Burden of treatment in patients with chronic heart failure

In this new paper, researcher at the University of Stavanger explore the associations between burden of treatment, psychological distress and health–related quality of life. They suggest that the treatment regimens need to be simplified and tailored to the individual heart failure patient to reduce the burden related to treatment and self-care.

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Oda Karin Nordfonn
Oda Karin Nordfonn is a postdoctoral fellow at The Faculty of Health Sciences and the first author of the article.

Heart failure is a clinical syndrome characterised by the hearts’ inability to pump sufficiently to meet the body’s metabolic needs. The prevalence rates of heart failure are increasing and affecting approximately 5-9% of those aged 65 and older. The patients with heart failure must manage both a challenging medical treatment regimens and self-care at home, which can lead to a burden of treatment.

Burden of treatment is defined as the “workload” assigned to long-term ill patients from health care professionals and the impact this has on well-being and functioning. In this study, burden of treatment is measured over nine different dimensions. The aim of the study was to assess the levels of burden from treatment and self-care, and to explore the associations between burden of treatment, psychological distress and health-related quality of life (HRQoL).

The study had a cross-sectional design and collected self-report data from 125 patients diagnosed with mild to moderate heart failure. All the participants attended or previously attended a nurse-led heart failure outpatient clinic. Clinical variables, such as numbers of daily medications and comorbidities were assembled from medical records. We performed descriptive statistics and partial correlation analysis, controlling for age, gender and severity of heart failure.

The participants mean age (SD) was 67 (±9.2), most were male (74,4%) and the majority had heart failure due to reduced pump contraction (ejection fraction 35.4 ±10.8). The highest mean burden scores emerged for insufficient medical information (34.65, range 0 - 86), difficulty with health care service (34.57, range 0 - 81), and physical and mental fatigue due to self-care (34.12, range 0 - 90). Significant positive associations were observed between physical and mental fatigue from self-care, role and social activity limitation, and psychological distress, and HRQoL. Our study advances knowledge of this field as it suggests that burden dimensions assessing patient “work” have less influence on emotional stress and HRQoL, and imply that the burden dimensions assessing the “impact” from treatment and self-care have the greatest influence on well-being in patients with heart failure.

Burden of treatment is an important aspect of heart failure treatment as it contributes to valuable knowledge on patient workload. This study emphasizes the need to simplify and tailor the treatment regimens to alleviate the burden.