Association of depressive symptoms and engagement in physical activity with event-free survival in patients with heart failure.

Background: Heart failure (HF) subtype, depressive symptoms, and physical inactivity independently contribute to survival outcomes, but the effect of the interaction of these variables on survival outcomes remains unknown.

Objectives: We aimed to determine whether depressive symptoms and engagement in physical activity differentially interact to predict the combined endpoint of all-cause death or rehospitalization among patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF).

Methods: This study was a secondary analysis.

Protocol for a feasibility randomized controlled trial of gentle yoga in older patients discharged from phase II cardiac rehabilitation.

Background: Physical activity (PA) is essential following an acute cardiac event. Cardiac rehabilitation (CR) is commonly prescribed, and PA after CR is recommended. Because of age-related changes in functional ability and multi-comorbidity, many older cardiac patients struggle to continue performing PA at home after CR.

The relationship of health activation with risk of future cardiovascular disease among rural family caregivers of patients with chronic illnesses.

Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations.

Diet Quality Mediates the Relationship Between Chronic Stress and Inflammation in Patients With Metabolic Syndrome.

Background: Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake.

Objective: The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation in patients with metabolic syndrome.

Examining Food Security, Choices and Barriers among Community Supported Agriculture participants during COVID- 19 in Kentucky.

The coronavirus disease (COVID-19) pandemic is challenging food security. Our study's purpose was to examine relationships among food security status, eating patterns and perceived barriers to food choices among shareholders (N= 209) in a Community Supported Agriculture (CSA) program during stay-at-home restrictions due to the pandemic. The food insecure group (n= 33) reported lower consumption of fruits/vegetables, whole grains and greater consumption of fast foods and more barriers to food choices compared to the food secure group (p<.

Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses.

Background: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses.

Age- and sex-matched comparison of diet quality in patients with heart failure to similarly aged healthy older adults.

The aims of this study were to (1) compare diet quality between patients with heart failure (HF) and age- and sex-matched community-dwelling healthy older adults and (2) determine whether having HF was associated with a lower Healthy Eating Index-2015 (HEI-2015) score and risk of micronutrient deficiency. The HEI-2015 and macro- and micronutrient intakes of patients with HF were compared with healthy older adults ( 102; 55-92 years old; 53 % female). A paired -test or Wilcoxon singed-rank test, McNemar's test, and conditional logistic regression were used to assess the association between diet quality and HF status.

Changes in physical activity during the initial stages of the COVID-19 pandemic.

Introduction: The COVID-19 pandemic response limited access to many traditional forms of physical activity (PA). Purpose:To assess changes in objectively measured PAofUniversity staff during the initial stageofthe COVID-19 pandemic.

Methods: We implemented a repeated measures natural experiment design.

Older and younger patients' perceptions, evaluations, and responses to worsening heart failure symptoms.

Background: Whether recognition and prompt response to worsening symptoms are worse in older compared with younger patients with heart failure (HF) is unclear.

Objectives: The aims of this study were to compare older and younger patients (1) perceptions, evaluations, and responses to worsening HF symptoms, and (2) responses once worsening symptoms were perceived.

Methods: A mixed-methods study was conducted and to compare data between older (≥ 65) and younger (< 65) in 185 patients hospitalized with HF.

Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms.

Background: The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms.

Methods: A total of 611 rural HF patients were included.

Hostility predicts mortality but not recurrent acute coronary syndrome.

Background: Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical.

Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events.

Aims: The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death.

Methods And Results: We studied 153 patients hospitalized with an exacerbation of HF.

Perceived Control Predicts Symptom Status in Patients With Heart Failure.

Background: Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF.

Objective: The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status.

Inflammatory properties of diet mediate the effect of depressive symptoms on Framingham risk score in men and women: Results from the National Health and Nutrition Examination Survey (2007-2014).

Depression is common in patients with cardiovascular disease (CVD) and associated with inflammation. Inflammation contributes to the development of CVD and can be modulated by diet. However, the role of inflammatory properties of diet in the relationship between depressive symptoms and CVD risk is not well understood.

Predictors of Adherence to Self-Care in Rural Patients With Heart Failure.

Background: The common reality of not following a recommended course of treatment is a major cause of poor health outcomes in patients with heart failure (HF). The purpose of this study was to identify predictors of adherence to HF self-care recommendations in rural HF patients who received an intervention to promote symptom management and self-care.

Methods: Data from 349 rural HF patients (42% female, 90% Caucasian) randomized to the intervention arms of the study were used.

Factors Influencing Cardiovascular Risk Factors and Health Perception Among Kentuckians Living in Appalachia.

Background: Cardiovascular disease (CVD) and risk factors for CVD are prevalent among Appalachians from Kentucky. Appalachian men and women have high rates of engagement in unhealthy behaviors and poor physical health measures that increase their risk for CVD.

Objective: In this study, the relationship among gender, CVD risk factors, and health perception in Appalachians from Kentucky was explored.

Missed opportunities! End of life decision making and discussions in implantable cardioverter defibrillator recipients.

Background: Recent guidelines highlight the need for clinician-patient discussions regarding end-of-life (EOL) choices prior to implantable cardioverter defibrillator (ICD) implantation. Health literacy could affect the quality and quantity of such discussions.

Objective: Our objective was to determine the association of health literacy with experiences, attitudes, and knowledge of the ICD at EOL.

Perceived control and quality of life among recipients of implantable cardioverter defibrillator.

Background: Perceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients.

Objectives: To determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population.

A cohort study examining the factors influencing changes in physical activity levels following an acute coronary syndrome event.

Background: Low physical activity has long been identified as a risk factor for coronary heart disease.

Aims: The aim of this study was to determine the factors that influence changes in the physical activity of patients following an acute coronary syndrome event.

Methods: The prospective, inferential cohort design recruited patients admitted to hospital following an acute coronary syndrome event across five research sites.

A cluster and inferential analysis of myocardial infarction symptom presentation by age.

Background: Pre-hospital delay time in myocardial infarction is usually longer in older than in younger patients, with symptom presentation known to be a contributing factor.

Aim: The aim of this article is to examine symptom presentation differences, by age, in patients with myocardial infarction.

Methods: This is a cross-sectional study using secondary analysis of a multi-site randomised controlled trial on pre-hospital delay time.

Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults.

Purpose: This study was conducted to (1) compare diet quality among depressed and nondepressed overweight and obese rural-dwelling adults and (2) determine whether body mass index (BMI) category moderates the relationship between depressive symptoms and overall diet quality.

Methods: Rural adults in Kentucky (n = 907) completed the 9-item Patient Health Questionnaire (PHQ-9) that assessed depressive symptoms and a food frequency questionnaire that generated 2005 Healthy Eating Index (HEI) scores. Participants were grouped into overweight (BMI 25-29.

Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey.

Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients' last days.

Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation.

Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire.

Two-Step Screening for Depressive Symptoms and Prediction of Mortality in Patients With Heart Failure.

Background: Comorbid depression in patients with heart failure is associated with increased risk for death. In order to effectively identify depressed patients with cardiac disease, the American Heart Association suggests a 2-step screening method: administering the 2-item Patient Health Questionnaire first and then the 9-item Patient Health Questionnaire. However, whether the 2-step method is better for predicting poor prognosis in heart failure than is either the 2-item or the 9-item tool alone is not known.