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Resilience and Depressive Symptoms in Adults With Cardiac Disease: A Systematic Review

Ketcham, Amy; Matus, Austin; Riegel, Barbara

The Journal of Cardiovascular Nursing. 37(4):312-323, July/August 2022.

Background Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Resilience, defined as a dynamic process of positively responding to adversity, could protect against depressive symptoms in cardiac disease. No systematic review has been conducted on the relationship between these variables in this population. Objective The aim of this review was to explore the association between psychological resilience and depressive symptoms in adults with cardiac disease. Methods Seven databases (PubMed, EMBASE, CINAHL, PsycInfo, Web of Science, SCOPUS, and Cochrane) were searched from inception to December 2019 using the search terms “cardiac disease,” “depressive symptoms,” “depression,” and “resilience.” Inclusion criteria dictated that studies reported original research on the association between resilience and depressive symptoms in adults with a cardiac disease broadly defined. Quality ratings were performed by 2 independent raters. Results We identified 13 studies for final review. Study sample sizes ranged from 30 to 1022 participants, average age ranged from 52 to 72 years, and all studies had majority male participants (64%–100%). Resilience and depressive symptoms were inversely related in 10 of 13 studies. The 3 studies with poor-quality sampling techniques or significant loss to follow-up found no relationship. Conclusions Resilience seems to protect against depression in adults with cardiac disease. Gaps in the literature include poor understanding of the direction of causality. Methods of promoting resilience need to be identified and studied.

Comparative Effectiveness of Behavioral Interventions for Cardiovascular Risk Reduction in Latinos: A Systematic Review

Estrada, Leah V.; Solano, Jasmine; Reading Turchioe, Meghan; More

The Journal of Cardiovascular Nursing. 37(4):324-340, July/August 2022.

Background Latinos, the fastest growing ethnic minority group in the United States, are at a high risk for cardiovascular disease (CVD). However, little is known about effective strategies to reduce CVD risk in this population. Objective The aim of this study was to systematically review and synthesize evidence from randomized controlled trials that examined the effectiveness of behavioral interventions to reduce CVD risk in Latinos living in the United States. Methods Four electronic databases were searched for relevant peer-reviewed English- and Spanish-language articles published between January 1, 2000, and December 31, 2019. Four reviewers independently completed article screening, data abstraction, and quality appraisal. At least 2 reviewers completed data abstraction and quality appraisal for each article, and a third reviewer was assigned to settle disagreements. Data on study characteristics and outcomes were abstracted. Results We retrieved 1939 articles. After applying inclusion/exclusion criteria, 17 articles were included. Most interventions were led by community health workers (n = 10); 2 family-based interventions were identified. None of the included studies was nurse led. Behavioral factors were assessed across all included studies, whereas only 4 studies reported on psychosocial outcomes. Improvements were observed in dietary habits and psychosocial outcomes. Findings for physical activity and biological outcomes were mixed. We identified no differences in outcomes based on intervention modalities used or the role of those who led the interventions. Conclusion Existing evidence is mixed. Future research should assess the effectiveness of understudied treatment modalities (including nurse-led, mobile health, and family-based interventions) in reducing CVD risk in Latinos.

The Edmonton Symptom Assessment Scale in Heart Failure: A Systematic Review

Asano, Reiko; Anderson, Kelley M.; Koirala, Binu; More

The Journal of Cardiovascular Nursing. 37(4):341-349, July/August 2022.

Background Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety. Purpose The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes. Methods The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms “heart failure,” “CHF,” “cardiac failure,” “heart decompensation,” “myocardial failure,” “Edmonton Symptom Assessment Scale”. Hand searching of articles was also undertaken. Results The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status. Conclusion This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration. Clinical Implications The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.

Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure

Saleh, Zyad T.; Alraoush, Ahmad T.; Aqel, Ahmad A.; More

The Journal of Cardiovascular Nursing. 37(4):386-393, July/August 2022.

Background Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined. Aim The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables. Method This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF. Results There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation. Conclusion These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.