Cardiovascular Nursing

The Efficacy of Psychological Interventions on Health-Related Quality of Life for Patients with Heart Failure and Depression: A Systematic Review Background Depression is prevalent among adults with chronic heart failure (CHF) and is associated with higher rates of morbidity and mortality and higher healthcare costs. Objectives The aim of this study was to explore the efficacy of psychological interventions in reducing depression and improving quality of life and clinical outcomes (mortality, hospitalization) among adults with CHF. Methods This study performed a systematic review involving searches of 6 databases (MEDLINE, CINAHL, EMBASE, PsycINFO, ASSIA, and SSCI), the Cochrane library, and gray literature, completed in January 2020. Experimental and nonexperimental quantitative studies of psychological interventions for adults with CHF were included. Each study was quality appraised, and key data were extracted and tabled. Overall findings are presented as a narrative synthesis. Results Nine studies met eligibility. Study authors sampled 757 participants and evaluated 4 psychological interventions: cognitive behavioral therapy alone or combined with exercise, mindfulness-based psychoeducation, coping skills training, and innovative holistic meditation. Cognitive behavioral therapy was significantly associated with improved depression and quality of life, and reduced hospitalization risk. Mindfulness-based psychoeducation, holistic meditation, and coping skills training positively impacted depression and quality of life. Coping skills training also reduced hospitalization and mortality risks. Conclusion Although this review indicates that psychological interventions can be beneficial to adults with CHF who have depression, the overall weight of evidence contains a number of biases. Larger, higher-powered studies are needed to confirm or refute these findings and to better understand how specific intervention and sample characteristics relate to outcomes. The authors have no funding or conflicts of interest to disclose. Catherine Evans (co-author) is funded by Health Education England/National Institute of Health Research (NIHR) Senior Clinical Lectureship (ICASCL-2015-01-001). Correspondence Sameera I. Helal, MSN, BSN, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Rehabilitation and Policy, King's College London, Bessemer Rd, London SE5 9PJ, England(sameera.helal@kcl.ac.uk). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Psychometric Properties of the Polish Version of the Self-Care of Hypertension Inventory Background According to evidence-based guidelines, adherence to blood pressure–lowering medication and lifestyle modifications is a crucial part of hypertension management. Self-care is an effective method for secondary prevention. However, patients continue to exhibit major deficits in terms of adherence, self-control, and self-care. Standardized instruments for the effective monitoring of patients' self-care abilities are still lacking. Objective The objectives of this study were to produce a translation and cross-cultural adaptation of the Self-Care of Hypertension Inventory (SC-HI) and to evaluate the psychometric properties of its Polish version. Methods The scale underwent translation and psychometric assessment using the standard methodology (forward-backward translation, review, psychometric analysis, criterion validity). The study included 250 patients, with a mean age of 61.23 ± 14.34 years, treated in a hypertension clinic. Results Mean self-care levels were evaluated in 3 domains: self-care maintenance (56.73 ± 18.57), self-care management (64.17 ± 21.18), and self-care confidence (62.47 ± 24.39). The Cronbach α for each domain showed satisfactory parameters: 0.755 for maintenance, 0.746 for management, and 0.892 for confidence. In the Polish version, the 3-factor structure of the SC-HI was not directly confirmed. Therefore, so-called modification indices were applied to obtain a standardized root mean square residual value less than 0.09 and a root mean square error of approximation value less than 0.06. Conclusions The SC-HI has been successfully translated and adapted for Polish settings, and is suitable for application among patients with hypertension. This work was prepared under the project financed from the funds granted by the Ministry of Science and Higher Education in the "Regional Initiative of Excellence" program for the years 2019–2022, project number 016/RID/2018/19 (http://www.rid.umed.wroc.pl/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. All data and materials used in this research are freely available. References have been provided. The study was approved by the local bioethics committee (approval no. KB 42/2019). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Written informed consent was obtained from all individual participants included in the study. All coauthors have agreed to the submission and publication of this article. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. The authors have no conflicts of interest to disclose. Correspondence Beata Jankowska-Polańska, PhD, Department of Clinical Nursing, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland (beata.jankowska-polanska@umed.wroc.pl). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Resilience and Depressive Symptoms in Adults With Cardiac Disease: A Systematic Review Background Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Resilience, defined as a dynamic process of positively responding to adversity, could protect against depressive symptoms in cardiac disease. No systematic review has been conducted on the relationship between these variables in this population. Objective The aim of this review was to explore the association between psychological resilience and depressive symptoms in adults with cardiac disease. Methods Seven databases (PubMed, EMBASE, CINAHL, PsycInfo, Web of Science, SCOPUS, and Cochrane) were searched from inception to December 2019 using the search terms "cardiac disease," "depressive symptoms," "depression," and "resilience." Inclusion criteria dictated that studies reported original research on the association between resilience and depressive symptoms in adults with a cardiac disease broadly defined. Quality ratings were performed by 2 independent raters. Results We identified 13 studies for final review. Study sample sizes ranged from 30 to 1022 participants, average age ranged from 52 to 72 years, and all studies had majority male participants (64%–100%). Resilience and depressive symptoms were inversely related in 10 of 13 studies. The 3 studies with poor-quality sampling techniques or significant loss to follow-up found no relationship. Conclusions Resilience seems to protect against depression in adults with cardiac disease. Gaps in the literature include poor understanding of the direction of causality. Methods of promoting resilience need to be identified and studied. The authors have no funding or conflicts of interest to disclose. Correspondence Amy Ketcham, BSN, RN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 (aketcham@nursing.upenn.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcnjournal.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Development and Validation of a Scale to Measure Self-efficacy and Self-management in People With Coronary Heart Disease Background Self-management is important in reducing coronary risk factors and in preventing recurrent cardiac events. An enabling factor that promotes self-management among patients with coronary heart disease (CHD) is self-efficacy. However, there is no standardized measure that captures self-efficacy and self-management concurrently in this population. Aim The authors of this study report on the development and validation of a brief scale to measure self-efficacy and self-management in patients with CHD. Methods Scale development and testing comprised (1) item generation, (2) content validity, and (3) pilot testing. The Heart Health Self-Efficacy and Self-Management (HH-SESM) scale includes 2 constructs: self-efficacy and self-management, measured concurrently. Components of the HH-SESM scale consisted of items related to behavioral and coronary risk factor modification. Survey data from 143 participants were used in exploratory factor analyses to test the factorial validity and internal consistency of the scale. Results Twelve items with the same response format were included in the exploratory factor analysis. The factor analysis revealed a single-factor solution accounting for 36.7% and 36.5% of the variance in scores of the self-efficacy and self-management scales, respectively. The correlation (r = 0.72, P < .001) between the self-efficacy and self-management constructs indicates moderate convergent validity. Cronbach α of self-efficacy (0.83) and self-management (0.81) constructs showed good internal consistency. Conclusion The HH-SESM is a brief, easy-to-administer, and reliable measure of self-efficacy and self-management in patients with CHD. The authors have no funding or conflicts of interest to disclose. All authors have agreed on the final version and meet the following criteria (recommended by the International Committee of Medical Journal Editors [http://www.icmje.org/ethical_1author.html]): substantial contributions to conception or design of the work; acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcnjournal.com). Correspondence Maria Mares, BN(Hons), RN, Building 7, Campbelltown campus. Narellan Rd, Cnr David Pilgrim Dr & Goldsmith Ave, Campbelltown, New South Wales, Australia (M.Mares@westernsydney.edu.au). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure Background Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the involvement of others. Objective This study applied a naturalistic decision-making approach to better understand everyday decision making by older adults with heart failure. Methods We present a cross-sectional qualitative field research study using a naturalistic decision-making conceptual model and critical incident technique to study health-related decision making. The study recruited 24 older adults with heart failure and 14 of their accompanying support persons from an ambulatory cardiology center. Critical incident interviews were performed and qualitatively analyzed to understand in depth how individuals made everyday health-related decisions. Results White, male (66.7%), older adults' decision making accorded with a preliminary conceptual model of naturalistic decision making occurring in phases of monitoring, interpreting, and acting, both independently and in sequence, for various decisions. Analyses also uncovered that there are barriers and strategies affecting the performance of these phases, other actors can play important roles, and health decisions are made in the context of personal priorities, values, and emotions. Conclusions Study findings lead to an expanded conceptual model of naturalistic decision making by older adults with heart failure. In turn, the model bears implications for future research and the design of interventions grounded in the realities of everyday decision making. This work was supported by the Agency for Healthcare Research & Quality (R21 HS025232). Dr Holden reports consultant payments from federal research grants awarded to the University of Wisconsin, Clemson University, Oregon Health & Science University, and Kent State University. He receives an annual honorarium for editorial duties from Taylor & Francis publisher. Dr Mirro reports grants from Biotronik Inc, the Agency for Healthcare Research and Quality, Medtronic plc, and Janssen Scientific Affairs; consulting fees/honoraria from iRhythm Technologies Inc and Zoll Medical Corporation; and nonpublic equity/stock interest in Murj, Inc/Viscardia. Dr Mirro's relationships with academia include serving as a trustee of Indiana University. Dr Toscos reports grants from Biotronik Inc, Medtronic plc, Janssen Scientific Affairs, and iRhythm Technologies, Inc. All other authors have no conflicts to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research & Quality or Parkview Health. Correspondence Richard J. Holden, PhD, Regenstrief Institute, 1101 W 10th St #421, Indianapolis, IN 46202 (rjholden@iu.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

A Pilot Study to Evaluate a Computer-Based Intervention to Improve Self-care in Patients With Heart Failure Background Cognitive dysfunction contributes to poor learning and impaired self-care (SC) for patients with heart failure. Objectives The aims of this study were to (1) evaluate the feasibility and acceptability of a nurse-led, virtual home-based cognitive training and SC education intervention to support SC and (2) evaluate the relationship between improvements in SC and cognitive change and examine 30-day readmission rates. Methods In this 2-phase pilot study, we used a prospective, exploratory design. In phase 1, recruitment criteria and retention issues threatened feasibility and acceptance. Significant modifications were made and evaluated in phase 2. Results In phase 2, 12 participants were recruited (7 women and 5 men). Feasibility was supported. All participants and the study nurse positively evaluated acceptability of the intervention. Median SC scores improved over time. Thirty-day hospital readmission rates were 25%. Conclusion Phase 1 indicates the intervention as originally designed was not feasible or acceptable. Phase 2 supports the feasibility and acceptability of the modified intervention. Further testing is warranted. This study was supported by NIH/NINR P20 NR015331-02 (funded as part of the University of Michigan School of Nursing, P20 Center for Complexity and Self-management of Chronic Disease [PIs: Debra Barton, PhD, RN, FAAN; Ivo Dinov, PhD], and Donald and Karin Allen Faculty Fund, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan). The authors have no conflicts of interest to disclose. Correspondence Cynthia Arslanian-Engoren, PhD, RN, ACNS-BC, FAHA, FAAN, University of Michigan School of Nursing, 400 N Ingalls, Room 2176, Ann Arbor, MI 48109 (cmae@umich.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Translation and Psychometric Evaluation of the German Version of the Thirst Distress Scale for Patients With Heart Failure Background In patients with chronic heart failure, thirst can be perceived as an intensive and burdensome symptom, which may have a negative impact on patients' quality of life. To initiate thirst-relieving interventions, assessment of thirst and its related distress is essential. At the time of this study, no instrument was available to evaluate thirst distress in patients with heart failure in Germany. Objective The aims of this study were to translate the "Thirst Distress Scale for patients with Heart Failure" (TDS-HF) from English into German and to test validity and reliability of the scale. Methods The English version of the TDS-HF was translated into German. A linguistically and culturally sensitive forward-and-backward translation was performed. Psychometric