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Psychosocial Predictors of Adverse Events in Heart Failure: The Utility of Multiple Measurements
Uniformed Services University of the Health Sciences Bethesda United States
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Background and Methods Approximately 5.7 million Americans experience heart failure. Heart failure is associated with a high rate of hospitalization and has a sizeable economic impact. Numerous physiological risk factors are associated with the onset of heart failure, however evidence suggests that psychosocial factors are important. Depression, stress, and major life events are common in populations with cardiovascular disease, who are likely to develop heart failure, and have all been associated with poorer physical health. Rushton and colleagues principle of aggregation suggests that averages taken from multiple measurements of psychosocial and other factors may improve predictive power as compared to single measurements. Using a longitudinal design, the aim of the present study was to determine if depression, perceived stress, and major life events predict adverse events cardiac-related hospitalization or death in heart failure patients over a maximum long-term follow-up of 36 months. In addition, we aimed to evaluate whether averages taken from multiple measures were better predictors of time to first adverse event than single measures. Similar analyses were conducted using standard predictors of heart failure outcomes, including the Kansas City Cardiomyopathy Questionnaire Overall Score KCCQ-OS, KCCQ Symptom Burden Score KCCQ-SB, KCCQ Total Symptom Score KCCQ-TS, brain natriuretic peptide BNP, and the 6-Minute Walk Test 6-MWT. Results In our sample n106, median event-free survival following 3 month assessment was 747 days. Results from unadjusted and adjusted Cox regression survival analyses indicated that no single or average measure of perceived stress, depression, or major life events significantly predicted event-free survival.
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