Fifty caregivers and 41 heart failure patients participated in a study examining the association of caregiver characteristics and the caregiving environment on caregiver burden. Using a cross-sectional design, caregivers were interviewed face-to-face using a caregiver characteristic/demographic tool designed for this study, the Centers for Epidemiological Studies Short Depression Scale, the Caregiver Reaction Assessment questionnaire, and the New York Heart Association Functional Classification Guide to obtain the caregiver's perception of patient disease severity. Patient medical records were assessed following caregiver interviews for patient demographics, comorbidities, and ejection fraction percentages. Significantly higher levels of burden were found among Caucasian caregivers, those caring for other relatives besides the patient, unemployed caregivers, and single- versus two-family caregivers (respite caregiving). Fifty-one percent of the variance in caregiver burden was accounted for by the variables caregiver advanced age, higher caregiver hours, more caregiver physical health problems, higher levels of caregiver depressive symptoms, and more patient comorbidities. This article concludes with implications for nursing practice and future research.

Indicators of caregiver health-related quality of life (HRQL) were identified among 50 caregivers of older patients living with heart failure (HF). Using a cross-sectional design, caregivers were interviewed for perceptions pertaining to caregiver burden, depressive symptoms, patient disease severity, and HRQL. Caregiver burden explained 62% of the variance in caregiver HRQL, adjusted R(2) = .58, F (5, 44) = 14.54, p < .01. Caregiver depressive symptoms explained an additional 2% of variance in HRQL. Significant indicators of caregiver HRQL were in the burden domains of caregiver health and caregiver finances. The findings suggest the need for nurses to conduct caregiver health assessments to include screening for depression and assessment of the financial impact caregiving has on the caregiver. Interventions to improve caregiver health and lessen financial burdens should be investigated in future HRQL studies among HF caregivers.

This study aimed to expand understanding of hospitalizations involving patients with heart failure by considering characteristics of the caregiver as a facet of the problem. In face-to-face interviews, 41 caregivers registered agreement or disagreement on a Likert scale of items associated with caregiver depressive symptoms, caregiver appraisal, and perceptions of patient disease severity. Correlation and regression analyses showed lack of family support, increased care hours at home, and greater perceived patient disease severity to be associated with higher rates of hospitalizations for patients with heart failure.

Depression is a common comorbid condition in patients with heart failure (HF) that often goes undiagnosed and untreated. Unless symptoms of depression are specifically looked for, they can be easily missed or mistaken for HF. Clinical depression is a syndromal diagnosis based on patient history, the report of signs and symptoms, and the exclusion of competing diagnoses. This article describes the recommended strategies for recognizing and diagnosing depression. General, psychotherapeutic, and pharmacological approaches to treatment of depression in HF are also discussed. General treatment measures include optimization of medical therapy, patient education, exercise, social support, and family care. Although there are many types of psychotherapy, cognitive-behavioral therapy is particularly appropriate for patients with HF and is described in this article. Categories of antidepressant drugs, including serotonin reuptake inhibitors, tricyclic antidepressants, and miscellaneous antidepressants, are reviewed relative to treating depression in patients with HF. Given the high prevalence and adverse impact of untreated depression in patients with HF, it is essential for advanced practice nurses to develop the requisite knowledge and skills for the identification and treatment of depression.