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Heart failure is a leading cause of hospitalisation and often coexists with seven comorbid conditions on average. This study aimed to examine the gender differences in disease burden, symptom burden, and quality of life among older adults with heart failure and multimorbidity.
Cross-sectional study.
This study utilised a baseline survey from an ongoing cohort study in 2022–2023. Adults aged ≥ 50 years with heart failure and more than one chronic condition were recruited from a university-affiliated hospital using an electronic patient portal. Disease burden was measured using a modified Disease Burden Impact Scale. The Edmonton Symptom Assessment Scale and EuroQoL-5D-5L assessed symptom burden and quality of life. Gender differences in baseline outcomes were examined using Pearson's Chi-square tests, Welch's t-tests, and multiple linear regressions.
Among 353 participants who completed the baseline survey, the mean (±SD) age was 70 (±9.5) years, and 50.1% were women (mean age: 67 ± 9 vs. men: 72 ± 10). In adjusted models, women had 4.9 points higher disease burden (p = 0.003) and reported higher symptom scores of pain (p = 0.018), tiredness (p = 0.021), nausea (p = 0.007), and loss of appetite compared to men (p = 0.036). Women had significantly more moderate/severe problems in usual activities and pain/discomfort and 0.07 points lower EuroQoL index than men (p = 0.010).
There were gender differences in disease/symptom burdens and quality of life. Women living with heart failure and multimorbidity had higher burdens but lower quality of life.
Identifying gender differences among people with heart failure and multimorbidity can be the first step to explaining health disparities. Research should take more inclusive and equitable approaches to address these differences. Healthcare providers, including nurses, should implement targeted strategies for effective multimorbidity management by considering these differences and disparities in clinical settings.
STROBE checklist, cross-sectional.
No patient or public contribution.
Increasing physical activity and effectively managing stress can positively impact immunity and may reduce the duration of respiratory tract infections (RTIs). As part of a larger trial, participants accessed a digital behavioural change intervention that encouraged physical activity and stress management to reduce RTIs. We aimed to understand the barriers and facilitators to engaging in physical activity and stress reduction.
A qualitative process analysis from semistructured interviews of the behavioural intervention in a randomised control trial.
Primary care in the UK.
34 participants (aged 18–82 years) in the behavioural intervention arm.
The larger trial involved four interventions: a gel-based antiviral nasal spray; a saline water-based nasal spray; a behavioural intervention; usual care. In this study, we focused on participants allocated to the behavioural intervention. The behavioural intervention included two components: one to increase physical activity (getting active) and another for stress management techniques (healthy paths) to reduce RTIs.
We analysed the interviews using thematic analysis with a critical realist perspective (focusing on). We developed five themes: digital intervention engagement, views on intervention allocation, the role of getting active, the role of healthy paths and benefits reinforcing behaviour. Participants’ views on the relevance and benefit of the behavioural intervention shaped their engagement with the intervention website and behaviour. Facilitators of intervention engagement included awareness of inactivity, goal setting, increasing immunity, positive outcome expectations and benefits from changing behaviour. Barriers to engagement included negative outcome expectations, such as around efficacy of the behaviours.
Overall, the results highlighted the importance of positive expectations for a digital intervention promoting physical activity and stress management for RTI reduction. Future interventions should consider how to clearly communicate a broad range of perceived benefits to users.
The trial was prospectively registered with International Standard Randomized Controlled Trial Number (ISRCTN) registry (17936080).
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