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Heart failure is a chronic condition in which people experience multiple symptoms and use numerous symptom management strategies, but the effectiveness of these is varied, affecting health-related quality of life. This descriptive, correlational study aimed to examine the predictability of health–related quality of life using symptom experience (prevalence, frequency, severity, and distress), symptom management strategies, and selected variables (age, employment status, and comorbid condition) among people with heart failure. One hundred and forty people with heart failure were recruited using purposive sampling from the outpatient departments of three general hospitals in Myanmar. Data were collected using four self-administered questionnaires: a Personal Information Questionnaire, the Minnesota Living with Heart Failure Questionnaire, the Memorial Symptom Assessment Scale–Heart Failure, and the Symptom Management Strategies–Heart Failure. Data were analyzed using descriptive statistics, Spearman’s correlation and hierarchical multiple regression.
Lack of energy was ranked first in almost all dimensions of symptom experience. The participants used an average of 18.53 symptom management strategies of which the most effective strategy was “taking the prescribed drugs to excrete extra water," and their health–related quality of life was reported at a moderate level. The predictors of health-related quality of life were symptom experience, symptom management strategies, age, employment status, and comorbid condition, which explained 54.3% of the variance, and the symptom severity dimension was the strongest predictor. The findings highlight that heart failure nursing intervention should focus on reducing symptom experience, increased use of effective symptom management strategies, and prevention of comorbidities to improve health–related quality of life.
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2. Lam CS. Heart failure in Southeast Asia: facts and numbers. ESC Heart Failure. 2015 May 6; 2(2): 46-9. doi: 10.1002/ehf2.12036.
3. Department of Public Health. Hospital Statistics Report 2017-2018. Nay Pyi Taw: Ministry of Health and Sports; 2020. Available from: https:// www.mohs.gov.mm/main/ content/publication/any/list/2/12
4. Mamas MA, Sperrin M, Watson MC, Coutts A, Wilde K, Burton C, et al. Do patients have worse outcomes in heart failure than in cancer? A primary care‐based cohort study with 10‐year follow‐up in Scotland. Eur J Heart Fail. 2017 May 3; 19(9):1095-104. doi:10.1002/ejhf.822.
5. Bekelman DB, Rumsfeld JS, Havranek EP, Yamashita TE, Hutt E, Gottlieb SH, et al. Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. J Gen Intern Med. 2009 Mar 14; 24(5):5928. doi: 10.1007/s11606-009-0931-y.
6. Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL. Symptom distress and quality of life in patients with advanced congestive heart failure. J Pain Symptom Manage. 2008 Jun; 35(6): 594-603. doi:10.1016/j. jpainsymman. 2007.06.007.
7. Heo S, Doering LV, Widener J, Moser DK. Predictors and effect of physical symptom status on health-related quality of life in patients with heart failure. Am. J. Crit. Care. 2008 Mar; 17(2):124-32. doi:10.4037/ajcc2008.17.2.124.
8. Krethong P, Jirapaet V, Jitpanya C, Sloan R. A causal model of health‐related quality of life in Thai patients with heart‐failure. J Nurs Scholarsh. 2008 Aug 25; 40(3): 254-60doi:10.1111/j.1547-5069.2008.00235.x.
9. Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2005 May 23; 4(3):198-206. doi:10.1016/j.ejcnurse.2005. 03.010.
10. Chandra A, Vaduganathan M, Lewis EF, Claggett BL, Rizkala AR, Wang W, et al. Health-related quality of life in heart failure with preserved ejection fraction: the PARAGON-HF trial. JACC: Heart Failure. 2019 Oct 1; 7(10):862-74. doi: 10.1016/j.jchf.2019.05.015.
11. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016 Jul 14; 37(27):2129-200. doi:10.1002/ejhf.592.
12. Reeder KM, Ercole PM, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs. 2015 Jan 1; 30(1): E1–E7. doi:10.1097zJCN.0000000000000117.
13. Chiaranai C, Salyer J. Best A. Self-care and quality of life in patients with heart failure. PRIJNR [Internet]. 2009 Oct-Dec [cited 2017 Jan 2]; 13(4): 302-17. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/ article/view/6474
14. Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, et al. Correlates of quality of life in rural patients with heart failure. Circ Heart Fail. 2014 Nov; 7(6): 882- 7. doi: 10.1161/CIRCHEARTFAILURE.113. 000577.
15. Audi G, Korologou A, Koutelekos I, Vasilopoulos G, Karakostas K, Makrygianaki K, et al. Factors affecting health related quality of life in hospitalized patients with heart failure. Cardiol Res Pract. 2017 Nov 1; 2017. doi:10.1155/2017/4690458.
16. Streng KW, Nauta JF, Hillege HL, Anker SD, Cleland JG, Dickstein K, et al. Noncardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol. 2018 Jul 7; 271:132-9. doi: 10.1016/j. ijcard.2018.04.001.
17. Larson PJ, Carrieri-Kohlman V, Dodd MJ, Douglas M, Faucett J, Froelicher E, et al. A model for symptom management. Image J Nurs Sch. 1994 Nov 4; 26(4): 272-6.
18. Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et al. Advancing the science of symptom management. J Adv Nurs. 2001 Mar; 33(5): 66876. doi:10.1046/j.1365-2648.2001.01697.x.
19. Humphreys J, Janson S, Donesky D, Dracup K, Lee KA, Puntillo K, et al. Theory of symptom management. In Smith M J, Liehr PR. editors. Middle range theory for nursing. 3rd ed. New York: Springer Publishing; 2014. pp. 141-64.
