Background: In the fight against heart failure (HF), informal caregivers are an indispensable part of the team. As a protective factor against stress, resilience can help to enhance caregivers’ psychological adaptation and ultimately increase the quality of care during the HF caregiving period. Recognizing its predictors and exploring how these variables interact could promote tailored strategies to enhancing caregivers’ resilience of HF patients. Thus, this study aimed to identify promoting and risk factors of resilience in informal caregivers of HF patients from the Chinese context and to understand the interactions between these factors and resilience. Methods: This cross-sectional study was conducted from December, 2020 to March, 2022 among 210 caregivers in Nanjing, China. The General Information Questionnaire, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Perceived Social Support Scale, the Positive and Negative Affect Scale, the Simplified Coping Style Questionnaire and the Family Hardiness Index were used in this survey. Data were analysed with Pearson’s correlation analysis, the multiple linear regression model and the structural equation modeling (SEM). Results: The resilience of 210 Chinese HF caregivers was at the moderate and higher level (66.40± 15.08). The SEM had a good fit (root mean square error of approximation=0.047, comparative fit index=0.994, Tucker-Lewis index=0.987). Perceived social support (β=0.390, P< 0.001), positive coping style (β=0.159, P=0.019) and self-efficacy (β=0.332, P< 0.001) had positive direct effects on resilience among HF caregivers, separately. Both perceived social support (β=0.04, P< 0.001) and self-efficacy (β=0.07, P< 0.001) indirectly influenced resilience through positive coping style. Conclusion: We recommended that multi-dimensional and greater social support, higher self-efficacy and especially, positive coping strategies should be offered or encouraged during the caregiving period, which may contribute to enhancing HF caregivers’ resilience.

Background: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally.Objective: To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients.Methods: Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.Results: A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase.Conclusion: This study characterized CR engagement, and explored demographic, medical, and psychological factors—with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Aim: This study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management?Design: In this study, qualitative evidence synthesis was performed using the Thomas and Harden method.Data Sources: Electronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021.Review Methods: Two researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.Results: A total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: ‘Diagnosing AF’; ‘The impact of AF on the patients’; ‘Self‐reorientation in the therapeutic process’; ‘Living with AF and QoL’; and ‘External support to facilitate coping strategies.’Conclusions: Our findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF.Impact: Understanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services.Patient or Public Contribution: This paper presents a review of previous studies and did not involve patients or the public.

Background: Struggling with heart failure (HF) may be a distressful experience for the entire family. As a key variable contributing to positive family functioning, family hardiness can protect against HF-related harm. Thus, recognizing factors associated with family hardiness could promote strategies that enable successful adaptation to HF. This study aimed to explore protective factors linked to family hardiness among HF patients. Patients and Methods: A cross-sectional study was undertaken in 2020 among 167 HF patients in Nanjing, China. The study measures comprised a self-designed general information questionnaire, the Family Hardiness Index, the Mutuality Scale, the Positive and Negative Affect Scale, and the Simplified Coping Style Questionnaire. The data analysis was performed using IBM SPSS, version 25 and comprised Pearson’s correlation analysis, a multiple linear regression model, and an analysis of mediating effects. Results: The average Family Hardiness Index score for the 167 HF patients was 57.95 ± 11.41. The multiple linear regression analysis revealed that mutuality, active coping style, and positive emotions of HF patients positively predicted family hardiness (β = 0.359, 0.308, and 0.215, respectively; all P ˂ 0.05). Mutuality between patients and family members had partial mediating effects between active coping style, positive emotions, and family hardiness. Conclusion: Our results revealed that patients’ active coping styles, positive emotions, and mutuality were protective factors associated with family hardiness. In light of our findings, we suggest that active coping strategies, positive emotions, and, especially, closer relationships within families should be encouraged during the rehabilitation and follow-up care of HF patients.