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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3101 — The Influence of Spousal Well-Being on Heart Failure Disease Management: Conceptual Model and Pilot Data

Trivedi RB (Seattle HSR&D CoE), Piette J (Ann Arbor HSR&D CoE), Fihn SD (Seattle HSR&D CoE), Edelman D (Durham HSR&D CoE)

Objectives:
Caregiver research has highlighted the positive influence of spouses on patient outcomes in heart failure (HF). However, research has seldom focused on how patients and spouses can influence each others’ well-being, or evaluated whether spousal well-being affects the success of patients’ disease management. Our goals were to test the reciprocity between patient and spouses’ well-being, especially as it relates to disease management.

Methods:
A novel conceptual model was developed and tested using data from a preliminary cross-sectional study of 23 Veterans with HF and their spouses. Depressive symptoms, caregiver burden, relationship satisfaction, perceived social support, and disease management were assessed in both Veterans and their spouses. Descriptive analyses and bivariate correlations between these measures were calculated. All probabilities (p) < .05 were statistically significant.

Results:
Using standard cutoffs, analyses suggested clinically significant depressive symptoms in patients (CES-D > 16; Mean = 21.8±13) and a high level of caregiver burden among spouses (Zarit Burden Interview > 15; Mean = 22.4±15.4). Both patients and spouses reported high relationship satisfaction levels (Dyadic Adjustment Scale score > 100; Mean = 112.6±26.5 and 115.9±14.4, respectively). On average, patients reported poor disease management (Self-care of HF Index subscale < 70) across all subscales: Confidence = 53.3±28.2; Maintenance = 59.7±17.3; Management = 54.0±19.4). Correlational analyses showed that patient depressive symptoms were positively correlated with spouse depressive symptoms (r = .53) and caregiver burden (r = .64). Spouses’ depressive symptoms were correlated with lower levels of perceived social support among patients (r = -.47), poor patient relationship satisfaction (r = -.51), and worse patient confidence in HF management (r = -.48). Greater caregiver burden was associated with more patient disease complaints (r = .49), poorer patients’ relationship satisfaction (r = -.72), and poorer patients’ perceived social support (r = -.73).

Implications:
Results suggest that both patient and spouses can not only influence each others’ well-being, but also disease management. Further research is necessary to test the model and to determine which spousal factors appear to be most relevant to patient outcomes.

Impacts:
Results underscore the important role played by spouses and suggest that expanding HF treatment to include spouses may be beneficial for disease management. Results also suggest that spousal well-being should be considered when treating Veterans with HF.


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