (> or =75% agreement) and topics with variability in practice (no uniformity and 2 or more choices endorsed by >/=10% of respondents). METHODS AND RESULTS: An online survey of members of the Heart Failure Society of America (HFSA) actively engaged in clinical practice was conducted in Fall 2004. A total of 347 of the 1420 HFSA members in clinical practice (24.4%) responded to the survey. Of these, 321 completed the survey and 290 (90.3%) identified themselves as experts in HF. Areas in which there appears to be variability in practice include advising patients about: (1) sodium-restricted diet; (2) alcohol; (3) sexual activity; (4) increased swelling or weight gain, including use of a flexible diuretic regimen; and (5) palliative care. Providers vary in their treatment of risk factors and comorbid illnesses, the attention given to subtle losses of weight over time, beliefs about treatment adherence and ways to improve it, and opinions about the most important areas for patient education, and beliefs about health literacy. CONCLUSION: Research on which to base advice for HF patients is greatly needed.

Adult↗

PubMed2006

Gender differences in adherence to the sodium-restricted diet in patients with heart failure.

BACKGROUND: Despite the importance of the sodium-restricted diet (SRD) to heart failure (HF) management, patient adherence is poor. Little is known about gender differences in adherence or factors that affect patients' ability to follow SRD recommendations. The purposes of this study were to determine whether there were gender differences in (1) adherence to the SRD; (2) knowledge about SRD and HF self-care; and (3) perceived barriers to following the SRD. METHODS AND RESULTS: Forty-one men and 27 women completed the Heart Failure Attitudes and Barriers questionnaire that measured HF self-care, knowledge, and perceived barriers to follow an SRD. Diet adherence was measured by 24-hour urinary sodium excretion (UNa). Women were more adherent to the SRD than men as reflected by 24-hour urine excretion (2713 versus 3859 mg UNa, P = .01). Women recognized signs of excess sodium intake such as fluid buildup (P = .001) and edema (P = .01) more often than men and had better understanding of appropriate actions to take related to following an SRD. There were no gender differences in perceived barriers to follow an SRD. CONCLUSIONS: Although men and women perceived similar barriers, women were more adherent to the SRD and had greater knowledge about following an SRD. Further investigation of this phenomenon is warranted to determine if better adherence contributes to improved outcomes in women.

Aged↗

PubMed2006

Evidence-based interventions for post discharge nausea and vomiting: a review of the literature.

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) continue to be a problem for one third of all patients who require surgery and anesthesia. Very few studies have been reported that specifically target PDNV in the outpatient surgery population for interventions after discharge home. Twenty studies were identified that specifically addressed the effect of an intervention for the purpose of preventing PDNV or rescuing the patient who develops PDNV. This article presents an integrative review of the research literature to determine the best evidence for prevention of PDNV in adults or for the rescue of patients who suffer from PDNV.

Adult↗

PubMed2006

Comparison of anxiety between smokers and nonsmokers with acute myocardial infarction.

BACKGROUND: Increased anxiety correlates with increased complications after acute myocardial infarction. Anxiety levels and use of anxiolytic agents have not been compared between smokers and nonsmokers hospitalized because of acute myocardial infarction. OBJECTIVES: To compare anxiety level, sociodemographic factors, and clinical variables between smokers and nonsmokers hospitalized with acute myocardial infarction and to examine predictors of use of beta-blockers and anxiolytic agents among smokers and nonsmokers. METHODS: Secondary data analysis of a prospective multisite study on anxiety in 181 smokers and 351 nonsmokers with acute myocardial infarction. Anxiety was measured by using the State Trait Anxiety Inventory and the anxiety subscale of the Basic Symptom Inventory within 72 hours of admission. RESULTS: Smokers reported higher anxiety levels than nonsmokers reported on both anxiety scales. Female smokers reported the highest anxiety and peak pain levels of all, yet women were the least likely to receive anxiolytic agents. Smoking status was not a predictor for anxiety level when sex, peak pain, use of beta-blockers in the hospital, and age were controlled for. However, smokers were twice as likely as nonsmokers to receive an anxiolytic agent and 60% more likely to receive a beta-blocker in the emergency department, and smokers were 80% more likely than nonsmokers to receive an anxiolytic agent during hospitalization when these variables were controlled. CONCLUSIONS: Older female smokers are at risk for complications because they are older than their male counterparts and less likely to receive beta-blockers and antianxiety medications in the emergency department.

