Of the 5 million persons in the United States with heart failure (HF), 10% have advanced disease, defined as persistent symptoms despite optimal treatment. Seventy-five percent are older than 65, with a higher prevalence in older women than men. Diastolic heart failure, now known as heart failure with preserved systolic function (HFPSF), is common in older women. While significant strides have been made in the management of systolic HF, little is known either about older women with HFPSF or about palliation in advanced disease. OBJECTIVE AND SPECIFIC AIMS: The purpose of this mixed methods study is to describe the characteristics and daily life experiences of older women with advanced HFPSF.
Specific aims are to: 1) Describe the sociodemographic and clinical characteristics of a sample of older women with HFPSF 2) Measure the functional status of the sample of older women 3) Describe the women's physical and emotional symptoms, comfort and quality of life (QOL) and identify variables associated with (QOL) 4) Examine the congruence between patient descriptions of the advanced HF experience and self-rated symptoms, comfort and QOL. DESIGN: This mixed methods design will combine an assessment of functional status, three quantitative instruments and the qualitative interview method of interpretive phenomenology. One hundred women with advanced HFPSF, aged 60 and older, will complete a 6-Minute Walk Test, the Minnesota Living with Heart Failure Questionnaire (MLWHF), the Memorial Symptom Assessment Scale - Heart Failure (MSAS-HF) and the General Comfort Questionnaire (GCQ). A subgroup of 20 women will be interviewed in depth. Sociodemographic and clinical data will be obtained from the women and from medical records. DATA ANALYSIS: Descriptive statistics will be used to address aims 1-3, and will specifically be employed to characterize the sample. A multiple regression model will be constructed to identify variables associated with QOL. Interview data analysis will include identification of common themes, interpretation and identification of paradigms. Qualitative and quantitative data will be examined for congruence. SIGNIFICANCE: Older women with HFPSF are an understudied group. Research addressing the experience of older women with advanced HFPSF advances the National Institute for Nursing Research goal: Enhancing the End-of-Life Experience for Patients and their Families.
Heart failure, a condition of impaired heart pumping efficiency, is an important health issue for older women. Little is known about the characteristics and daily life of older women when heart failure worsens. Increasing understanding of these women and what they experience may help find ways to increase their comfort. ? ? ?