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Volume 1, 2016, Issue 1, Pages 1-5; Paper doi: 10.15412/J.JCC.02010101; Paper ID: 20002.
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Physical and Psychosocial Needs Assessment in Patients with Heart Failure in the Yazd Afshar Hospital
(Research Paper)
  • 1 Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • 2 Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • Correspondence should be addressed to Hamideh Dehghani, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Tel: ; Fax: ; Email: hamide.dehghani@yahoo.com.

Abstract

Heart failure is a major cause of hospitalization and referring to heart clinics. Studying the needs of patients with heart failure makes better regulation of care programs and appropriate interventions in various aspects of health according to priority of need. The aim of this study is assessment of physical and psychosocial needs in patient with heart failure. This study is cross-sectional. Heart Failure Needs Assessment Questionnaire (HFNAQ) for pa-tients with heart failure in class 3 and 4, EF and lv (left ventricular) systolic dysfunction less than 35% were ad-mitted in hospital, after discharge was completed through interviews. The data was analyzed by SPSS software version22. The highest score in the area of physical need with an average of 28, followed by psychological need with an average of 26 and social need with an average of 24. Mean scores of social and existential needs were increased with increasing age. Mean score of psychological need, social need and existential need in women was significantly higher than men. Only, mean score of physical need in single patient was significantly higher than the married. Mean score of social and existential needs in patients had under diploma education was significantly higher than patients with a higher diploma. Mean score of social and existential needs in pa-tients employed was significantly higher than unemployed patients. Mean scores of physical and psychological needs were increased with increasing severity of illness. Scores of physical need significantly increased by re-ducing of ejection fraction (EF) (P<0.05). Most of needs are relevant to the domain of physical, psychological, social and existential. Age, sex, marital status, education, occupation, severity of illness and the rejection frac-tion of patients effected on the areas of needs assessment.

Keywords

Needs Assessment, Heart Failure, HFNAQ Questionnaire physical and psychosocial needs

1. INTRODUCTION
H

eart failure is a major cause of hospitalization and referring to the heart clinic (1). It is the only common cardiovascular dysfunction, and its prevalence is increasing. In the United States, there are nearly 1 million hospitalizations and 40,000 deaths per year (2). The incidence of the disease increases with age. At least 5 million people in the United States suffer from this disease, and 550,000 new cases are diagnosed each year, and for this reason, it challenges health care resources (3). Heart failure is the most common causes of hospitalization over 65 years, and is the second most common reason for visits to a cardiologist. Economic burden that the disease causes (directly and indirectly) is more than $ 25 billion, which is expected to rise (4). Despite the different methods of treatment, the disease is still increasing. Heart failure is a major cause of death and is vulnerable in the society. Patients are encountered with different mental health, economic, social cognitive problems, in many cases and it is considered as a disease similar to cancer in terms of complexity of the problems in the course of the disease (5). The impact of this disease on the deteriorating quality of life is more intense than other chronic diseases. Anxiety and depression is one of the most common mental distress in these patients. Research has shown that almost 25% of outpatients, and 35 to 50% of hospitalized patients are depressed, and the risk of death in patients with heart failure and depression is higher than non-depressed patients (3). Many studies have been done on quality of life, sleep disorder and depression in patients with heart failure, and yet, less research has been done in terms of actual and unfulfilled needs of patients of different aspects of physical and psychosocial (6). According to Fisher et al, examination of patients' needs leads to adjust the care plan, and appropriate interventions in different aspects of health according to need priority (7). Because, less research has been done on heart failure and assess their needs, the researchers decided to do a research entitled "Evaluation of patients need with heart failure˝˝. Aimed to determine the psychosocial and physical needs, so using their results, appropriate planning and action can be taken in order to reduce or meet the needs of patients.

