Browsing by Author "Jung, Miyeon"
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Item 911 Calls for Emergency Medical Services in Heart Failure: A Descriptive Qualitative Study(Wolters Kluwer, 2022-09) Jung, Miyeon; Hays, Laura M.; Pang, Peter S.; Newhouse, Robin P.; Arkins, Thomas P.; O'Donnell, Daniel; Cook, Ryan; Gradus-Pizlo, Irmina; McAdams, Ellen; Pressler, Susan J.; School of NursingBackground Heart failure (HF) is a common condition leading to activation of emergency medical services (EMS). Objective The aim of this study was to describe reasons given by persons with HF, family members, or other caregivers for requesting EMS activation during 911 calls. Methods In this descriptive qualitative study, a content analysis was performed on transcribed audio files of 383 EMS requests involving 383 persons with HF in the community. Results One hundred forty-seven calls (38.4%) were placed by the family members, 75 (19.6%) were placed by the patients, 56 (14.6%) were placed by healthcare workers or personnel from living facilities, and the remaining calls (n = 105, 27.4%) were placed by others (eg, friends, neighbors, officers). Three broad categories of symptoms, signs, and events were identified as the reasons for an EMS request. Frequently reported symptoms were breathing problems (55.4%), chest pain (18.3%), and other pain (eg, head, extremities) (16.7%). Signs included decreased consciousness (15.4%), swelling (5.7%), and bleeding (5.0%). The reported events involved falls (8.1%), heart attack (6.3%), hypoxic episodes (6.0%), stroke (5.2%), and post–hospital-discharge complications (4.7%). In most calls (74.9%), multiple reasons were reported and a combination of symptoms, signs, and events were identified. Heart failure diagnosis was mentioned in fewer than 10% of the calls. Conclusions Overall, symptoms and signs of HF exacerbation were common reasons to activate 911 calls. Falls were frequently reported. Under the duress of the emergent situations surrounding the 911 call, callers rarely mentioned the existence of HF. Interventions are needed to guide patients with HF and their family members to promote the management of HF to reduce EMS activation as well as to activate EMS quickly for acute changes in HF conditions.Item Characterizing pain leading to emergency medical services activation in heart failure(Wolters Kluwer, 2022) Smith, Asa B.; Jung, Miyeon; Lee, Christopher; Pressler, Susan J.; School of NursingBackground: Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS. Methods: Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ 2 , analysis of variance, and logistic and multiple linear regression analyses were used. Results: The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age ( b = -0.05, SE = 0.013), being a woman ( b = 1.17, SE = 0.357), and White race ( b = -1.11, SE = 0.349). Conclusions: Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.Item Chronic Heart Failure With Memory and Attention Dysfunction: Old Problem, Thinking Anew(Elsevier, 2018) Pressler, Susan J.; Jung, Miyeon; School of NursingItem Construct Validity of the Multi-Source Interference Task to Examine Attention in Heart Failure(Wolters Kluwer, 2018-11) Jung, Miyeon; Jonides, John; Berman, Marc G.; Northouse, Laurel; Koelling, Todd M.; Pressler, Susan J.; School of NursingBackground Patients with heart failure (HF) are at risk of cognitive dysfunction, including decreased directed attention. Directed attention is critical for performing daily activities including HF self-care by facilitating one to follow instructions or train-of-thought when there are interferences in which presented stimuli are in conflict with one another. The Multi-Source Interference Task (MSIT) is a computerized neuropsychological test that examines the function of the dorsal anterior cingulate cortex, the neurological substrate for directed attention. However, the MSIT has not been used in past HF studies. Objective The purpose of the study was to examine construct validity of the MSIT in HF. Methods Baseline data were obtained from a cognitive intervention study among patients with HF (n = 22) and age- and education-matched healthy adults (n = 20). Construct validity was evaluated using t tests to examine differences between patients with HF and healthy adults and congruent and incongruent MSIT trials. Pearson’s correlations were computed to examine relationships between the MSIT and Trail-Making Test, Stroop Test, and Attentional Function Index. Results Compared with healthy adults, patients with HF demonstrated worse performance (i.e., slower response times and higher error rates) on MSIT. Patients with HF had worse performance on MSIT incongruent trials than congruent trials. Interference z scores of MSIT did not correlate with Trail-Making Tests A and B and Stroop Test interference z scores, but the MSIT interference z scores correlated with perceived attention function measured by Attentional Function Index. Discussion Construct validity of the MSIT was supported, in part, among patients with HF. The MSIT is a sensitive measure of detecting worse directed attention among patients with HF compared with healthy adults. The preliminary findings support the use of the MSIT as a measure of directed attention in HF. Confirmation is warranted for current findings in larger samples.Item Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study(Wolters Kluwer, 2018-07) Pressler, Susan J.; Giordani, Bruno; Titler, Marita; Gradus-Pizlo, Irmina; Smith, Dean; Dorsey, Susan G.; Gao, Sujuan; Jung, Miyeon; School of NursingBACKGROUND: Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS: A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS: This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.Item Differential Gene Expression Among Patients With Heart Failure Experiencing Pain(Wolters kluwer Health, 2023-02-26) Smith, Asa; Jung, Miyeon; Pressler, Susan; Mocci, Evelina; Dorsey, SusanBackground: Chronic pain is frequently experienced by patients with heart failure (HF) and is associated with higher mortality, higher symptom burden, and worsened health-related quality of life. However, the genomic mechanisms underlying chronic pain in HF are understudied. Building an understanding of the mechanistic underpinnings of pain may inform novel interventions. Objective: The objective was to identify genes associated with pain from mRNA sequence data collected from patients with HF with and without pain. Methods: The current study analyzed data from 40 patients with HF previously enrolled in a clinical trial. Pain presence was measured using the Health Utilities Index Mark-3. Genes were tested for differential expression using DESeq2, and differentially expressed genes were analyzed for protein–protein interaction (PPI) and relevant ontological pathways using Metascape. Genes located within the core of the PPI network were considered key in disease-relevant biological pathways. Differentially expressed genes within this PPI network were reviewed in existing literature to narrow down candidate genes of interest. These target genes of interest were reanalyzed in a second sample of 24 patients with HF using validation quantitative polymerase chain reaction. Results: A total of 334 genes (279 upregulated, 55 downregulated) were differentially expressed between patients with and without pain in the primary sample of 40. These genes were largely aligned with neutrophil degranulation pathways. Seven genes of interest were identified from a core network of 15 co-expressed genes in the PPI network and existing literature. Three of these seven genes: matrix metallopeptidase 8 (MMP8), proprotein convertase subtilisin/kexin type 9 (PCSK9), and neutrophil defensin 3 (DEFA3) were upregulated in patients with pain versus without pain in both the primary and validation samples. All seven genes of interest are involved in immune, inflammatory, and atherosclerotic processes. Discussion: These results identify potential genes that may play a mechanistic role in chronic pain in HF. Further research is needed to evaluate these potential genes among clearly delineated pain phenotypes.Item Does pain at hospital discharge predict transition from hospital to home and 12-month mortality among patients with heart failure?(N/A, 2022-11) Smith, Asa; Jung, Miyeon; Pressler, SusanIntroduction: Pain is present in 37%-68.9% of hospitalized patients with heart failure (HF), but little is known about how pain at discharge influences transition from hospital to home or 12-month mortality. The aims were to examine if pain at discharge predicts 1) return to home status and 2) 12-monthmortality among hospitalized patients with HF. Methods: In this prospective study, data were obtained from a dataset of 1,475 patients with HF hospitalized at 3 tertiary-care hospitals from 2009-2017. Pain at discharge (yes/no) was obtained from medical records using ICD-9 or ICD-10 codes. Return to home status (yes/no) and all-cause 12-month mortality were obtained from medical records. Descriptive statistics, independent samples t-tests, and χ2 were used to describe the sample. Logistic regression was computed to address the aims. Results: The sample was 59.5% women and 40.5% men. The mean age was 68.6 (SD 13.6) years. Race was 53.6% Black and 46.4% White. Of 1,475 patients, 239 (16.2%) had pain documented at discharge. Patients with pain documented at discharge were younger compared to patients without pain (p<.001). One hundred