The Journal of cardiovascular nursing
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Obstructive sleep apnea (OSA) is a condition in which the upper airway becomes constricted or occluded during sleep, leading to decreased or absent airflow, hypoxia, and sympathetic activation. This chain of events, occurring dozens of times an hour, can contribute to the development of hypertension, coronary artery disease, heart failure, and stroke. ⋯ The importance of having a high suspicion for OSA in people with risk factors (including obesity, middle age, male or postmenopausal female) or symptoms (snoring, excessive daytime sleepiness, difficulty concentrating) is pointed out. The article concludes with clinical and research implications.
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Health-related quality of life (HRQOL) has been viewed as the most important clinical outcome of heart failure (HF) management. However, information about the predictors of HRQOL in Taiwanese people with HF is limited, especially for the effects of sleep disturbances on HF. ⋯ Nurses should use a holistic perspective to help patients understand and manage the impact of HF on their daily lives. Effective interventions for improving HRQOL should be designed based on patients' needs and lifestyles. The study findings could serve as a baseline for further longitudinal studies to explore the long-term effects of correlates and causal relationships among the variables in this Taiwanese population with HF.
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Millions of family members deliver informal care and support to patients with heart failure (HF). Caregivers of patients with HF experience depressive symptoms, but factors associated with depressive symptoms are unknown. The purposes of this study were (1) to examine differences between caregivers with and without depressive symptoms in patients' characteristics and caregivers' functional status, caregiving burden (time devoted to caregiving, difficulty of caregiving tasks, and overall perceived caregiving distress), and perceived control; and (2) to determine predictors of depressive symptoms of caregivers. ⋯ Caregivers' poor functional status, overall perception of caregiving distress, and perceived control were associated with depressive symptoms. Depressed caregivers of patients with HF may benefit from interventions that improve caregivers' perceived control, address the caregiving burden, and improve or assist with caregivers' functional status.
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The aim of this small-scale study was to explore the use of cluster analysis to identify subgroups of heart failure patients whose patterns of symptoms may help guide clinical management. The empirically derived clusters were compared on (1) demographics, (2) clinical characteristics, and (3) subscales of the Kansas City Cardiomyopathy Questionnaire. ⋯ Of 139 respondents, 33 (24%) were female and 106 (76%) were male. The mean (SD) age was 70.6 (9.7) years, and all were white, except for a single African American female. Most subjects were married (84%) with a median level of high school education, and 5% were New York Heart Association classification I, 38% class II, 52% class III, and 5% class IV. Hierarchical cluster analysis was used to derive a 3-cluster solution based on the presence or absence of 14 symptoms. Cluster 1 patients had significantly lower incidence of symptoms and were more likely to be New York Heart Association class I or class II, with lower body mass index and higher education levels compared with patients in the other clusters. Both clusters 2 and 3 were more symptomatic than cluster 1. Compared with cluster 3, patients in cluster 2 reported more shortness of breath under circumstances other than activity, and the majority reported difficulty sleeping. They also tended to report greater symptom severity and impact on physical activity and enjoyment of life. Additional differences included comorbidities and percentage of subjects on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Examination of the clusters suggested clinical implications related to pharmacological management and raised questions concerning potential influences of duration of the heart failure condition, presence of sleep-disordered breathing, and impact of educational level on self-management behavior and symptom patterns.
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Comparative Study
Symptom clusters in men and women with heart failure and their impact on cardiac event-free survival.
Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. ⋯ Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes.