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5. Quality of life and social support of older adults with chronic heart failure
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4. Heart failure hospital nurses need help (health education and logical planning) to educate patients N.M. Albert, L. Aspinwall, X. Liu, L. Pratt, Nursing research and Innovation, Cleveland Clinic, Cleveland, OH, C.H. Best, Nursing, Hillcrest Hospital, Mayfield Heights, OH, B. Cohen, Nursing, South Georgia Medical Center, Valdosta, GA Purpose: RN comfort in teaching heart failure (HF) themes and specific topics, and the frequency in delivering HF education to patients while hospitalized is unknown. Background: Hospital RNs should deliver patient education in 8 HF themes: what HF means, medications, diet, activity, weight monitoring, fluid restriction, signs/symptoms of worsening condition and signs/symptoms of fluid overload. Methods: Using a descriptive, correlational design, RNs from 3 hospitals completed surveys on comfort and frequency in delivering HF education on 8 themes/ 43 items and personal characteristics. Pearson’s correlation and two-sample T-test were used to assess relationships between theme comfort, frequency in educating patients and RN characteristics. General linear models were performed to assess associations with theme comfort and frequency in educating patients after controlling for significant RN characteristics. Bonferroni adjustment was applied as needed. Results: Of 118 RNs, mean age was 39 11.6 years, 61.9% worked on cardiac unit and 58.3% spent <15 minutes providing pre-discharge HF education to each patient. On a scale of 0-100, mean comfort theme scores ranged from 73-90 and item scores of ‘comfortable or very comfortable’ were 29.6 to 90.7. Nurses were most comfortable teaching about weight followed by signs/ symptoms of worsening condition and signs/symptoms of fluid overload and least comfortable in providing education on activity, followed by medications and low sodium diet. Frequency of educating patients was associated with comfort in each education theme (all P <0.001), with highest frequency in educating on signs and symptoms of worsening condition (mean frequency 71.5% 29%) and lowest frequency in educating on activity (42.7% 29.4%). Overall comfort educating patients was associated with RN age (P ¼ 0.019), number of years as an RN (P ¼ 0.004) and amount of time providing pre-discharge education, P ¼ 0.003. Overall frequency of delivering HF education was not associated with any RN characteristic except the perceived amount of time providing pre-discharge education, P<0.001. In multivariable regression, the amount of time spent in pre-discharge education remained associated with overall RN comfort (P ¼ 0.04) and frequency in providing HF education (P<0.001). For individual HF education themes, comfort in fluid restriction education was associated with working on a cardiac floor, P ¼ 0.031; RN education at a bachelors or higher level, P¼0.011; and length of time as a RN, P ¼ 0.023. Nurses at the large urban hospital provided fluid restriction (P ¼ 0.025),
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signs/symptoms of worsening condition (P ¼ 0.044) and fluid overload (P ¼ 0.026) education with higher frequency than midsized community hospitals. Conclusion: Of 8 HF education themes studied, RN comfort and frequency in educating patients varied by HF theme and topic. Education themes associated with patient survival and/or prevention of rehospitalization (e.g., medication, sodium-restricted diet and activity) had the lowest comfort scores and were delivered the least often. RNs need to increase their comfort in educating patients about important HF content and hospital administrators need to implement systems and processes that ensure optimal time for RNs to deliver HF education and assess patient understanding.
5. Quality of life and social support of older adults with chronic heart failure B. Fahlberg, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI Purpose: The purpose of this study was to describe the social support, individualized quality of life and health related quality of life of older adults with chronic heart failure. Background: Chronic Heart Failure (HF) affects 5 million individuals in the US. Empirical studies have shown that older individuals with HF may have a poor health-related quality of life (HRQOL), worsening with declining functional status. HRQOL measures often emphasize health status, yet they may fail to measure other concepts important to individuals’ sense of wellbeing. Individualized quality of life (IQOL) is the subjective perception of well-being in domains of importance to the individual. This concept appears relevant to the provision of patient-centered care for older adults with HF, yet IQOL in this population has not been described. Social support (SS) may positively influence perceptions of quality of life, however, as functional status worsens, individuals with HF may need more support while having difficulty maintaining support networks. However, the SS of older individuals with HF and the relationship between SS and quality of life is poorly understood. Methods: A descriptive study was conducted in a convenience sample of 52 community-dwelling older individuals with stable HF in the US. Tools included the Minnesota Living with Heart Failure Questionnaire, Medical Outcomes Study Social Support Survey, Schedule for the Evaluation of Individualized Quality of Life, Specific Activity Scale, and a demographic questionnaire. Data was analyzed using descriptive and inferential statistics, hierarchical multiple regression and thematic content analysis. Results: The SS index score mean was 78.5 (SD 19.9, range 19.7-100), Participants who were married or partnered had higher mean rank SS scores(MannWhitney U ¼ 118.5, p ¼ <.001). MLHFQ reversed score (HRQOL) was 69.8 (SD 19.9, range 32-103). SEIQOL index score (IQOL) was 5.2 (SD 1.3), indicating that IQOL
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determinant status was “good” for most participants. SS contributed 8.1% of the variance in IQOL (p ¼ .049), but only 2.2% of the variance in HRQOL (p ¼ .24). Affectionate support was the most important contributor to IQOL (DR2¼.142, p ¼ .008), while positive social interaction also played a significant role in IQOL (DR2 ¼ .118, p ¼ .016). Relationships and enjoyable activities were the most important determinants of IQOL. Conclusion: These findings show that affectionate support and positive social interaction play a significant role in the IQOL of older individuals with HF. Unfortunately, functional limitations, symptoms and medication side effects may negatively impact social support by limiting individuals’ ability to leave home and to do things they enjoy and to be with people important to them. In order to maintain IQOL over the course of a chronic illness, care providers should help individuals preserve and maintain support systems, particularly those that are sources of affectionate support and positive social interaction.
6. Genetic polymorphism of interleukin-6 gene and susceptibility to acute myocardial infarction S. Ghaderian, R. Akbarzadeh Najar, Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF, A. Tabatabaei Panah, Department of Biology, Islamic Azad University, East Tehran Branch, Tehran, IRAN, ISLAMIC REPUBLIC OF, H. Vakili, Department of Cardiology, Faculty of Medicine, Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF, E. Azargashb, Department of Health & Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF Purpose: The aim of present study was to investigate whether molecular polymorphism of the IL-6 gene is involved in the predisposition to acute myocardial infarction (AMI). Furthermore, CRP stimulates the production of the vasoconstrictor endothelin-1 and IL6 by endothelial cells. Therefore, because of CRP predictive role in determining cardiovascular risk, the association of this polymorphism with IL-6 and CRP plasma levels was evaluated. Background: Inflammatory processes play a pivotal role in the pathogenesis of atherosclerosis. Genes coding for cytokines such as interleukin-6 (IL-6) are candidates for predisposing to coronary artery disease (CAD) risk and heart failure (HF). Methods: We prospectively evaluated 450 consecutive patients with AMI (229 males; age, 55.2 0.64 years and 221 females; age, 51.9 0.55 years). Genomic DNA and peripheral blood mononuclear cells (PBMCs) of patients with AMI and control subjects were extracted. IL-6 gene variations were evaluated by polymerase