sixty-five of 239 patients (69.0%) with pain and 831 of1,236 patients (67.2%) without pain returned to home (χ2=0.297, p=.585). At 12 months after discharge, 20 of 239 patients (8.4%) with pain had died compared to 134 of 1,236 patients (10.8%) without pain (χ2=1.31, p=.252). In logistic regressions, pain at hospital discharge was not a statistically significant predictor of return to home status or 12-month mortality (Table 1). Conclusions: Over 30% of patients with HF did not return to home after hospitalization. Patients with HF have significant transitional care needs, including pain management. Future studies are needed to determine the phenotypes of pain among patients with HF, evaluate associations between pain at discharge and transitional care needs, and design innovative strategies to ameliorate pain.Item Does the location of a primary pain complaint during transport by emergency medical services predict hospitalization status, length of stay, and mortality among patients with heart failure?(N/A, 2023-03) Smith, Asa; Jung, Miyeon; Pressler, SusanPurpose: The purpose was to examine which locations of pain (abdominal, back, chest, or generalized) predict hospitalization status, length of stay, and mortality among patients with heart failure (HF) transported by emergency medical services (EMS) to the emergency department (ED). Research Question: Does presenting to EMS with a primary complaint of abdominal, back, chest, or generalized pain predict 1) higher hospital admission rates 2) longer length of stay, or 3) higher mortality rates compared to patients presenting with other primary complaints? Rationale: About 22% of patients with HF are transported by EMS to the ED with a primary complaint of pain. Locations of pain vary among patients with HF, but whether different locations of pain can differentiate health outcomes are unknown. Methods: A retrospective comparative descriptive study was conducted using electronic health records from EMS and hospitals. A total of 2,592 patients with HF transported between 2009-2017 were included in the analysis. Pain complaints included abdominal, back, chest, and generalized. Outcomes were hospitalization status, in-hospital mortality, and inpatient length of stay. Binomial logistic and linear regressions were used to answer research questions. Results: Demographics were mean age 66.15 (SD=14.93); gender 59.7% women, 54.6% men; race 54.6% Black, 44.6% White, 0.8% Other. Of 2,592 patients, 581 (22.4%) presented with pain, 1,886 were hospitalized (72.8%), 127 died during hospitalization (4.9%), and median length of hospital stay was 4.63 days. Pain frequencies were: chest=404 (69.5%), abdominal=100 (17.2%), generalized=45 (7.7%), and back=32 (5.5%). Compared to patients without pain, no locations of pain were significantly associated with hospitalization. Surprisingly, patients with chest pain were less likely to die during hospitalization compared to patients without pain (OR=0.44, p=.024). Furthermore, patients with chest pain (β =-0.49, p<.001) and generalized pain (β =-0.57, p=.011) were associated with a shorter length of stay compared to patients without pain. Conclusion: No locations of pain predicted hospitalization status. Chest pain was associated with decreased odds of in-hospital mortality, and both chest and generalized pain were associated with a shorter length of stay. One explanation may be the higher illness severity among patients with other primary complaints. Prospective studies are needed to understand the impact chronic pain in HF.Item Evaluating Depressive Symptoms, BDNF Val66Met, and APOE-ε4 as Moderators of Response to Computerized Cognitive Training in Heart Failure(Elsevier, 2023) Pressler, Susan J.; Jung, Miyeon; Giordani, Bruno; Titler, Marita G.; Gradus-Pizlo, Irmina; Reid Lake, Kittie; Wierenga, Kelly L.; Clark, David G.; Perkins, Susan M.; Smith, Dean G.; Mocci, Evelina; Dorsey, Susan G.; School of NursingBackground: Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). Objectives: The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). Methods: 256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. Results: As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. Conclusions: Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.Item Genes linked with inflammatory processes are differentially expressed in patients with chronic heart failure and pain(N/A, 2022-09) Smith, Asa; Dorsey, Susan; Mocci, Evelina; Jung, Miyeon; Pressler, SusanBackground and Aims Pain is a significant problem among patients with chronic heart failure (HF). The mechanisms underlying pain in HF remain poorly understood. Gene expression analysis using mRNA sequencing can highlight mechanistic underpinnings of complex symptoms