2. MATERIALS AND METHODS

After confirming the plan to collect samples, we referred to the Heart wards in the Yazd Afshar hospital. (At the time of hospital discharge), and 150 heart failure patients were enrolled that have inclusion criteria in class 3 and 4 and heart failure, lv systolic dysfunction According to the Association of Flb America NYHA with EF less than 35 percent based on the results of echocardiography were selected as samples in the study period using census method. After consent of patient to participate in research, demographic data questionnaire (age, sex, occupation, disease duration, education) and HFNAQ (heart failure needs assessment questionnaire), (the needs of patients with heart failure in physical-psychological-social and biological aspects) and questionnaireSF36 of quality of life were completed by an interview with the patient. The questionnaire HFNAQ (study of the physical and psychosocial needs of patients with heart failure), which its validity and reliability was confirmed (Cronbach's alpha coefficient of all areas of the questionnaire was 0.833) had 30 questions, which is based on the Likert scale (Not at all-rarely-sometimes-often-always) was graded from 1 to 5. Less importance has score of 1, and the most important option has score of 5. These needs are related to physical dimensions (10 questions), psychological dimensions (9 items), and social-biological dimensions (8 questions), existential (3questions) (1). SF-36 questionnaire is about quality of life, and there is an open question at the end of the questionnaire. Results are reported as mean ± SD. Continuous variables were compared between groups using independent test and U_MannWhitney test. Categorical were compared between groups using chi square test and Fisher’s exact test. Data analyzed by using SPSS v. 22. P values less than 0.05 were considered statistically significant.

3. RESULTS AND DISCUSSION

In this study, 150 heart failure patients which have inclusion criteria were enrolled .The mean age was 62.88±12.36 years and 97 (64.7%) of patients were men. 132 (88%) of patients were married. Based on the educational level, 80 (53.3%) patients were illiterate, 55 (36.7%) less than diplomas, 6 (4%) diploma, 9 (4%) higher than diploma.36 (24%) of patients were housewives, 39 (26%) self-employed and farmer, 7 (4.7%) laborer, 3 (2%) employees and 65 (43.3%) retired and unemployed. The mean Duration of disease was 4.74±4.18 years. The class of NYHA in 111 (74%) of patients were 3 and 39 (26%) equal to 4.The mean ejection fraction (EF) was 27.59±6.18.The HFNAQ overall mean ± SD score was 84.21 ± 14.93, with mean ± SD scores of each subscale being psychological 26.04 ± 5.93, social 24.18 ± 2.96, existential 8.78 ± 16.92, and physical 28.06 ± 6.36 (Figure 1 ). The Quality of Life overall mean ± SD score was 60.98 ± 16.92.

Figure 1. Distribution for items of needs assessment in patients with heart failure

There was no significant difference between HFNAQ physical subscale score in two group of age, sex, level of education, job status and duration of disease (P>0.05). There was significant difference between HFNAQ physical subscale score in two group of marital, severity of disease and ejection fraction (P<0.05). There was no significant difference between HFNAQ psychological subscale score in two group of age, marital, level of education duration of disease and ejection fraction (P>0.05). There was significant difference between HFNAQ psychological subscale score in two group of sex, job status and severity of disease (P<0.05). There was no significant difference between HFNAQ social subscale score in two group of marital, job status, duration of disease, severity of disease and ejection fraction (P>0.05). There was significant difference between HFNAQ social subscale score in two group of age, sex and level of education (P>0.05). There was no significant difference between HFNAQ existential subscale score in two group of marital, duration of disease, severity of disease and ejection fraction (P>0.05). There was significant difference between HFNAQ existential subscale score in two group of age, sex, level of education and job status (P>0.05). There was no significant difference between HFNAQ overall score in two group of age, marital, level of education, job status, duration of disease, severity of disease and ejection fraction (P>0.05). There was significant difference between HFNAQ overall score in two group of sex (P>0.05) (Table 1 ). There was no significant difference between QoL (Quality of life) overall score in two group of age, sex, marital, level of education, job status, duration of disease, severity of disease and ejection fraction (P>0.05) (Table 2 ).

Table 1. Comparison Needs Assessment for Heart Failure Patient in two group of age, sex, marital, level of education, job status, duration of disease, severity of disease and ejection fraction