Towards Optimal Heart Failure Care: Couples-Oriented Strategies to Improve Patient Adherence and Health Outcomes

Abstract

Psychosocial factors play an important role in the development and progression of cardiovascular diseases (CVD), such as chronic heart failure (CHF). In particular, psycho-cognitive disturbance is common in CHF, which presents additional challenges to secondary prevention and management strategies. This review provides a summary of the contemporary psycho-cardiology literature, including coverage of common mood and cognitive symptoms, and explores some of the pathophysiologic evidence linking psycho-cognition to CHF, with particular emphasis on sympathetic nervous system activation and neuroendocrine functioning. Social support is identified as a strategy by which to reduce depressive symptoms, manage cognitive impairment and to, potentially, improve health outcomes through improved patient self care and adherence. Recent research outcomes suggest that the integration of family caregivers into CHF psycho-educational disease management programs, as providers and recipients of support, may achieve best outcomes. In this regard, couples-oriented strategies that promote communication, emotional attachment and support may enhance health-promoting behaviours in patients and their partners.

Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis

“…Recent research, however, suggests that including family caregivers in the disease management of patients with HF may improve outcomes. 51 In this article, the one study that reported no significant improvement in attitudes toward DNR and hospice enrollment 38 highlighted a social discordance among the limitations: that the patient population was predominantly African American whereas the providers were mostly Caucasian. The authors recommended that future studies should include more diverse palliative care teams.…”

Couple-based collaborative management model of type 2 diabetes mellitus for community-dwelling older adults in China: protocol for a hybrid type 1 randomized controlled trial

“…As self-management takes place in the context of families, family members, especially spouses, play a pivotal role in working with their loved ones in the management of chronic disease conditions [6,7]. As such, the strained health workers shall leverage the daily interactions between the older couple, and incorporate the mutual efforts of the couple into the management plan.…”

<p>Moving the Dial on Heart Failure Patient Adherence Rates</p>

“…39 Optimal approaches appear to involve a combination of inpatient and outpatient education, 40 which can also extend to caregivers (often close family members) 37 who often lack relevant healthcare knowledge. 41…”

“…Social support has been shown to play a critical role in reducing patient stress associated with chronic diseases, 41,52 and the effect of psychosocial factors noted in the progression of HF. 41 Medicine and treatment adherence rates have been found to increase when social support is present for CHF and CVD patients, 53,54 which can be categorized into three types: patient-to-patient, patient-tofamily, and patient-to-provider.…”