Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial

Chantal F Ski; Martje H L van der Wal; Michael Le Grande; Dirk J van Veldhuisen; Ivonne Lesman-Leegte; David R Thompson; Sandy Middleton; Jan Cameron; Tiny Jaarsma

doi:10.1136/bmjopen-2018-025525

Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial

BMJ Open. 2019 Aug 27;9(8):e025525. doi: 10.1136/bmjopen-2018-025525.

Authors

Chantal F Ski¹, Martje H L van der Wal^{2

3}, Michael Le Grande⁴, Dirk J van Veldhuisen², Ivonne Lesman-Leegte⁵, David R Thompson¹, Sandy Middleton⁶, Jan Cameron⁷, Tiny Jaarsma³

Affiliations

¹ School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
² Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
⁴ Faculty of Health, Deakin University, Burwood, Victoria, Australia.
⁵ Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Nursing Research Institute, Australian Catholic University, Sydney, New South Wales, Australia.
⁷ School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.

Abstract

Objective: To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke.

Design and participants: A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.

Setting: Seventeen hospitals located across the Netherlands.

Outcomes measures: Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years.

Results: Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years.

Conclusions: Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.

Keywords: comorbidity; heart failure; mortality; psychosocial; rehospitalisations; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Depression / epidemiology
Depression / etiology
Female
Heart Failure / complications
Heart Failure / mortality
Heart Failure / psychology*
Heart Failure / therapy
Humans
Male
Middle Aged
Netherlands
Patient Compliance
Psychiatric Status Rating Scales
Psychology
Stroke / complications
Stroke / mortality
Stroke / psychology*
Stroke / therapy
Surveys and Questionnaires
Treatment Outcome