Caregiver determinants of patient clinical event risk in heart failure

Abstract

Background Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes. Aims To quantify the influence of patient and caregiver characteristics on patient clinical-event risk in HF. Methods This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers (n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient NYHA Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression. Results Over the course of follow-up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival. Conclusion Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event-risk in HF.

Psychometric evaluation of the Caregiver Preparedness Scale in caregivers of adults with heart failure

“…In fact, a cross‐walk with HF care guidelines (Ponikowski et al, ) shows that each item measures a critical part of HF care. HF patients generally have many physical (e.g., symptoms such as fatigue, dyspnea) and emotional (e.g., depression) needs; they need care coordination (e.g., multiple clinicians are generally involved in HF management); they need caregivers who are able to cope with the stress of caregiving because poorer caregiver mental health is a predictor of worse event‐free survival in patients (Bidwell et al, ); they need caregivers who can handle emergency situations such as during HF exacerbations; and they need caregivers who are able to navigate the healthcare system to obtain help and information. All these aspects of HF care are assessed by the CPS, even though the instrument was not specifically developed for the HF population.…”

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

“…Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical events risk in CHF [335]. The influence of an effective caregiver on CHF patient outcomes has been shown in improved quality of life, lower hospitalization rates [335] and reduced mortality.…”

“…The influence of an effective caregiver on CHF patient outcomes has been shown in improved quality of life, lower hospitalization rates [335] and reduced mortality. Psychological distress of the spouse increases the symptoms of heart failure, regardless of the stress perceived by the patient and/or NYHA class [336].…”

We told you so: ‘knowledge is not enough to improve heart failure self‐care behaviour’

“…Support is needed from either informal or formal caregivers . Easy access to a multidisciplinary team and nurse‐led heart failure clinics for follow‐up and self‐care support as well as greater caregiver contributions to heart failure self‐care have been found to be associated with less hospitalizations and better survival . Patients themselves might not directly recognize this need for support and do not want to be a bother to others and ask for help.…”

“…11 Easy access to a multidisciplinary team and nurse-led heart failure clinics for follow-up and self-care support as well as greater caregiver contributions to heart failure self-care have been found to be associated with less hospitalizations and better survival. [12][13][14] Patients themselves might not directly recognize this need for support and do not want to be a bother to others and ask for help. Organizing support should be more than only asking a partner to accompany the patient to the clinic and sit on the side and receive an educational session aimed at the patient.…”