Oliver Tamara L, Hetland Breanna, Schmaderer Myra, Zolty Ronald, Wichman Christopher, Pozehl Bunny
College of Nursing, Creighton University, Omaha, NE 68178, USA.
College of Nurisng Omaha Campus, University of Nebraska Medical Center, Omaha, NE 68178, USA.
J Clin Med. 2024 Aug 15;13(16):4797. doi: 10.3390/jcm13164797.
: This study explores heart failure (HF) dyadic contextual factors and caregiver burden during acute exacerbation hospitalization and discharge. : It employed a mixed-methods approach, with HF dyads completing questionnaires and semi-structured interviews at a one-week post-discharge outpatient visit. Quantitative tools included the SF-12 Quality of Life, Zarit Burden Interview (ZBI), Bakas Caregiving Outcomes Scale (BCOS), and Self-Care of Heart Failure Index v. 6 (SCHFI). Thematic analysis was conducted on interview data to assess caregiver burden, disease trajectory, comorbidities, caregiving time, and employment status. : Twelve HF dyads participated, with caregivers (six female, six male) averaging 65.76 years. The ZBI indicated a low caregiver burden (median score of 15), but qualitative data revealed a higher perceived burden related to social isolation, future fears, and caregiver dependence. Male caregivers reported a lower burden than females. Positive goal congruence was noted in caregiving hours and HF management compliance. HF patients had a 10-year survival prediction of 22.75% per the Charlson Comorbidity Index, with 69% in NYHA class III and an average ejection fraction of 37.7%. Caregivers working full-time and caring for higher NYHA-class patients showed higher ZBI and BCOS scores. : The study highlights the need for mixed methods and longitudinal research to understand HF disease trajectory and caregiver burden, emphasizing the importance of including caregivers in HF education and screening for perceived burden to improve outcomes and reduce re-hospitalizations.
本研究探讨了急性加重期住院及出院期间心力衰竭（HF）的二元情境因素及照顾者负担。本研究采用混合方法，让HF二元组在出院后一周的门诊随访中完成问卷调查和半结构化访谈。定量工具包括SF - 12生活质量量表、扎里特负担访谈量表（ZBI）、巴卡斯照顾结果量表（BCOS）以及心力衰竭自我护理指数第6版（SCHFI）。对访谈数据进行主题分析，以评估照顾者负担、疾病轨迹、合并症、照顾时间和就业状况。12个HF二元组参与了研究，照顾者（6名女性，6名男性）平均年龄为65.76岁。ZBI显示照顾者负担较低（中位数为15分），但定性数据显示，与社会隔离、未来担忧和对照顾者的依赖相关的感知负担较高。男性照顾者报告的负担低于女性。在照顾时间和HF管理依从性方面观察到积极的目标一致性。根据查尔森合并症指数，HF患者的10年生存预测为22.75%，69%的患者为纽约心脏协会（NYHA）Ⅲ级，平均射血分数为37.7%。全职工作且照顾NYHA分级较高患者的照顾者，其ZBI和BCOS得分较高。本研究强调需要采用混合方法和纵向研究来了解HF疾病轨迹和照顾者负担，强调将照顾者纳入HF教育以及筛查感知负担以改善结局和减少再次住院的重要性。