evaluation included confirmatory factor analysis, reliability in terms of internal consistency, and concurrent validity. Results Eighty-four hospitalized patients (mean age, 72 ± 10 years; 29% female; mean left ventricular ejection fraction, 36% ± 12%; 62% New York Heart Association functional classes III–IV, 45% on fluid restriction) from an acute care hospital were involved in the study. The item-total correlation ranged from 0.58 to 0.78. Interitem correlations varied between 0.37 and 0.79. Internal consistency was high, with a Cronbach α of 0.89. There was a high correlation between the total score of the TDS-HF and the visual analog scale to assess thirst intensity (r = 0.72, P ≤ .001), and a low correlation with fluid restriction (r = 0.35, P = .002). Conclusions The evaluation of the German TDS-HF showed satisfactory psychometric properties in this sample. The instrument is usable for further research and additional psychometric testing. The authors have no funding or conflicts of interest to disclose. Correspondence Christiane Kugler, PhD, RN, FAAN, Faculty of Medicine, Institute of Nursing Science, Albert-Ludwigs-University Freiburg, Elsässer Str. 2-o, 79106 Freiburg, Germany (christiane.kugler@uniklinik-freiburg.de). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

The Influence of Preparedness, Mutuality, and Self-efficacy on Home Care Workers' Contribution to Self-care in Heart Failure: A Structural Equation Modeling Analysis Background Home care workers (HCWs) are increasingly caring for patients with heart failure (HF). Previous studies have shown that they contribute to HF patients' care, but how their preparedness and their relationship with patients (mutuality) influence caregiving is unknown, as well as the role of HCWs' self-efficacy. Objective Guided by the Situation-Specific Theory of Caregiver Contribution to HF Self-Care, we investigated the influence of HCWs' preparedness and mutuality on HCWs' contribution to HF self-care and the mediating effect of HCWs' self-efficacy in the process. Methods We conducted a cross-sectional survey of HCWs who cared for patients with HF. The survey included the Caregiver Preparedness Scale, Mutuality Scale, Caregiver Contribution to Self-Care of HF Index, and Caregiver Self-Efficacy in Contributing to Self-Care Scale. We performed structural equation modeling and a mediation analysis. Results A total of 317 HCWs employed by 22 unique home care agencies across New York, NY, completed the survey. They had a median age of 50 years, 94% were women, and 44% were non-Hispanic Black. Results demonstrated that mutuality had a direct influence on HCW contribution to self-care and preparedness influenced their contribution to self-care, but only through the mediation of self-efficacy. Conclusion Home care workers' preparedness, mutuality, and self-efficacy have important roles in influencing their contribution to HF self-care. As a workforce increasingly involved in the care of patients with HF, knowing the mechanisms underpinning HCWs' contribution to self-care may illuminate future interventions aimed at improving their contributions and HF patient outcomes. This research was made possible, in part, through a generous donation by Douglas Wigdor, Esq. Dr Sterling and this research are supported by the National Heart, Lung, and Blood Institute (K23HL150160). Dr Riegel is supported by the National Institute of Nursing Research of the National Institutes of Health (R01NR018196). REDCap at Weill Cornell Medicine is supported by Clinical and Translational Science Center grant UL1 TR002384. The authors have no conflicts of interest to disclose. Correspondence Madeline R. Sterling, MD, MPH, MS, Weill Cornell Medicine, 420 E 70th St, Box 331, New York, NY 10021 (mrs9012@med.cornell.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Health-Related Quality of Life in Patients With a Left Ventricular Assist Device (QOLVAD) Questionnaire: Initial Psychometrics of a New Instrument Background Patients with a left ventricular assist device are a unique and growing population who deserve their own valid, reliable instrument for health-related quality of life. Objective We developed and tested the Health-Related Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire. Methods In a prospective, descriptive study, patients from 7 sites completed the QOLVAD and comparator questionnaires. Construct validity was tested using confirmatory factor analysis. Convergent validity was tested using correlations of QOLVAD scores to well-established measures of subjective health status, depression, anxiety, and meaning/faith. Reliability and test-retest reliability were quantified. Results Patients (n = 213) were 58.7 ± 13.9 years old; 81.0% were male, 73.7% were White, and 48.0% had bridge to transplant. Questionnaires were completed at a median time of 44 weeks post ventricular assist device. The 5 QOLVAD domains had acceptable construct validity (root mean square error of approximation = 0.064, comparative and Tucker-Lewis fit indices > 