such as pain. The aim of this study was to identify differentially expressed genes linked with pain in patients with HF with pain compared with patients with HF but without pain. The research question was: what genes linked with pain are differentially expressed between patients with HF and pain compared to patients with HF without pain? Methods Data were collected as part of a parent randomized controlled trial to test the efficacy of a computerized cognitive intervention for memory among patients with chronic HF (R01 NR016116). Blood specimens, pain measures, and sociodemographic characteristics were collected during the baseline visit in the parent trial. Data from 40 patients with HF: 20 with pain and 20 without pain, were analyzed in the current study. Pain presence (yes/no) was assessed using 1 item of the Health Utilities Index Mark-3 questionnaire. Sociodemographic data collected were age, self-reported gender, race and ethnicity, years of education, marital status, depressive symptoms (Patient Health Questionnaire-8), and health-related quality of life (Minnesota Living with Heart Failure Questionnaire). Clinical characteristics included body mass index, left ventricular ejection fraction (LVEF), and New York Heart Association heart failure class. Differences in demographic and clinical variables between the pain and no pain groups were examined using independent samples t-tests and chi square. The mRNA was isolated from whole blood and sequenced using a 150bppaired-end read configuration. Genes were tested for differential expression between HF patients with pain and without pain using DESeq2. Genes were considered differentially expressed if the log fold change between groups was ≥ ± 0.58 with a false discovery p-value < 0.05. Differentially expressed genes were examined using protein-protein interactions analysis, disease-related biological pathways, and existing pain literature. Independent samples t-tests were used to identify statistically significant differences in gene expression between the pain and no pain groups. Target genes of interest were validated through real-time polymerase chain reaction in a different sample of 24 patients: 10 with pain and 14 without pain, selected from the parent study and matched to the discovery sample on age and gender. Results Among the patients with pain, the mean age was 66.45 ± 6.21 years compared to 62.65 ± 13.87 years in the patients with pain. Most patients were men (60% in the pain group vs. 70% in the no pain group) and White(75% vs. 60%, respectively). The sample was primarily New York Heart Association class II (42.5%), with an average LVEF of 42.56% ± 13.58%. There were no statistically significant differences in demographic or clinical status variables between patients with and without pain. A total of 334 differentially expressed genes were identified (279 upregulated and 55 downregulated); they were mostly involved in neutrophil degranulation pathways (n = 57, false discovery p-value = 7.9e-17), followed by extracellular matrix organization pathways (n = 19, false discovery p-value = 4.5e-03). The protein-protein interactions analysis produced a network of 288 nodes and 497 edges, compared to the expected number of 182 edges(enrichment p-value < 1.0e-16), with a core network consisting of 15 co-expressed genes. From this core network of 15 genes, 7 target genes of interest were identified: (1) cathepsin G (CTSG), (2) lactotransferrin(LTF), (3) lipocalin-2 (LCN2), (4) matrix metallopeptidase 8 (MMP8), (5) matrix metallopeptidase 9 (MMP9), (6)proprotein convertase subtilisin/kexin type 9 (PCSK9), and (7) neutrophil defensin 3 (DEFA3). All 7 genes were connected to inflammatory pathways and inflammatory pain conditions (e.g., arthritis) in existing pain literature. All 7 genes were upregulated in patients with HF and pain compared to those with HF and without pain. Three of these 7 genes (MMP8,PCSK9,andDEFA3) were also validated in the second sample of 24patients with HF. Conclusions This study identified 7 genes that were differentially expressed in patients with chronic HF and pain compared to patients with HF but no pain. Of these, 3 were validated in an additional sample which further strengthens the proposed connection of these genes with pain. The genes were significantly enriched in inflammatory and extracellular matrix organization and may play a role in development of chronic pain among patients with HF. This study is novel in that the biologic mechanisms underlying pain in this population have not been previously examined using gene expression analysis. Further research is needed with a more ethnically diverse sample and more robust pain measures, particularly regarding severity and locations of pain.