chain reaction (PCR) followed by restriction enzyme analysis. The mRNA expression of IL-6 gene and plasma levels of IL-6 and C-reactive protein (CRP) were analyzed by real time reverse transcriptase-polymerase chain reaction (RT-PCR) and Enzyme-linked immunosorbent assay (ELISA), respectively. Multiple logistic regression analysis was performed to eliminate confounding influences. A P value less than 0.05 was considered statistically significant. Results: The prevalence of ‘C’ allele in -174G/C variation was higher in patients with AMI than in controls. The IL-6 -174 ‘C’ allele is associated with high levels of IL-6 in the patients which the patients with CC and GC genotypes significantly have higher IL-6 concentrations, respectively. Increased CRP concentrations were associated with -174 G/C variation in the patients comparing with controls. The mRNA expression levels of IL-6 were significantly higher in the patient compared with controls (P < 0.001). Logistic regression analysis indicated that ‘C’ allele of IL-6 might be an independent risk factor for developing AMI; the calculated odds ratio was 1.5 (95% confidence interval: 1.231.82). Multivariate logistic regression analysis showed that the -174G/C polymorphism, age, sex, cigarette smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and alcohol drinking remained significantly associated with AMI (Table 3). Compared with individuals of GG genotype, individuals carrying the ‘C’ allele showed a higher risk of developing AMI (odds ratio 5.78, 95% CI 3.10-10.76, P > 0.001). Conclusion: Our findings indicated a significant relation between the IL-6 promoter polymorphism -174 G/C and risk of AMI. Although it is clear that AMI is a multifactorial disease due to the combination of many genetic and well known environmental risk factors, our results suggest that polymorphism in the IL-6 promoter might be contributed to susceptibility to AMI. We conclude that there is a significant association between IL-6 gene polymorphism and AMI and therefore, is a suitable genetic marker for increased risk of AMI. There is also a genetic influence on the production of plasma IL6 after occurrence of acute injury in the patients. Plasma levels of IL-6 and CRP may be important post-infarction prognosis of patients with myocardial infarction.
7. Predictors of heart failure readmissions A.P. Sherer, Nursing Clinical Support, Moses Cone Health System, Greensboro, NC, P.B. Crane, W.M. Abel, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC Purpose: The purposes of this study were to (a) examine the effects of sociodemographic and clinical factors on hospital readmissions and/or all-cause mortality; and (b) explore combinations of HF medications prescribed at discharge and their effect on readmissions. Background: With the potential addition of readmission rates to the current Heart Failure (HF) Core
4. Heart failure hospital nurses need help (health education and logical planning) to educate patients N.M. Albert, L. Aspinwall, X. Liu, L. Pratt, Nursing research and Innovation, Cleveland Clinic, Cleveland, OH, C.H. Best, Nursing, Hillcrest Hospital, Mayfield Heights, OH, B. Cohen, Nursing, South Georgia Medical Center, Valdosta, GA Purpose: RN comfort in teaching heart failure (HF) themes and specific topics, and the frequency in delivering HF education to patients while hospitalized is unknown. Background: Hospital RNs should deliver patient education in 8 HF themes: what HF means, medications, diet, activity, weight monitoring, fluid restriction, signs/symptoms of worsening condition and signs/symptoms of fluid overload. Methods: Using a descriptive, correlational design, RNs from 3 hospitals completed surveys on comfort and frequency in delivering HF education on 8 themes/ 43 items and personal characteristics. Pearson’s correlation and two-sample T-test were used to assess relationships between theme comfort, frequency in educating patients and RN characteristics. General linear models were performed to assess associations with theme comfort and frequency in educating patients after controlling for significant RN characteristics. Bonferroni adjustment was applied as needed. Results: Of 118 RNs, mean age was 39 11.6 years, 61.9% worked on cardiac unit and 58.3% spent <15 minutes providing pre-discharge HF education to each patient. On a scale of 0-100, mean comfort theme scores ranged from 73-90 and item scores of ‘comfortable or very comfortable’ were 29.6 to 90.7. Nurses were most comfortable teaching about weight followed by signs/ symptoms of worsening condition and signs/symptoms of fluid overload and least comfortable in providing education on activity, followed by medications and low sodium diet. Frequency of educating patients was associated with comfort in each education theme (all P <0.001), with highest frequency in educating on signs and symptoms of worsening condition (mean frequency 71.5% 29%) and lowest