20. Alpert CM, Smith MA, Hummel SL, Hummel EK. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart fail. rev. 2017 Sep 3; 22(1): 2539. doi: 10.1007/s10741-016-9581-4.
21. Albert N, Trochelman K, Li J, Lin S. Signs and symptoms of heart failure: are you asking the right questions? Am J Crit Care. 2010 Sep; 19(5): 443-52. doi: 10.4037/ ajcc2009314.
22. Suwanratsamee W, Pinyopasakul W, Charoenkitkarn V, Dumavibhat C. Symptom experiences, symptom management, and functional status in patients with heart failure. Thai J Cardio-Thorac Nurs. 2013 Jan-Jun; 24(1): 2-16 (in Thai).
23. Okada A, Tsuchihashi-Makaya M, Kang J, Aoki Y, Fukawa M, Matsuoka S. Symptom perception, evaluation, response to symptom, and delayed care seeking in patients with acute heart failure: an observational study. J Cardiovasc Nurs. 2019 Jan 1; 34(1):36-43. doi: 10.1097/JCN. 0000000000000526.
24. Olano‐Lizarraga M, Oroviogoicoechea C, Errasti‐Ibarrondo B, Saracíbar‐Razquin M. The personal experience of living with chronic heart failure: a qualitative meta‐synthesis of the literature. J Clin Nurs. 2016 Sep; 25(17-18): 2413-29. doi: 10.1111/jocn.13285
25. Riegel B, Lee S, Hill J, Daus M, Baah FO, Wald JW, Knafl GJ. Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure. Heart Lung. 2019 May 1; 48(3): 179-85. doi: 10.1016/j. hrtlng.2018.12.008.
26. Scott LD. Caregiving and care receiving among a technologically dependent heart failure population. Adv Nurs Sci. 2000 Dec 1; 23(2): 82-97. doi: 10.1097/ 00012272200012000-00008.
27. Goodman H, Firouzi A, Banya W, Lau-Walker M, Cowie MR. Illness perception, selfcare behavior and quality of life of heart failure patients: a longitudinal questionnaire survey. Int J Nurs Stud. 2013 Jul 1; 50(7): 945-53. doi: 10.1016/j.ijnurstu.2012.11.007.
28. Loo DW, Jiang Y, Koh KW, Lim FP, Wang W. Self-efficacy and depression predicting the health-related quality of life of outpatients with chronic heart failure in Singapore. Appl Nurs Res. 2016 Nov 1; 32: 148-55. doi: 10.1016/j. apnr.2016.07.007.
29. Suresh R, Wang W, Koh KW, Shorey S, Lopez V. Self- Efficacy and HealthRelated Quality of Life among heart failure patients in Singapore: A descriptive correlational study. J Transcult Nurs. 2018 Jul; 29(4): 326-34. doi: 10.1177/ 1043659617723437.
30. Behlouli H, Feldman DE, Ducharme A, Frenette M, Giannetti N, Grondin F, et al. Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. In 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Minnesota: IEEE; 2009 Sep 3. 6242-6. doi: 10.1109/IEMBS.2009.5334659.
31. Heo S, Moser DK, Lennie TA, Fischer M, Kim J, Walsh MN, et al. Prediction of heart failure symptoms and health-related quality of life at 12 months from baseline modifiable factors in patients with heart failure. J. Cardiovasc. Nurs. 2020 Mar 1; 35(2):116-25.doi: 10.1097/JCN.0000 000000000642.
32. Knofczynski GT, Mundfrom D. Sample sizes when using multiple linear regression for prediction. Educ Psychol Meas. 2008 Jun; 68(3): 431-42. doi: 10.1177/ 0013164 407310131.
33. World Health Organization. Process of translation and adaptation of instruments [Internet]. [cited 2017 May 9]. Available from https://www. who.int/ substance_ abuse/ research_tools/translation/en/
34. Brodaty H, Pond D, Kemp NM, Luscombe G, Harding L, Berman K, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002 Mar; 50(3): 530-4. doi:10.1046/j.1532-5415. 2002. 50122.x.
35. Pietri G, Van Ganse E, Ferrer M, Garin O, Wiklund I. MLHF Minnesota living with heart failure questionnaire user manual. Lyon: MAPI Research Institute; 2004.
36. Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994; 30(9): 1326-36. doi:10.1016/0959- 8049(94)90182-1.
37. Ivynian SE, DiGiacomo M, Newton PJ. Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis. Heart Fail Rev. 2015 Nov 1; 20(6): 655-71. doi: 10.1007/s10741-015-9511-x.
38. Myint CY, Pavlova M, Groot W. Health insurance in Myanmar: Knowledge, perceptions, and preferences of Social Security Scheme members and general adult population. Int J Health Plann Mgmt. 2019 Jan; 34(1):346-69. doi: 10.1002/hpm.2643.
39. Chavanon ML, Inkrot S, Zelenak C, Tahirovic E, Stanojevic D, Apostolovic S, et al. Regional differences in health-related quality of life in elderly heart failure patients: results from the CIBIS-ELD trial. Clin Res Cardiol. 2017 Aug 1; 106(8): 64555. doi:10.1007/s00392-017-1101-6.
40. Ray TK, Tat’Yana AK, Pana-Cryan R. Employment arrangement, job stress, and health-related quality of life. Saf Sci. 2017 Dec 1; 100: 46-56. doi: 10.1016/j.ssci. 2017.05.003.