Measuring emotional representation of heart failure symptoms in older adults

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Delville, Carol Lynn

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Chronic heart failure (HF) affects one in five Americans over age 40. It is the leading cause of emergency room visits and hospitalizations. More Medicare dollars are spent for the diagnosis and treatment of HF than any other condition. This study examined emotional representation of HF symptoms after a five-minute verbalization of feelings about these symptoms: 1) What are the characteristics of language used by participants in a verbalization of feelings related to HF symptoms? 2) How does positive affect, negative affect, heart rate (HR), blood pressure (BP), salivary alpha-amylase (sAA), and salivary cortisol (sC) vary over time after verbalization of feelings related to HF symptoms? And 3) What are the significant relationships between emotional word usage, positive and negative affect, HR, BP, sAA, and sC after verbalization of feelings about HF symptoms? A sample of sixty-adults (46 males) with symptomatic HF had a mean age of 71.99 years (SD 9.40), mean education 14.14 (SD 2.86), and Mini-Mental State Exam mean of 29.10 (SD 1.64). They were primarily Caucasian (85%) and married (56.67%) and had a mean time since diagnosis of HF of 104.75 months (SD 106.01). Participants' positive and negative emotional words usages were similar to samples with cancer, HIV/AIDES, and caregivers of chronically ill children. Positive and negative affect, BP, and HR were stable over time. Negative affect scores nearly doubled the reported means for healthy older adults. After speaking about HF symptoms, pulse pressure (F= 5.42, p= .007) and cortisol decreased (t=2.27, p= .027), whereas sAA was elevated (t= -4.31, p< .001). This finding was unexpected in a sample where 90% of the participants were treated with [beta]-blocking medications. Activation of the sympathetic nervous system (SNS) occurred after speaking about feelings related to HF in 70% of this sample. This is relevant given the role of the SNS in HF progression. This was the first study to explore relationships between a description of symptoms, hemodynamic measures, and neurohormonal responses from a verbal description of HF symptoms. This study has demonstrated that human emotions are a representation of the daily health experience of older adults with symptomatic HF.