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Li Y, Li J, Qin J, Zhou S, Gong K. The Sleep Patterns and Influencing Factors of Chronic Heart Failure Patients in China: A Latent Profile Analysis. Nat Sci Sleep 2025; 17:571-581. [PMID: 40231044 PMCID: PMC11994472 DOI: 10.2147/nss.s509059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 03/12/2025] [Indexed: 04/16/2025] Open
Abstract
Purpose Sleep problems such as reduced sleep efficiency, difficulty initiating sleep, and increased sleep disturbances significantly affect the quality of life and health status of patients with chronic heart failure (CHF). However, the sleep patterns of CHF patients and their influencing factors need to be further studied. Therefore, this study aimed to explore the latent sleep patterns in patients with CHF and to analyze the factors influencing different sleep patterns. Patients and Methods A convenience sampling method was adopted to select 290 patients with CHF who were hospitalized in the Department of Cardiology of a tertiary hospital in Yangzhou City, Jiangsu Province, China, from January to August 2024. The investigation utilized a general information questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). Utilizing Mplus version 8.3 for potential profile analysis, the influences on potential categorization were examined through univariate and multivariate logistic regression analyses. Results The sleep quality score of 290 patients with CHF was (12.00±3.95). The findings from latent profile analysis indicated that the sleep quality patterns of patients with CHF were categorized into three distinct profiles: relatively good sleep group (n=87, 30.3%), low sleep efficiency-low medication use group (n=160, 54.9%), and sleep disorder-substance dependence group (n=43, 14.8%). Multiple logistic regression analysis showed that age, monthly income, number of hospitalizations for heart failure in a year, number of comorbidities, and fear of progression were influential factors (P < 0.05). Conclusion Sleep quality among patients with CHF exhibits distinct distributional profiles. Healthcare providers should implement tailored sleep management strategies and psychological interventions, aligning with the sleep patterns and influencing factors specific to patients with CHF. However, it is necessary to note that this study employed a cross-sectional design, and future research could benefit from a longitudinal design.
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Affiliation(s)
- Yan Li
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, People’s Republic of China
- School of Nursing School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Jiamin Li
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, People’s Republic of China
- School of Nursing School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Jingwen Qin
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, People’s Republic of China
| | - Sixin Zhou
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, People’s Republic of China
- School of Nursing School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Kaizheng Gong
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, People’s Republic of China
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Fang W, Zhang X, Zhang Y, Li X, Li J, Fan X. Quality of life of older adult patients with heart failure with different somatic symptom profiles: The mediating role of depressive symptoms. Geriatr Gerontol Int 2025; 25:251-259. [PMID: 39827904 DOI: 10.1111/ggi.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 12/13/2024] [Accepted: 01/03/2025] [Indexed: 01/22/2025]
Abstract
AIM With an increasingly aging population, the management of heart failure (HF) in older adult patients warrants greater attention. This study aimed to identify somatic symptom profiles by using the person-oriented approach, explore the association between somatic symptom profiles and quality of life (QoL) and examine the mediating effect of depressive symptoms on this association among older adult patients with HF. METHODS This cross-sectional study involved a convenience sample of 445 older adult patients with HF from two tertiary hospitals in China. Patients' somatic symptoms, depressive symptoms and QoL were measured using self-reported questionnaires. Latent profile analysis, linear regression analysis and mediation analysis were used to analyze the data. RESULTS Among the 445 patients (71.84 ± 7.61 years, 49.7% women), four somatic symptom profiles were identified: mild symptoms, high dyspnea symptoms, high difficulty sleeping symptoms and severe symptoms. Considering the mild symptoms profile as a reference, the high difficulty sleeping symptoms and severe symptoms profiles were associated with reduced physical and mental QoL (β = -0.277 to -0.179, all P < 0.001), whereas the high dyspnea symptoms profile was associated with reduced mental QoL (β = -0.105, P = 0.041). Furthermore, both the high difficulty sleeping symptoms and severe symptoms profiles had significantly indirect effects on physical and mental QoL through depressive symptoms. CONCLUSIONS Our findings showed that older adult patients with different HF somatic symptom profiles experience varying levels of QoL. Tailored interventions that facilitate somatic symptom management and alleviate depressive symptoms might improve older adult patients' physical and mental QoL. Geriatr Gerontol Int 2025; 25: 251-259.