Adrenergic beta-Antagonists↗

PubMed2005

Compliance in heart failure patients: the importance of knowledge and beliefs.

AIMS: Non-compliance in patients with heart failure (HF) contributes to worsening HF symptoms and may lead to hospitalization. Several smaller studies have examined compliance in HF, but all were limited as they only studied either the individual components of compliance and its related factors or several aspects of compliance without studying the related factors. The aims of this study were to examine all dimensions of compliance and its related factors in one HF population. METHODS AND RESULTS: Data were collected in a cohort of 501 HF patients. Clinical and demographic data were assessed and patients completed questionnaires on compliance, beliefs, knowledge, and self-care behaviour. Overall compliance was 72% in this older HF population. Compliance with medication and appointment keeping was high (>90%). In contrast, compliance with diet (83%), fluid restriction (73%), exercise (39%), and weighing (35%) was markedly lower. Compliance was related to knowledge (OR=5.67; CI 2.87-11.19), beliefs (OR=1.78; CI 1.18-2.69), and depressive symptoms (OR=0.53; CI 0.35-0.78). CONCLUSION: Although some aspects of compliance had an acceptable level, compliance with weighing and exercise were low. In order to improve compliance, an increase of knowledge and a change of patient's beliefs by education and counselling are recommended. Extra attention should be paid to patients with depressive symptoms.

Aged↗

PubMed2005

Development and testing of the Dutch Heart Failure Knowledge Scale.

BACKGROUND: Heart failure (HF) knowledge as well as compliance are considered to be underlying mechanisms of the effects of HF management programs. However, there are no valid and reliable measurement instruments available which measures knowledge of HF patients. AIM: To develop a reliable and valid instrument, which measures the knowledge, patients have on their disease and the HF-related health care regimen. METHODS: The HF knowledge scale was developed in 3 phases; (1) concept analysis and first construction, (2) revision of items and (3) testing for validity and reliability. RESULTS: The Dutch HF knowledge scale is a 15-item, self-administered questionnaire that covers items concerning HF knowledge in general, knowledge on HF treatment (including diet and fluid restriction) and HF symptoms and symptom recognition. Face validity as well as content and construct validity was tested in HF patients in 19 hospitals in the Netherlands. The scale was able to differentiate between HF patients with high and low level of HF knowledge. Cronbach's alpha of the knowledge scale in this population (n=902) was .62. CONCLUSION: The instrument is a valid and reliable scale that can be used in research to gain insight in the effect of education and counselling of HF patients. After additional testing, the instrument seems to be a valid and reliable scale to be used in clinical practice to measure HF knowledge.

Heart Failure↗

PubMed2005

Factors related to nonadherence to low sodium diet recommendations in heart failure patients.

BACKGROUND: A low sodium diet is a cornerstone of nonpharmacologic therapy for heart failure patients. Although nonadherence is common, little is known about why heart failure patients fail to adhere to this diet. AIMS: The purpose of this study was to explore the experience of heart failure patients in following a low sodium diet. METHODS AND RESULTS: We conducted a qualitative descriptive study with a convenience sample of 20 participants. Interviews were conducted and analyzed for themes. The data reflected three primary themes about nonadherence to the low sodium diet: lack of knowledge, interference with socialization, and lack of food selections. Participants expressed a need for details about low sodium food selection, food preparation, and rationale for the diet. Lack of knowledge also was manifested as diet confusion for participants who required additional dietary restrictions. Interference with socialization was manifested by patients' experiences with family conflict when family members ate high-sodium foods and difficulty eating out. The theme of lack of low sodium food selections was reflected by comments about limited food choices, and lack of palatability. CONCLUSION: Researchers and clinicians need to consider patients' perceptions as they generate and evaluate interventions to increase adherence to a low sodium diet.