frequency in educating on activity (42.7% 29.4%). Overall comfort educating patients was associated with RN age (P ¼ 0.019), number of years as an RN (P ¼ 0.004) and amount of time providing pre-discharge education, P ¼ 0.003. Overall frequency of delivering HF education was not associated with any RN characteristic except the perceived amount of time providing pre-discharge education, P<0.001. In multivariable regression, the amount of time spent in pre-discharge education remained associated with overall RN comfort (P ¼ 0.04) and frequency in providing HF education (P<0.001). For individual HF education themes, comfort in fluid restriction education was associated with working on a cardiac floor, P ¼ 0.031; RN education at a bachelors or higher level, P¼0.011; and length of time as a RN, P ¼ 0.023. Nurses at the large urban hospital provided fluid restriction (P ¼ 0.025),
363
signs/symptoms of worsening condition (P ¼ 0.044) and fluid overload (P ¼ 0.026) education with higher frequency than midsized community hospitals. Conclusion: Of 8 HF education themes studied, RN comfort and frequency in educating patients varied by HF theme and topic. Education themes associated with patient survival and/or prevention of rehospitalization (e.g., medication, sodium-restricted diet and activity) had the lowest comfort scores and were delivered the least often. RNs need to increase their comfort in educating patients about important HF content and hospital administrators need to implement systems and processes that ensure optimal time for RNs to deliver HF education and assess patient understanding.
5. Quality of life and social support of older adults with chronic heart failure B. Fahlberg, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI Purpose: The purpose of this study was to describe the social support, individualized quality of life and health related quality of life of older adults with chronic heart failure. Background: Chronic Heart Failure (HF) affects 5 million individuals in the US. Empirical studies have shown that older individuals with HF may have a poor health-related quality of life (HRQOL), worsening with declining functional status. HRQOL measures often emphasize health status, yet they may fail to measure other concepts important to individuals’ sense of wellbeing. Individualized quality of life (IQOL) is the subjective perception of well-being in domains of importance to the individual. This concept appears relevant to the provision of patient-centered care for older adults with HF, yet IQOL in this population has not been described. Social support (SS) may positively influence perceptions of quality of life, however, as functional status worsens, individuals with HF may need more support while having difficulty maintaining support networks. However, the SS of older individuals with HF and the relationship between SS and quality of life is poorly understood. Methods: A descriptive study was conducted in a convenience sample of 52 community-dwelling older individuals with stable HF in the US. Tools included the Minnesota Living with Heart Failure Questionnaire, Medical Outcomes Study Social Support Survey, Schedule for the Evaluation of Individualized Quality of Life, Specific Activity Scale, and a demographic questionnaire. Data was analyzed using descriptive and inferential statistics, hierarchical multiple regression and thematic content analysis. Results: The SS index score mean was 78.5 (SD 19.9, range 19.7-100), Participants who were married or partnered had higher mean rank SS scores(MannWhitney U ¼ 118.5, p ¼ <.001). MLHFQ reversed score (HRQOL) was 69.8 (SD 19.9, range 32-103). SEIQOL index score (IQOL) was 5.2 (SD 1.3), indicating that IQOL
364
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determinant status was “good” for most participants. SS contributed 8.1% of the variance in IQOL (p ¼ .049), but only 2.2% of the variance in HRQOL (p ¼ .24). Affectionate support was the most important contributor to IQOL (DR2¼.142, p ¼ .008), while positive social interaction also played a significant role in IQOL (DR2 ¼ .118, p ¼ .016). Relationships and enjoyable activities were the most important determinants of IQOL. Conclusion: These findings show that affectionate support and positive social interaction play a significant role in the IQOL of older individuals with HF. Unfortunately, functional limitations, symptoms and medication side effects may negatively impact social support by limiting individuals’ ability to leave home and to do things they enjoy and to be with people important to them. In order to maintain IQOL over the course of a chronic illness, care providers should help individuals preserve and maintain support systems, particularly those that are sources of affectionate support and positive social interaction.