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Affiliation(s)
- Wenjie Fang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiuting Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Ximiao Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Jinliang Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
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Conley S, Jeon S, Wang Z, Tocchi C, Linsky S, O'Connell M, Redeker NS. Daytime symptom trajectories among adults with stable heart failure and insomnia: evidence from a randomised controlled trial of cognitive behavioural therapy for insomnia. J Sleep Res 2024; 33:e14058. [PMID: 37933085 DOI: 10.1111/jsr.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/08/2023]
Abstract
People with heart failure (HF) experience a high symptom burden and prevalent insomnia. However, little is known about daytime symptom trajectories after cognitive behavioural therapy for insomnia (CBT-I). In this study we describe: (1) daytime symptom trajectories among adults with insomnia and stable HF over 1 year, (2) how symptom trajectories differ between CBT-I versus HF self-management interventions, and (3) associations between demographic, clinical, and sleep characteristics, perceived stress, health-related quality of life (HRQoL), functional performance and daytime symptoms trajectories. We retrospectively analysed data from a randomised controlled trial of CBT-I versus HF self-management (NCT0266038). We measured sleep, perceived stress, HRQoL, and functional performance at baseline and symptoms at baseline, 3, 6, and 12 months. We conducted group-based trajectory modelling, analysis of variance, chi-square, and proportional odds models. Among 175 participants (mean [standard deviation] age 63.0 [12.9] years, 57.1% male, 76% White), we found four daytime symptom trajectories: (A) low improving symptoms (38.3%); (B) low psychological symptoms and high improving physical symptoms (22.8%); (C) high improving symptoms (24.0%); and (D) high not improving symptoms (14.9%). The CBT-I versus the HF self-management group had higher odds of belonging to Group A compared to other trajectories after controlling for baseline fatigue (odds ratio = 3.27, 95% confidence interval 1.39-7.68). The difference between the CBT-I and the HF self-management group was not statistically significant after controlling for baseline characteristics. Group D had the highest body mass index, perceived stress, and insomnia severity and the lowest cognitive ability, HRQoL, and functional performance. Research is needed to further evaluate factors contributing to symptom trajectories.
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Affiliation(s)
| | | | - Zequan Wang
- University of Connecticut, Storrs, Connecticut, USA
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Tofthagen C, Umberfield EE, Al-Saleh SA, Conley S, Lindroth HL, Chlan LL. Nursing science at Mayo Clinic: An alternative model to traditional hospital-based nurse scientist positions. Nurs Outlook 2024; 72:102187. [PMID: 38851165 DOI: 10.1016/j.outlook.2024.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
The role of the Nurse Scientist in clinical settings represents a relatively new career path that has garnered attention in recent literature. Although there is considerable variability in how this role is operationalized across institutions, Mayo Clinic stands out as one of the few health systems in the United States employing nurse scientists who are fully and exclusively engaged in their own programs of research. Given the need for practical information to guide development and implementation of a research-focused nurse scientist role, the purpose of this paper is to describe the infrastructure and resources supporting Mayo Clinic nurse scientists, share role expectations and metrics for success, discuss both the facilitators of success and ongoing challenges, and compare our current practices to those found in the literature.
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Affiliation(s)
- Cindy Tofthagen
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Jacksonville, FL.
| | - Elizabeth E Umberfield
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN; Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN
| | - Stacy A Al-Saleh
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Pheonix, AZ
| | - Samantha Conley
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN
| | - Heidi L Lindroth
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN; Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN; Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN
| | - Linda L Chlan
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN
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Wang Z, Conley S, Redeker NS, Tocchi C. An Evolutionary Concept Analysis in People With Heart Failure-Symptom Clusters or Symptom Cluster Profiles? ANS Adv Nurs Sci 2024; 47:166-187. [PMID: 37185222 DOI: 10.1097/ans.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The concept of symptom clusters in heart failure (HF) has been defined and measured inconsistently. We used Rodgers' evolutionary method to review related concepts in the HF literature. Symptom clusters and symptom cluster profiles are characterized by multiple symptoms, a synergistic relationship, and result in a myriad of poor outcomes. Researchers should carefully consider the conceptual differences underpinning symptom clusters and symptom cluster profiles and choose the appropriate concept aligned with their research questions, empirical methods, and target HF population.
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Affiliation(s)
- Zequan Wang
- Author Affiliations University of Connecticut School of Nursing, Storrs (Ms Wang and Drs Redeker and Tocchi); and The Mayo Clinic, Rochester, Minnesota (Dr Conley)
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Locatelli G, Iovino P, Pasta A, Jurgens CY, Vellone E, Riegel B. Cluster analysis of heart failure patients based on their psychological and physical symptoms and predictive analysis of cluster membership. J Adv Nurs 2024; 80:1380-1392. [PMID: 37788062 DOI: 10.1111/jan.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
AIM Patients with heart failure experience multiple co-occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables. DESIGN Secondary analysis of MOTIVATE-HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy. METHODS Cluster analysis was performed based on the two scores of the Hospital Anxiety-Depression scale and two scores of the Heart-Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi-square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership. RESULTS Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA-class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership. CONCLUSIONS These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms-related data is absent. IMPLICATIONS These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms-data is absent. IMPACT Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership. REPORTING METHOD The authors have adhered to the EQUATOR guidelines STROBE to report observational cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION Patients were included only for collecting their data.