Aged↗

PubMed2005

Patients with heart failure who die in hospice.

BACKGROUND: Patients with end-stage heart failure experience disability, dyspnea, pain, and suffering at the end of life despite progress in treatment approaches. Little is known about the patients with heart failure in hospice and the impact of hospice care on health-related outcomes. METHODS AND RESULTS: The purposes of this retrospective, descriptive chart review were to (1) describe the characteristics of patients who receive hospice care, (2) identify symptoms most commonly reported by patients with heart failure in hospice during the last 7 days of life, and (3) identify interventions used by hospice nurses to manage the symptoms. The majority of the patients were women, widowed, and white. Median length of stay was 10 days. Nearly 37% of the patients were admitted to hospice during the last week of life. Primary symptoms at admission for hospice care included dyspnea, confusion at least some of the time, and poor appetite. There was no statistically significant difference in symptoms between the day of admission for hospice care and the day of death. Symptom management strategies included oxygen, family reassurance or education, skin care, and patient education. Medications commonly used to relieve symptoms included antianxiety medications, morphine, and/or other narcotics. Although mainstay heart failure drugs had been prescribed for some patients, prescription rates were low and not in line with current guideline recommendations, nor were those medications recorded as being used for symptom management. CONCLUSION: Further research including prospective study is needed to clearly articulate the impact of hospice care on patients and families affected by heart failure.

Aged↗

PubMed2005

Vulnerabilities of patients recovering from an exacerbation of chronic heart failure.

BACKGROUND: Many rehospitalizations for heart failure (HF) are preventable as they are precipitated by modifiable factors. High early readmission rates suggest that patients commonly are discharged from HF hospitalizations with such problems unaddressed. The purpose of this study was to describe the prevalence of multiple risk factors for rehospitalization in patients recently discharged from a hospitalization for decompensated HF. METHODS AND RESULTS: The following potentially modifiable risk factors for rehospitalization were evaluated in 202 patients: functional status; whether the patient lived alone; presence of anxiety, depression, or poor quality of life; and symptom status and adherence to prescribed medications, low-sodium diet, and symptom monitoring recommendations. Most patients were severely functionally impaired (70% New York Heart Association [NYHA] functional class III/IV). Of the 28% of patients who lived alone, 50% were rated as NYHA functional class III or IV. Fifty percent of patients were anxious, whereas 69% of patients were depressed. Health-related quality of life was substantially impaired. Patients reported substantial symptom burden. Adherence with recommended self-care strategies was poor: 14% weighed themselves daily, 9% of patients reported monitoring for symptoms of worsening HF, 31% could not name any symptom, and only 34% of patients taking all medications as prescribed. A total of 23% of patients had all of the following risk factors: NYHA functional class III or IV, lived alone, > or =1 comorbidities, and were depressed or anxious. CONCLUSIONS: Patients newly discharged from a hospitalization for HF exhibit many psychosocial and behavioral risk factors for rehospitalization, although they have been judged clinically stable.

Aged↗

PubMed2005

Testing a published model of health-related quality of life in heart failure.

BACKGROUND: Health-related quality of life (HRQOL) in patients with heart failure is compromised and associated with increased mortality and rehospitalization. Inadequate conceptualization of variables related to HRQOL has hampered clinicians' efforts to enhance HRQOL. The purpose of this study was to test the Wilson and Cleary model (WCM) of HRQOL in patients with heart failure. METHODS AND RESULTS: Data from 293 patients with heart failure were analyzed to determine the best multivariate HRQOL model given variables derived from WCM. HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Health perception, symptom status, and age predicted the total MLHFQ (P < .0001) and the emotional scale (P < .0001), and health perception, symptom status, New York Heart Association predicted the physical scale (P < .0001). Health perception was a mediator of the effect of symptom status on HRQOL. Functional status was not a mediator of the effect of symptom status on health perception. CONCLUSION: The most influential variables associated with HRQOL were the subjective variables: health perception and symptom status. Objective variables proposed by WCM to drive the model were not significant predictors. Mediator effects hypothesized in the WCM were not fully demonstrated in this sample. Thus modification of the WCM is warranted.

