Heart Failure Society of America

The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF.

Heart failure is a serious and complex chronic illness and family caregivers often assist these individuals in performing self-care. Unsurprisingly, caregivers often are overwhelmed by daily activities associated with heart failure management and frequently have depressive symptoms. This study examined predictors (i.e., sociodemographic and clinical characteristics, social support, social problem-solving, family functioning, and objective and subjective burden) of depressive symptoms in 530 informal caregivers of individuals with heart failure in a large cross-sectional, descriptive study in the community. Younger caregivers who provided care for longer periods of time, lived in rural areas, and had less social support and lower problem-solving skills were more likely to have depressive symptoms. These findings emphasize the need for further studies to develop dynamic and innovative approaches that incorporate multiple components to lessen caregiving challenges. Social support and problem-solving skills training may be useful components to lessen depressive symptoms in these younger, rural caregivers.

Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care-especially among patients with heart failure (HF). We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.

Letters1 March 2005Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Chronic Heart FailureMark B. McClellan, MD, PhD, Jerod M. Loeb, PhD, Carolyn M. Clancy, MD, Gary S. Francis, MD, Alice K. Jacobs, MD, Kenneth W. Kizer, MD, MPH, Margaret E. O'Kane, and Michael J. Wolk, MDMark B. McClellan, MD, PhDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Jerod M. Loeb, PhDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Carolyn M. Clancy, MDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Gary S. Francis, MDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Alice K. Jacobs, MDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Kenneth W. Kizer, MD, MPHFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., Margaret E. O'KaneFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699., and Michael J. Wolk, MDFrom Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850; Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 60181; Agency for Healthcare Research and Quality, Rockville, MD 20850; Heart Failure Society of America, Saint Paul, MN 55114; American Heart Association, Dallas, TX 75231; National Quality Forum, Washington, DC 20005; National Committee for Quality Assurance; Washington, DC 20036; and American College of Cardiology, Bethesda, MD 20814-1699.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-5-200503010-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITORS:As noted in Lee and colleagues' meta-analysis (1), the evidence for use of angiotensin-receptor blockers (ARBs) for chronic heart failure and acute myocardial infarction (MI) with left ventricular systolic dysfunction has evolved, and relevant performance measures now need to be revised. The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have been working toward this goal with the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America since the publication of the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial (2) and the ...