Quality of Life and Mental Health in Patients with Heart Failure

Approximately 6.2 million adults in the United States have heart failure, according to the Centers for Disease Control and Prevention. Heart failure self-care maintenance behaviors, including taking medications as prescribed, monitoring symptoms and consuming a low-salt diet, have been recognized as effective strategies for reducing symptoms and progression of the condition and improving quality of life. In addition, depression and anxiety are common in adults with heart failure.

A team of nurses from Cleveland Clinic Avon Hospital led by Marlene Patrick, BSN, RN, CMSRN, assistant nurse manager of a medical-surgical/telemetry unit, conducted a research study aimed at the confluence of these factors. The quantitative, cross-sectional study using survey methods sought to answer two primary questions:

• What is the relationship between self-care maintenance and management behaviors and quality of life in older adults with heart failure?
• Does depression or anxiety moderate the relationship between self-care maintenance or management behaviors and quality of life?

“It’s important for nurses to understand how heart failure self-care maintenance and management behaviors and confidence in completing self-care behaviors are related to quality of life in patients with heart failure,” says Patrick. “Furthermore, it’s important to understand the role of depression and anxiety in the relationship so nurses can better address these constructs in practice.”

How the study was conducted

Convenience sampling was used, and participants 65 years and older with a diagnosis of heart failure at Cleveland Clinic locations in Northeast Ohio were mailed survey packets. The packets included four self-administered questionnaires: the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), Self-Care of Heart Failure Index (SCHFI), Patient-Reported Outcomes Measurement Information System (PROMIS®) Anxiety short form 4a, and PROMIS Depression short form 4a.

Responses from 84 returned surveys were analyzed by the research team. Among participants, heart failure quality of life scores (KCCQ-12) were positively associated with self-care (SCHFI) confidence in older adults; however, confidence scores decreased with increasing age. About one-half of participants (56%) met criteria to self-assess their self-care management behaviors (that are aimed at reducing symptoms of heart failure). In general, quality of life scores were not associated with self-care maintenance or management behaviors; however, in patients with depression, as quality of life increased, self-care management behaviors decreased.

“Depressed older adults with heart failure who perceived themselves to have a high quality of life may have fewer symptoms to manage, which could account for lower self-care management scores in the setting of depression,” says Patrick. “Alternatively, and similar to other research findings, patients who experience depression may simply be less likely to carry out self-care management behaviors and require an incentive to do so. Nurses need to emphasize the importance of self-care management behaviors and provide practical information on self-care management to patients and families, regardless if they perceive themselves to be feeling well.”