6. Genetic polymorphism of interleukin-6 gene and susceptibility to acute myocardial infarction S. Ghaderian, R. Akbarzadeh Najar, Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF, A. Tabatabaei Panah, Department of Biology, Islamic Azad University, East Tehran Branch, Tehran, IRAN, ISLAMIC REPUBLIC OF, H. Vakili, Department of Cardiology, Faculty of Medicine, Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF, E. Azargashb, Department of Health & Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IRAN, ISLAMIC REPUBLIC OF Purpose: The aim of present study was to investigate whether molecular polymorphism of the IL-6 gene is involved in the predisposition to acute myocardial infarction (AMI). Furthermore, CRP stimulates the production of the vasoconstrictor endothelin-1 and IL6 by endothelial cells. Therefore, because of CRP predictive role in determining cardiovascular risk, the association of this polymorphism with IL-6 and CRP plasma levels was evaluated. Background: Inflammatory processes play a pivotal role in the pathogenesis of atherosclerosis. Genes coding for cytokines such as interleukin-6 (IL-6) are candidates for predisposing to coronary artery disease (CAD) risk and heart failure (HF). Methods: We prospectively evaluated 450 consecutive patients with AMI (229 males; age, 55.2 0.64 years and 221 females; age, 51.9 0.55 years). Genomic DNA and peripheral blood mononuclear cells (PBMCs) of patients with AMI and control subjects were extracted. IL-6 gene variations were evaluated by polymerase
chain reaction (PCR) followed by restriction enzyme analysis. The mRNA expression of IL-6 gene and plasma levels of IL-6 and C-reactive protein (CRP) were analyzed by real time reverse transcriptase-polymerase chain reaction (RT-PCR) and Enzyme-linked immunosorbent assay (ELISA), respectively. Multiple logistic regression analysis was performed to eliminate confounding influences. A P value less than 0.05 was considered statistically significant. Results: The prevalence of ‘C’ allele in -174G/C variation was higher in patients with AMI than in controls. The IL-6 -174 ‘C’ allele is associated with high levels of IL-6 in the patients which the patients with CC and GC genotypes significantly have higher IL-6 concentrations, respectively. Increased CRP concentrations were associated with -174 G/C variation in the patients comparing with controls. The mRNA expression levels of IL-6 were significantly higher in the patient compared with controls (P < 0.001). Logistic regression analysis indicated that ‘C’ allele of IL-6 might be an independent risk factor for developing AMI; the calculated odds ratio was 1.5 (95% confidence interval: 1.231.82). Multivariate logistic regression analysis showed that the -174G/C polymorphism, age, sex, cigarette smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and alcohol drinking remained significantly associated with AMI (Table 3). Compared with individuals of GG genotype, individuals carrying the ‘C’ allele showed a higher risk of developing AMI (odds ratio 5.78, 95% CI 3.10-10.76, P > 0.001). Conclusion: Our findings indicated a significant relation between the IL-6 promoter polymorphism -174 G/C and risk of AMI. Although it is clear that AMI is a multifactorial disease due to the combination of many genetic and well known environmental risk factors, our results suggest that polymorphism in the IL-6 promoter might be contributed to susceptibility to AMI. We conclude that there is a significant association between IL-6 gene polymorphism and AMI and therefore, is a suitable genetic marker for increased risk of AMI. There is also a genetic influence on the production of plasma IL6 after occurrence of acute injury in the patients. Plasma levels of IL-6 and CRP may be important post-infarction prognosis of patients with myocardial infarction.
7. Predictors of heart failure readmissions A.P. Sherer, Nursing Clinical Support, Moses Cone Health System, Greensboro, NC, P.B. Crane, W.M. Abel, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC Purpose: The purposes of this study were to (a) examine the effects of sociodemographic and clinical factors on hospital readmissions and/or all-cause mortality; and (b) explore combinations of HF medications prescribed at discharge and their effect on readmissions. Background: With the potential addition of readmission rates to the current Heart Failure (HF) Core