0.90, weighted root mean square residual = 0.95). The total score and domain-specific scores were significantly correlated with the instruments to which they were compared. Internal consistency reliability was acceptable for all subscales (α = .79–.83) except the cognitive domain (α = .66). Unidimensional reliability for the total score was acceptable (α = .93), as was factor determinacy for multidimensional reliability (0.95). Total test-retest reliability was 0.875 (P < .001). Conclusion Our analysis provided initial support for validity and reliability of the QOLVAD for total score, physical, emotional, social, and meaning/spiritual domains. The QOLVAD has potential in research and clinical settings to guide decision making and referrals; further studies are needed. This study was supported by grants from the following sources: Abbott-Northwestern Hospital Foundation, Minneapolis Heart Institute Foundation, and Minnesota Nurses Association Foundation. The funding sources had no role in the collection, analysis, or interpretation of the data. Additional support for K.E.S. was received from Bethel University (sabbatical). P.E. received honoraria from or is a consultant for Abbott Laboratories and Medtronic (paid to the institution, not the individual). S.M.J. receives speaking honoraria from Abbot (modest) and consulting fees from Medtronic (minimal). S.H. is a consultant for Abbott Laboratories. E.Y.B. received grants from Impulse Dynamics, personal fees from American Regent, and grants from Medtronic Inc. B.H. received a grant (shared with K.E.S.) from Minnesota Nurses Association Foundation (completed). All were paid to Minneapolis Heart Institute Foundation to be managed (not paid to the individual). J.A.C. Received personal fees from Abbott and Medtronic and is a member of the scientific advisory committee for Medtronic and Procyrion—all outside the submitted work. K.E.S. and B.H. are coauthors of the QOLVAD questionnaire and hold it as intellectual property. BH does contract work with Lippincott/WK as a Nurse Educator Consultant. (JCVN is owned/published by Lippincott/Wolters Kluwer - which is the owner of a Lippincott Clinical Experiences product from which BH receives royalties). [The QOLVAD questionnaire has been granted without charge to others who request permission in advance for nonprofit use.] Correspondence Kristin E. Sandau, PhD, RN, FAHA, FAAN, Bethel University, 3900, Bethel Drive, St Paul, MN 55112 (k-sandau@bethel.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Health-Related Quality of Life Declines Over 3 Years for Congenital Heart Disease Survivors Background Because of medical advancements, many congenital heart disease (CHD) survivors are relatively symptom-free until adulthood, at which time complications may occur. Worsening health status likely drives a change in patient-reported outcomes, such as health-related quality of life (HRQoL), although change in HRQoL has not been investigated among adolescent and young adult CHD survivors. Objective The aims of the current mixed cross-sectional and longitudinal study were to (1) examine changes in HRQoL over 3 years and (2) identify any demographic (age, sex, estimated family income, and distance from medical center) and medical predictors (functional status and number of cardiac-related medications) of that change. Methods Baseline and 3-year follow-up data were obtained via an online survey of 172 CHD survivors (15–39 years old at baseline; 25% simple, 45% moderate, 30% complex) recruited from a pediatric hospital and an adult hospital. Medical predictors were abstracted from electronic medical records. Results After controlling for New York Heart Association functional class, mixed-effects models identified significant declines in all subscales of the Research and Development Corporation 36-Item Health Survey 1.0 across the 3-year timeframe. A lower estimated family income (≤$35 000) predicted more decline in physical functioning (b = 0.5, 95% confidence interval, 0.2–0.8; P = .001) and emotional functioning (b = 0.3, 95% confidence interval, 0.1–0.5; P = .017). No other significant demographic or medical predictors were identified. Conclusions Study findings highlight the importance of tracking patient-reported outcomes over time, suggesting that medical staff should discuss HRQoL with CHD survivors during late adolescence and early adulthood before decline. The authors have no conflicts of interest to disclose. This work was supported by the National Institutes of Health (grant number T32HL-098039) to J.L. Jackson, The Heart Center at Nationwide Children's Hospital, and the Clinical and Translational Science Award (grant number UL1TR001070) to The Ohio State University and Nationwide Children's Hospital. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. Correspondence Jamie L. Jackson, PhD, 700 Children's Drive, Columbus, OH 43205 (Jamie.jackson2@nationwidechildrens.org). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

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