title: Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: a cross-sectional study.
abstract: BACKGROUND
  Heart failure is associated with high rates of hospitalization and mortality. The majority of patients with heart failure suffer from physical symptoms, and these symptoms are strongly associated with poor health-related quality of life. To improve physical symptoms and health-related quality of life, the modifiable factors associated with physical symptoms need to be examined.
  
  
  OBJECTIVE
  To examine modifiable psychosocial and behavioral factors associated with physical symptoms and health-related quality of life, and the mediator effects of physical symptoms on the relationships between the modifiable factors and health-related quality of life in patients with heart failure.
  
  
  METHODS
  Data on potential correlates of physical symptoms (i.e., depressive symptoms, perceived control, social support, medication adherence, sodium intake, and self-care management) were collected from 109 patients with heart failure (mean age 58 ± 14 years, 46% male, 89% New York Heart Association class II/III). Data on physical symptoms (Symptom Status Questionnaire-Heart Failure) and health-related quality of life (Minnesota Living with Heart Failure) also were collected. Simple and multiple regression analyses were used to analyze the data.
  
  
  RESULTS
  Among the potential correlates, depressive symptoms and sodium intake were associated with physical symptoms (F=11.63, p<.001), and depressive symptoms and perceived control were associated with health-related quality of life (F=9.917, p<.001). Physical symptoms mediated the relationship between depressive symptoms and health-related quality of life.
  
  
  CONCLUSIONS
  Improving depressive symptoms and eating the appropriate amount of sodium may be primary intervention targets to improve physical symptoms. To improve health-related quality of life, depressive symptoms as well as physical symptoms need to be managed appropriately.
authors.affiliation: University of Arkansas for Medical Sciences, College of Nursing, United States. Electronic address: sheo@uams.edu.
authors.forename: Seongkum
authors.initials: S
authors.lastname: Heo
authors.affiliation: University of Kentucky, College of Nursing, United States.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: University of Kentucky, College of Nursing, United States.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.affiliation: St. Vincent Hospital, Indianapolis, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Fischer
authors.affiliation: University of Arkansas for Medical Sciences, College of Medicine, United States.
authors.forename: Eugene
authors.initials: E
authors.lastname: Smith
authors.affiliation: St. Vincent Hospital, Indianapolis, United States.
authors.forename: Mary N
authors.initials: MN
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life
keywords: Depressive symptoms; Heart failure; Physical symptoms; Quality of life; Sodium