Paving the Way : A Biopsychosocial Survey Study of Young Adults Diagnosed with Heart Failure and Identification of Key Intervention Priorities

Abstract

Introduction: Rates of heart failure have been increasingly noticed in individuals between 20 and 50 years of age, especially in Eastern North Carolina. Little is known about this subset of patients with heart failure. The paucity of literature is problematic as diagnosis at younger developmental stages likely leads to more unique self-care and psychosocial implications for these individuals that may have an impact on heart failure outcomes. The aims of the study were to conduct a biopsychosocial assessment of young adult patients with heart failure and to identify psychosocial priorities for intervention with young adults with heart failure, specifically examining the relationships between heart failure self-care adherence, perceived fit within one's social group, and depression/anxiety. Method: A preliminary qualitative interview study was conducted with 7 young heart failure patients to aid in the conceptualization of the quantitative study. For the primary study, a sample of 46 heart failure patients between the ages of 20 and 50 completed a survey packet encompassing demographic, medical, psychological, and social domains. Results: Overall, the majority of the sample endorsed inadequate adherence (70%) and only 28% reported knowing that heart failure would shorten their life expectancy likely indicating limited disease knowledge in many patients. Overall, reports of annual income were low secondary to unemployment related to heart failure diagnosis. Also, the high rates of psychological distress in this sample were notable. Hypothesized relationships between heart failure self-care adherence and the aforementioned domains were partially supported. Independent t-tests revealed significant differences between patients classified as having good adherence and those classified as having inadequate adherence. Patients with inadequate adherence reported increased levels of depression, lower future expected quality of life, more dignity concerns, lower self-care confidence, less perceived fit with one's social group, and less total coping skills than patients who reported good self-adherence. In addition, correlational analyses indicated that lower perceived group fit was related to higher rates of depression and anxiety, worse heart failure self-care adherence, worse quality of life, and more dignity concerns. Further, there were no significant differences on any of the aforementioned domains between individuals who endorsed knowing another individual under 50 with heart failure versus those who did not. Finally, the hypothesis that perceived group fit would moderate the relationships between heart failure self-care adherence and psychosocial variables was not supported. Conclusions: Based on these findings, social comparisons in regard to perceived group fit, heart failure education and psychoeducation on the relationships between psychosocial symptoms and adherence, and building coping skills were identified as key intervention priorities for young adults diagnosed with heart failure. It was further proposed that the treatment modality for future interventions be a group format utilizing the harm reduction relapse prevention model as a contextual framework to aid in increased adherence and reduced psychological distress.