Family Caregiving for Patients With Heart Failure: Types of Care Provided and Gender Differences

doi:10.1016/j.cardfail.2009.12.019

Journal of Cardiac Failure

Volume 16, Issue 5, May 2010, Pages 398-403

https://doi.org/10.1016/j.cardfail.2009.12.019 Get rights and content

Abstract

Background

Knowledge about the potential burden for family caregivers related to the care of patients with heart failure (HF) is limited. The aims of the study were to compare the kind and amount of care provided by partners of HF patients and partners of healthy individuals and to examine the associations between gender and the performance of caregiving tasks.

Methods and Results

Caregiving tasks performed by 338 partners of HF patients were compared with those performed by 1202 partners of healthy individuals. Partners (age 70 ± 9, 76% female) of HF patients were more likely to provide personal care compared with partners (age 65 ± 7, 66% female) of healthy individuals after controlling for their age. However, the magnitude of the odds ratios (OR) differed by gender of partners (OR for male 6.7; 95% confidence interval [CI] 3.9–11.4; OR for female 3.7; 95% CI 2.7–5.1). Partners of HF patients were more likely to provide emotional care than partners of healthy individuals, controlling for age and gender (OR 2.4; 95% CI 1.5–3.6). Male partners of HF patients were more likely to provide personal care compared to female partners of HF patients (OR 1.9; 95% CI 1.1–3.2).

Conclusions

The care performed by partners of HF patients is above and beyond normal spousal assistance. The study underscores the crucial role of family caregivers in the care of HF patients and encourages health care providers to address the needs of both HF patients and their caregivers.

Section snippets

Participants and Procedure

A cross-sectional, comparative design was used to answer the research questions. Caregiving data obtained from a sample of partners of HF patients were compared with those from a reference group of individuals living with a healthy partner drawn from the general population in the Netherlands. The study was approved by the Central Ethics Committee and the investigation conformed to the principles outlined in the Declaration of Helsinki.

Response Rate

Among 1023 HF patients enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure trial, 605 patients (59%) were married or living with a partner. At 12 months after the initial hospitalization, 441 questionnaires were sent out because 112 patients had died before 12 months and 52 partners were unable or refused to complete the questionnaires. Four hundred and seven partners (92%) returned the questionnaire. To make a comparison to the reference group,

Discussion

This is the first study conducted to compare the kind and amount of caregiving tasks performed by partners of HF patients with those of healthy individuals from the general population. Compared with partners of healthy individuals, partners of HF patients were significantly more likely to perform caregiving tasks to help their partner physically and emotionally. Partners of HF patients were more likely to provide personal care and emotional care compared with partners of healthy individuals

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Dyadic effects of anxiety and depression on quality of life among couples facing cardiovascular disease
2021, Journal of Psychosomatic Research
Citation Excerpt :
The demographic characteristics of the participant sample were largely homogenous (i.e., white and well-educated) and all participants were recruited from one geographical area. Moreover, the majority of our patients were male and partners were female, which is not uncommon in studies investigating patient-partner effects in chronic illness contexts, including CVD [45]. All couples were heterosexual, which precludes generalization to same-sex couples.
Anxiety and depression are frequently comorbid in patients with cardiovascular disease (CVD) and a patient's poor mental health may implicate the quality of life (QoL) of a partner. The bidirectional effects of comorbid anxiety and depression on patient and partner outcomes are inadequately understood. The aim of this study was to investigate associations of the combined role of depression and anxiety on patients' and partners' QoL.
In this cross-sectional study, patients with CVD and their partners completed questionnaires measuring anxiety, depression, and QoL. Dyadic data was analyzed using the Actor-Partner Interdependence Model and polynomial interaction for examining the synergistic and dysergistic effects of anxiety and depression (i.e., in combination).
181 dyads comprised the study sample (66.3% coronary artery disease; 25.9% female patients). Anxiety and depression, in synergy was associated with poorer QoL in patients and partners (actor effects). Patients that are more anxious than depressed have greater physical QoL whereas partners that are more depressed than anxious have greater emotional QoL (dysergistic actor effects). Patients' more severe symptoms of anxiety and depression, in synergy, was associated with partners' poorer QoL (partner effect).
Anxiety and depression are comorbid and associated with poor QoL in patients and their partners. The results may have implications for secondary prevention programming but future longitudinal studies are warranted to substantiate the cross-sectional findings.
A trial of family partnership and education interventions in heart failure
2013, Journal of Cardiac Failure
Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA).
HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ²₍₂₎ = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention.
Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.
Qualitative study of challenges of caring for a person with heart failure
2018, Geriatric Nursing
Citation Excerpt :
Caregivers are also involved in more objective aspects of decision making with the PHF and the healthcare team, and take on full responsibility for healthcare decisions when a PHF is cognitively impaired, by serving as a proxy.11,12 Finally, caregivers provide immense emotional support to PHF in the form of showing understanding, keeping the PHF company, talking about worries, and providing comfort.13 While caregivers are critical to HF management, they often experience high burden, emotional distress, and depressive symptoms associated with care demands.14–16
Heart failure (HF) is a chronic health condition that causes significant morbidity among older adults, many of whom receive support and care from an informal caregiver. Caregiving is a difficult role with many responsibilities and challenges. An in-depth understanding of these challenges is necessary to develop services, resources, and interventions for HF caregivers. The goal of this study was to qualitatively ascertain the most significant challenges facing HF caregivers. We conducted semi-structured interviews with 16 caregivers of a person with HF (PHF). Content analysis revealed challenges rooted within the PHF (negative affect, resistant behavior, independence, and illness) Caregiver (balancing employment, lack of support, time, and caregiver health) and Relational level (PHF/caregiver dyadic relationship and other relationships). These findings can be used to inform interventions and support services for HF caregivers.
The Caregiver Contribution to Heart Failure Self-care Instrument: Further Psychometric Testing in a European Sample
2022, Journal of Cardiovascular Nursing
Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries
2022, Journal of Advanced Nursing
Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies
2022, Clinical Transplantation

View all citing articles on Scopus

: Supported by the Netherlands Heart Foundation (grant number NHF-2000Z003)

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Clinical InvestigationFamily Caregiving for Patients With Heart Failure: Types of Care Provided and Gender Differences

Abstract

Background

Methods and Results

Conclusions

Section snippets

Participants and Procedure

Response Rate

Discussion

Heart Lung

Heart Lung

J Card Fail

Eur J Heart Fail

Degree of disability and patterns of caregiving among older Americans with congestive heart failure

J Gen Intern Med

The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature

J Cardiovasc Nurs

Family caregiving and congestive heart failure. Review and analysis

Eur J Heart Fail

Burden and stress associated with spousal caregiving for individuals with heart failure

Prog Cardiovasc Nurs

Caregiver burden in partners of heart failure patients: limited influence of disease severity

Eur J Heart Fail

Family caregiving in heart failure

Nurs Res

Informal caregiving to aging family members: a critical review

Fam Relat

Failing in spousal caregiving: the ‘identity-relevant stress’ hypothesis to explain sex differences in caregiver distress

Br J Health Psychol

Gender differences in caregiver stressors, social resources, and health: An updated meta-analysis

J Gerontol B Psychol Sci Soc Sci

Clinical Investigation
Family Caregiving for Patients With Heart Failure: Types of Care Provided and Gender Differences