Activities of Daily Living↗

PubMed2005

Depression and anxiety in heart failure.

BACKGROUND: Although common among patients with heart failure, depression and anxiety have been relatively neglected by researchers and practitioners. Both depression and anxiety have been implicated in contributing independently to the poor outcomes seen in patients with heart failure. Emphasis in the literature is on physical symptom recognition and management, in contrast to the patient's perspective of the effects of heart failure on his or her daily life. METHODS AND RESULTS: This review summarizes and integrates research findings on anxiety and depression and translates these findings to clinical practice. Depression and anxiety are prevalent among patients with heart failure and require assessment and intervention. Short-term nonpharmacologic approaches, in conjunction with drug therapy, hold promise for successful management of patients who are depressed or anxious. CONCLUSION: Carefully designed clinical trials that are tailored to individual needs, yet are embedded within a systemic framework, are needed to inform clinicians regarding optimal practices for the treatment of patients with heart failure who suffer from depression or anxiety.

Anxiety↗

PubMed2005

Dietary fat intake and proinflammatory cytokine levels in patients with heart failure.

BACKGROUND: Dietary fat intake affects proinflammatory cytokine levels of healthy adults. Whether dietary fats have similar effects in patients with heart failure (HF) is unknown. The purposes of this study were to determine (1) effect of dietary fat on interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, and soluble receptors sTNF-R1 and sTNF-R2 levels in patients with HF and (2) subsequent impact of these levels on event-free survival. METHODS AND RESULTS: Forty-two patients provided 4-day food diaries and blood for cytokines. Event-free survival curves were calculated by Kaplan-Meier method and groups compared using log-rank test. IL-6 was not related to fat intake. TNF-alpha levels were elevated in patients with diets higher versus lower in saturated (6.9 +/- 5 versus 4.2 +/- 2 pg/mL) and trans fats (6.8 +/- 4.5 versus 4.5 +/- 2.8 pg/mL). Patients consuming diets higher in polyunsaturated fats had lower sTNF-R1 (2391 +/- 1010 versus 3373 +/- 2098 pg/mL) and sTNF-R2 (3803 +/- 1187 versus 5974 +/- 3275 pg/mL) levels. Higher omega-3 intake produced similar results: sTNF-R1 (2323 +/- 1304 versus 3307 +/- 1973) and sTNF-R2 (4117 +/- 2646 versus 5409 +/- 2801). Event-free survival was decreased in patients with higher TNF-alpha and sTNF-R1 levels. CONCLUSION: Dietary fat intake may affect proinflammatory cytokine levels in patients with HF. Research to determine whether changing composition of dietary fat can alter proinflammatory cytokine activity of HF patients is warranted.

Aged↗

PubMed2005

Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure.

BACKGROUND: Heart failure is an escalating health problem around the world. Despite significant scientific advances, heart failure patients experience multiple physical and psychological symptoms that can impact the quality of life. AIMS: To determine the (1) symptom prevalence, severity, distress and symptom burden in patients with heart failure; (2) impact of age and gender on symptom prevalence, severity, distress and symptom burden; and (3) impact of symptom prevalence and symptom burden on health-related quality of life (HRQOL) in patients with heart failure. METHODS: A convenience sample of 53 heart failure patients participated in this descriptive, cross-sectional design. Symptoms and HRQOL were measured using the Memorial Symptom Assessment Scale-Heart Failure and the Minnesota Living with Heart Failure Questionnaire. RESULTS: Patients experienced a mean of 15.1+/-8.0 symptoms. Shortness of breath and lack of energy were the most prevalent. Difficulty sleeping was the most burdensome symptom. Lower age, worse functional status, total symptom prevalence and total symptom burden predicted 67% of the variance in HRQOL. CONCLUSION: Patients with heart failure experience a high level of symptoms and symptom burden. Nurses should target interventions to decrease frequency, severity, distress and overall symptom burden and improve HRQOL.

Adaptation, Psychological↗