Wednesday, July 11, 2007
This presentation is part of : Theoretical Research Initiatives
Co-Impairments of dyspnea and depression on Functional Limitation, and Disability in Instrumental Activities of Daily Living Among Persons with Heart Failure
Yaewon Seo, PhD, RN, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA and Beverly L. Roberts, RN, PhD, FAAN, College of Nursing, University of Florida, Gainesville, FL, USA.
Learning Objective #1: describe that in HF patients, depressed patients may be validated by assessing dyspnea with daily activities.
Learning Objective #2: reinforce the need of interventions targeted to improve deyspnea and endurance measured here as the 6 Minute Walk for preventing and reducing further disability.

Background: In patients with heart failure (HF), depression is a common co-morbid condition that is related to higher costs of care and to greater perceived symptoms from HF that may affect performance of daily activities. This is the first study to examine the combined effects of depression and dyspnea on functional limitation (activity intolerance) and disability in instrumental activities of daily living (modification in IADLs).

Methods and Results: In a cross-sectional design, 48 men and 54 women over 18 years of age (mean 59.6 years) diagnosed with HF (NYHA Class II-IV) were recruited at an outpatient HF clinic. More than 50% of patients were African American and were categorized as a NYHA II. Dyspnea in performing IADLs was low (M = 2.02, SD = 1.79, range of .00 to 7.60), and 40% were mildly to severely depressed (score of > 14 on the Beck Depression Inventory II). In hierarchical multiple regressions, 29% of the variance in activity tolerance (6-Minute Walk) was significantly explained by dyspnea (β = -.47) and depression (β = .26). In contrast, after controlling for covariates (age, gender, and co-morbidity), the overall model explained 85% of variance in modification in IADLs with dyspnea (β = .74) and activity intolerance (β = -.25) being significant while depression was not significant.

Conclusion: The effect of depression on activity intolerance or disability may be attenuated by dyspnea with overlapping depressive symptoms (e.g., tired, level of activity) that may positively influence patient’s performance. In HF patients, assessment of depression may need to be validated by respiratory symptom. Incorporating assessment of the 6-Minute Walk as well as dyspnea into clinical practice may be useful to identify patients at risk for disability. Interventions targeted to improve dyspena and endurance (measured here as the 6-Minute Walk) may prevent or reduce disability in HF patients.