PMID- 34482256 OWN - NLM STAT- MEDLINE DCOM- 20220323 LR - 20221102 IS - 1873-3360 (Electronic) IS - 0306-4530 (Print) IS - 0306-4530 (Linking) VI - 133 DP - 2021 Nov TI - Caregiver subjective and physiological markers of stress and patient heart failure severity in family care dyads. PG - 105399 LID - S0306-4530(21)00273-0 [pii] LID - 10.1016/j.psyneuen.2021.105399 [doi] AB - Greater family caregiver exposure to uncontrolled patient symptoms is predictive of greater caregiver psychological and physiological stress in dementia and other chronic illnesses, but these phenomena have not been well-studied in heart failure (HF) - a disease with high symptom burden. The purpose of this study was to test the hypothesis that worse patient functional status (as reflected by increasing HF symptoms) would be associated with elevated psychological and physiological stress for the caregiver. This was a secondary analysis of data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured on four dimensions: care-related strain/burden (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression Scale), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was measured by markers of HPA axis function (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF patient functional status was quantified by caregiver assessment of New York Heart Association (NYHA) Class. Generalized linear models were used to test associations between patient NYHA Class and stress (one model per indicator). NYHA Class (ordinal) was backwards difference coded in each model to examine caregiver stress in relation to increasing levels of HF severity. Caregivers were mostly female and in their mid-fifties, with a slight majority of the sample being African American and the patient's spouse. Overall, patient functional status was associated with greater caregiver psychological and physiological stress. In terms of psychological stress, higher NYHA Class was significantly associated with greater caregiver anxiety and general stress, but not with caregiver burden or depression. In terms of physiological stress, higher NYHA Class was associated with elevated markers in all models (elevated CAR and higher IL-6, hsCRP, and PAI-1). Across models, most associations between NYHA Class and stress were present at relatively early stages of functional limitation (i.e. Class II), while others emerged when functional limitations became more severe. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory. CI - Copyright (c) 2021 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Bidwell, Julie T AU - Bidwell JT AD - Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Sacramento, CA 95817, United States. Electronic address: jtbidwell@ucdavis.edu. FAU - Hostinar, Camelia E AU - Hostinar CE AD - Department of Psychology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, United States. Electronic address: cehostinar@ucdavis.edu. FAU - Higgins, Melinda K AU - Higgins MK AD - Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States. Electronic address: mkhiggi@emory.edu. FAU - Abshire, Martha A AU - Abshire MA AD - School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, United States. Electronic address: mabshir1@jhu.edu. FAU - Cothran, Fawn AU - Cothran F AD - Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Sacramento, CA 95817, United States. Electronic address: facothran@ucdavis.edu. FAU - Butts, Brittany AU - Butts B AD - Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States. Electronic address: Brittany.butts@emory.edu. FAU - Miller, Andrew H AU - Miller AH AD - Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 12 Executive Park Dr, NE. 2nd Floor, Atlanta, GA 30329, United States. Electronic address: amill02@emory.edu. FAU - Corwin, Elizabeth AU - Corwin E AD - School of Nursing, Columbia University, 560 W. 168th St, Room 600, New York, NY 10032, United States. Electronic address: ejc2202@cumc.columbia.edu. FAU - Dunbar, Sandra B AU - Dunbar SB AD - Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States. Electronic address: sbdunba@emory.edu. LA - eng GR - T32 NR012715/NR/NINR NIH HHS/United States GR - P01 NR011587/NR/NINR NIH HHS/United States GR - UL1 TR001860/TR/NCATS NIH HHS/United States GR - UL1 TR000454/TR/NCATS NIH HHS/United States GR - KL2 TR001859/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20210828 PL - England TA - Psychoneuroendocrinology JT - Psychoneuroendocrinology JID - 7612148 RN - 0 (Interleukin-6) RN - 0 (Plasminogen Activator Inhibitor 1) RN - 9007-41-4 (C-Reactive Protein) SB - IM MH - C-Reactive Protein MH - *Caregivers/psychology MH - *Family Health MH - Female MH - *Heart Failure MH - Humans MH - *Hypothalamo-Hypophyseal System MH - Interleukin-6 MH - Male MH - Middle Aged MH - *Pituitary-Adrenal System MH - Plasminogen Activator Inhibitor 1 PMC - PMC8530937 MID - NIHMS1742118 OTO - NOTNLM OT - Caregivers OT - Heart failure OT - Stress, physiological OT - Stress, psychological OT - Symptoms COIS- Declaration of Interest: The authors declare no conflicts of interest. EDAT- 2021/09/06 06:00 MHDA- 2022/03/24 06:00 PMCR- 2022/11/01 CRDT- 2021/09/05 20:52 PHST- 2021/07/30 00:00 [received] PHST- 2021/08/23 00:00 [accepted] PHST- 2021/09/06 06:00 [pubmed] PHST- 2022/03/24 06:00 [medline] PHST- 2021/09/05 20:52 [entrez] PHST- 2022/11/01 00:00 [pmc-release] AID - S0306-4530(21)00273-0 [pii] AID - 10.1016/j.psyneuen.2021.105399 [doi] PST - ppublish SO - Psychoneuroendocrinology. 2021 Nov;133:105399. doi: 10.1016/j.psyneuen.2021.105399. Epub 2021 Aug 28.