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Affiliation(s)
- Giulia Locatelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | - Alessandro Pasta
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Corrine Y Jurgens
- Connell School of Nursing, Boston College, Massachusetts, Boston, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Riegel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
- School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia, USA
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Hoang HTX, Yeung WF, Truong QTM, Le CT, Bui ATM, Bui QV, Le QTL, Quach LH. Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study. Front Public Health 2024; 11:1281012. [PMID: 38375096 PMCID: PMC10875106 DOI: 10.3389/fpubh.2023.1281012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/28/2023] [Indexed: 02/21/2024] Open
Abstract
Objectives Insomnia is a common symptom after COVID-19 infection; however, its current evidence was among hospitalized COVID-19 patients. This study aimed to assess the prevalence of insomnia and identify its association with depression and anxiety among non-hospitalized COVID-19 recovered population. Methods We conducted a cross-sectional online survey of 1,056 COVID-19 survivors within 6 months of initial COVID-19 infection and retrieved did not require hospitalization. The Insomnia Severity Index, and Depression Anxiety and Stress Scale-14 were used. Multivariate logistic regression was used to examine the associations between depressive and anxiety score, and participants' insomnia level. Results The prevalence of insomnia was 76.1%, and among those, 22.8% of participants scored for severe insomnia. One third of participants reported worse sleep quality, shorter sleep duration, and harder to fall asleep, half reported more awaken nights after COVID-19 infection. Participants with depressive (OR 3.45; 95%CI 1.87-6.34) or anxiety (OR 3.93; 95%CI 2.52-6.13) had significantly higher odds of developing insomnia. Other risk factors of insomnia included pre-existing chronic conditions and higher education level, while COVID-19 symptoms and duration were not significantly associated. Conclusion Our study highlights the substantial burden of insomnia among non-hospitalized COVID-19 survivors and the significant association of depression and anxiety on the development of this long-term effect of COVID-19. These findings underscore the need for comprehensive interventions that address both sychological and sleeping health in this population.
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Affiliation(s)
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Cuc Thi Le
- Department of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Thi My Bui
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Linh Ha Quach
- Center for Ageing Research & Education, Duke-NUS Medical School, Singapore, Singapore
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Zheng AD, Cai LL, Xu J. Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure. World J Psychiatry 2023; 13:444-452. [PMID: 37547733 PMCID: PMC10401501 DOI: 10.5498/wjp.v13.i7.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND With the intensification of social aging, the susceptibility of the elderly population to diseases has attracted increasing attention, especially chronic heart failure (CHF) that accounts for a large proportion of the elderly.
AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.
METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received. The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group (SG; n = 62), and those who underwent routine detailed behavioral nursing intervention were included as a control group (CG; n = 54). Patients’ negative emotions (NEs), quality of life (QoL), and nutritional status were assessed using the self-rating anxiety/ depression scale (SAS/SDS), the Minnesota Living with Heart Failure Ques-tionnaire (MLHFQ), and the Modified Quantitative Subjective Global Assessment (MQSGA) of nutrition, respectively. Differences in rehabilitation efficiency, NEs, cardiac function (CF) indexes, nutritional status, QoL, and nursing satisfaction were comparatively analyzed.
RESULTS A higher response rate was recorded in the SG vs the CG after intervention (P < 0.05). After care, the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG (P < 0.05). The post-intervention SAS and SDS scores, as well as MQSGA and MLHFQ scores, were also lower in the SG (P < 0.05). The SG was also superior to the CG in the overall nursing satisfaction rate (P < 0.05).
CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients, and it can not only effectively enhance rehabilitation efficiency, but also mitigate patients’ NEs and improve their CF and QoL.
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Affiliation(s)
- Ai-Di Zheng
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Li-Li Cai
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Jing Xu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Manolis TA, Manolis AA, Melita H, Manolis AS. Neuropsychiatric disorders in patients with heart failure: not to be ignored. Heart Fail Rev 2022:10.1007/s10741-022-10290-2. [DOI: 10.1007/s10741-022-10290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
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