Caregiver determinants of patient clinical event risk in heart failure.
Julie T Bidwell, Ercole Vellone, Karen S Lyons and 6 others
PMID 28513209WHAT IT FOUND
Heart failure patients linked to lower death or hospitalization risk when caregivers reported better mental health and helped more with daily care.
Caregivers helping more with symptom response were linked to higher patient risk.
Key findings
01Higher caregiver strain, better caregiver mental health, and greater caregiver contributions to daily heart failure self-care maintenance were associated with lower patient risk of death or hospitalization.
02Higher patient New York Heart Association class and greater caregiver contributions to heart failure self-care management were associated with higher patient clinical event risk.
03Patients with caregivers in the highest self-reported mental health tertile had lower risk of clinical events over time than patients with caregivers in the lowest tertile.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis included only 183 patient-caregiver dyads, so the model could include only a limited number of predictors. Clinical events were reported by patients or caregivers by phone, not confirmed from long-term medical records, so events may have been underreported. The sample was from Italy only, so the results may not apply to other countries or healthcare systems. Patients were community-dwelling outpatients, and nearly half had no prior hospitalization, so findings may not apply to recently hospitalized heart failure patients. The study observed associations only; it did not test whether changing caregiver factors improves patient outcomes. Covariates were selected with a backward stepwise approach because of sample size, so other patient factors may not have been controlled.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that reducing caregiver strain or increasing caregiver help will lower heart failure events. The study only observed baseline associations over time and did not test an intervention.