Haller, Irina V.

Abstract Background Multimorbidity and functional limitation are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on health‐related quality of life in patients with HF is not well understood. Methods Patients aged ≥30 years with two or more HF diagnostic codes and one or more HF‐related prescription drugs from four U.S. institutions were mailed a survey to measure patient‐centric factors including functional status (activities of daily living [ADLs]) and health‐related quality of life (PROMIS‐29 Health Profile). Patients with HF from January 1, 2013 to February 1, 2018 were included. Multimorbidity was defined as ≥2 non‐cardiovascular comorbidities; functional limitation as any limitation in at least one of eight ADLs. Patients were categorized into four groups by multimorbidity (Yes/No) and functional limitation (Yes/No). We dichotomized the PROMIS‐29 sub‐scale scores at the median and calculated odd ratios for the four multimorbidity/functional limitation groups. Results A total of 3330 patients with HF returned the survey (response rate 31%); 3020 completed the questions of interest and were retained. Among these patients (45% female; mean age 73 [standard deviation: 12] years), 29% had neither multimorbidity nor functional limitation, 24% had multimorbidity only, 22% had functional limitation only, and 25% had both. After adjustment, having functional limitation only was associated with higher anxiety (odds ratio [OR]: 3.44, 95% confidence interval [CI]: 2.66–4.45), depression (OR: 3.11, 95% CI: 2.39–4.06), and fatigue (OR: 4.19, 95% CI: 3.25–5.40); worse sleep (OR: 2.14, 95% CI: 1.69–2.72) and pain (OR: 6.73, 95% CI: 5.15–8.78); and greater difficulty with social activities (OR: 9.40, 95% CI: 7.19–12.28) compared with having neither. Results were similar for having both multimorbidity and functional limitation. Conclusion Patients with only functional limitation have similar poor health‐related quality of life scores as those with both multimorbidity and functional limitation, underscoring the important role that physical functioning plays in the well‐being of patients with HF.

Background: Multimorbidity (MM) and functional limitation (FL) are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on mental health and quality of life in patients with HF is not well understood. Methods: Patients aged ≥ 30 years with 2 or more HF diagnostic codes and 1 or more HF-related prescription drugs from four US institutions were mailed a survey to measure functional status (activities of daily living [ADLs]), quality of life and mental health (PROMIS-29 Health Profile) and social support (PROMIS Informational Support, Instrumental Support, and Social Isolation Short Forms). The sampling frame was restricted to patients with a first ever-diagnosis of HF on or after 1/1/2013 at 1 of the participating sites and on or after 1/1/2015 for the other 3 participating sites. A total of 3330 patients returned the survey (response rate 35%); among these, 3020 completed the questions of interest for this analysis and were retained. MM was defined as the presence of ≥ 2 non-cardiovascular comorbidities, and FL was defined as reporting any limitation in at least 1 of 8 ADLs. Patients were categorized into 4 groups by MM (Yes/No) and FL (Yes/No). We dichotomized the subscale scores of the PROMIS-29 at the median and calculated odd ratios for the 4 MM/FL groups. Results: Among 3020 patients with HF (45% female; mean age 73±12 years), 29% had neither MM or FL, 24% had MM only, 22% had FL only, and 25% had both. After adjustment, having both MM and FL or only FL was associated with increased odds of higher anxiety, depression, fatigue, sleep, and pain scores compared to having neither (Figure); having MM only was associated with a higher pain score. Conclusions: Patients with both FL and MM and only FL have similar odds of poor mental health and quality of life scores, underscoring the importance of the role that FL plays in outcomes in patients with HF.

Background: Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the determinants of successful self-management and the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF. Methods: We developed a survey guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. The survey was administered to HF patients from 4 health care systems participating in PCORnet® (the National Patient-Centered Clinical Research Network). Patients were identified utilizing data available in the PCORnet common data model on or after 1/1/2013 at 1 health system and on or after 1/1/2015 at 3 health systems: age ≥30 years, ≥2 HF diagnostic codes, and ≥1 HF-related prescription (positive predictive value of algorithm: 81%). Results: A total of 10,662 patients with HF were identified, 9684 were mailed a survey, and 3330 completed a survey (response rate: 35%). Responders were older than non-responders (74 vs. 71 years), less racially diverse (3% vs. 12% non-White), less likely to have reduced ejection fraction (EF; 22% vs. 27% with EF <40%), and had higher prevalence of most chronic conditions. Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, more than half had difficulty climbing stairs, and more than 10% reported difficulties with bathing, preparing meals, and using transportation (Table). Nearly 80% of patients had family or friends sit with them during a doctor visit, and most (54%) manage their health by themselves. Conclusion: More than half of patients with HF manage their health by themselves even though most bring someone along to their health care appointments. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.

AbstractObjectiveObesity is stigmatized and people with obesity report experiencing stigmatizing situations when seeking health care. The implications of these experiences are not well understood. This study tests an indirect effects model of negative care experiences as an intermediate variable between obesity and care avoidance/utilization and switching primary care doctors.MethodsA survey was completed by 2380 primary care patients in the Learning Health Systems Network (LHSNet) Clinical Data Research Network with a BMI >25 kg/m2. Measures included scales assessing stigmatizing situations, perceived patient‐centered communication, perceived respect, having delayed needed care, and having looked for a new primary doctor in the past 12 months. Sequential and serial indirect effects of care experiences and respect in the association between BMI and care utilization outcomes was modeled.ResultsThe hypothesized model was supported by findings. The associations between BMI and delaying needed care (OR = 1.06, p < 0.001) and attempting to switch primary doctors (OR = 1.02, p = 0.04) was mediated by both stigmatizing situations experienced in a health care context and lower patient‐centered communication. Lower perceived respect mediated the association between care experiences and utilization outcomes.ConclusionsPeople with higher BMIs may avoid care or switch doctors as a result of stigmatizing experiences and poor communication with doctors. These outcomes may contribute to morbidity in people with obesity if they delay or avoid care for health concerns when symptoms first present.

SummaryObjectiveWeight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self‐confidence in ability to lose weight and sought to identify factors associated with patients' self‐confidence in ability to lose weight.MethodsThe authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management.ResultsAmong the 2,263 participants who completed the survey section on ‘Patients’ Experience with Weight Management’, perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value < 0.001). Reported desire to lose weight was also significantly higher among those with the highest BMI than those who were overweight (p value < 0.001). However, this same group had the lowest belief in ability to lose weight (p value < 0.001). In a multiple regression analysis, female gender, higher BMI and need to lose >10 lb were each independently associated with less belief in being able to lose weight.ConclusionsPatients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self‐confidence in ability to lose weight.