Sympathetic dysfunction is associated with worse fatigue and early and subtle symptoms in heart failure : An exploratory sex-stratified analysis

Journal article

Stutsman, Nina, Habecker, Beth, Pavlovic, Noelle, Jurgens, Corrine Y., Woodward, William R., Lee, Christopher S. and Denfeld, Quin E.. (2024). Sympathetic dysfunction is associated with worse fatigue and early and subtle symptoms in heart failure : An exploratory sex-stratified analysis. European Journal of Cardiovascular Nursing. 23(5), pp. 532-539. https://doi.org/10.1093/eurjcn/zvad121
AuthorsStutsman, Nina, Habecker, Beth, Pavlovic, Noelle, Jurgens, Corrine Y., Woodward, William R., Lee, Christopher S. and Denfeld, Quin E.
Abstract

Aims
Physical symptoms impact patients with heart failure (HF) despite treatment advancements; however, our understanding of the pathogenic mechanisms underlying HF symptoms remains limited, including sex differences therein. The objective of this study was to quantify associations between sympathetic markers [norepinephrine (NE) and 3,4-dihydroxyphenylglycol (DHPG)] and physical symptoms in patients with HF and to explore sex differences in these associations.

Methods and results
We performed a secondary analysis of combined data from two studies: outpatients with HF (n = 111), and patients prior to left ventricular assist device implantation (n = 38). Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) dyspnoea and early/subtle symptom subscales and the Functional Assessment in Chronic Illness Therapy Fatigue Scale (FACIT-F) to capture dyspnoea, early symptoms of decompensation, and fatigue. Norepinephrine and DHPG were measured with high-performance liquid chromatography with electrochemical detection. Multivariate linear regression was used to quantify associations between symptoms and sympathetic markers. The sample (n = 149) was 60.8 ± 15.7 years, 41% women, and 71% non-ischaemic aetiology. Increased plasma NE and NE:DHPG ratio were associated with worse FACIT-F scores (P = 0.043 and P = 0.013, respectively). Increased plasma NE:DHPG ratio was associated with worse HFSPS early/subtle symptoms (P = 0.025). In sex-stratified analyses, increased NE:DHPG ratio was associated with worse FACIT-F scores (P = 0.011) and HFSPS early/subtle scores (P = 0.022) among women but not men.

Conclusion
In patients with HF, sympathetic dysfunction is associated with worse fatigue and early/subtle physical symptoms with associations stronger in women than men.

Keywordsbiomarkers; heart failure; sex differences; sympathetic nervous system; symptoms
Year2024
JournalEuropean Journal of Cardiovascular Nursing
Journal citation23 (5), pp. 532-539
PublisherOxford University Press
ISSN1474-5151
Digital Object Identifier (DOI)https://doi.org/10.1093/eurjcn/zvad121
PubMed ID38196102
Scopus EID2-s2.0-85199186147
PubMed Central IDPMC11257751
Page range532-539
FunderEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health
National Institute of Nursing Research (NINR), National Institutes of Research
National Center for Advancing Translational Sciences (NCATS), National Institutes of Health
Publisher's version
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All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online10 Jan 2024
Publication process dates
Accepted21 Nov 2023
Deposited30 May 2025
Grant IDK12HD043488
R01NR013492
UL1TR002369
Additional information

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.

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Wleklik, Marta, Uchmanowicz, Izabella, Jankowska, Ewa A., Vitale, Cristiana, Lisiak, Magdalena, Drozd, Marcin, Pobrotyn, Piotr, Tkaczyszyn, Michał and Lee, Christopher. (2020). Multidimensional approach to frailty. Frontiers in Psychology. 11, p. 564. https://doi.org/10.3389/fpsyg.2020.00564
Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis
Uchmanowicz, Izabella, Lee, Christopher S., Vitale, Cristiana, Manulik, Stanisław, Denfeld, Quin E., Uchmanowicz, Bartosz, Rosińczuk, Joanna, Drozd, Marcin, Jaroch, Joanna and Jankowska, Ewa A.. (2020). Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis. ESC Heart Failure. 7(6), pp. 3427-3437. https://doi.org/10.1002/ehf2.12827
Patterns of heart failure dyadic illness management : The important role of gender
Lee, Christopher S., Sethares, Kristen A., Thompson, Jessica Harman, Faulkner, Kenneth M., Aarons, Emily and Lyons, Karen S.. (2020). Patterns of heart failure dyadic illness management : The important role of gender. Journal of Cardiovascular Nursing. 35(5), pp. 416-422. https://doi.org/10.1097/JCN.0000000000000695
Older adults can successfully monitor symptoms using an inclusively designed mobile application
Reading Turchioe, Meghan, Grossman, Lisa V., Baik, Dawon, Lee, Christopher S., Maurer, Mathew S., Goyal, Parag, Safford, Monika M. and Masterson Creber, Ruth M.. (2020). Older adults can successfully monitor symptoms using an inclusively designed mobile application. Journal of the American Geriatrics Society. 68(6), pp. 1313-1318. https://doi.org/10.1111/jgs.16403
A multilevel modeling approach to examine incongruent illness appraisals in family care dyads over time
Lyons, Karen S. and Lee, Christopher S.. (2020). A multilevel modeling approach to examine incongruent illness appraisals in family care dyads over time. Journal of Family Nursing. 26, pp. 229-239. https://doi.org/10.1177/1074840720944439
The association between longer durations of the active phase of labor and subsequent perinatal processes and outcomes among midwifery patients
Tilden, Ellen L., Phillippi, Julia C., Carlson, Nicole, Dissanayake, Mekhala, Lee, Christopher S., Caughey, Aaron B. and Snowden, Jonathan M.. (2020). The association between longer durations of the active phase of labor and subsequent perinatal processes and outcomes among midwifery patients. Birth. 47(4), pp. 418-429. https://doi.org/10.1111/birt.12494
The role of concealment and relationship quality on patient hospitalizations, care strain and depressive symptoms in heart failure dyads
Lyons, Karen S., Sadowski, Taylor and Lee, Christopher S.. (2020). The role of concealment and relationship quality on patient hospitalizations, care strain and depressive symptoms in heart failure dyads. Journal of Cardiovascular Nursing. 19(2), pp. 118-124. https://doi.org/10.1177/1474515119863791
Predicting postpartum hemorrhage after vaginal birth by labor phenotype
Erickson, Elise N., Lee, Christopher S. and Carlson, Nicole S.. (2020). Predicting postpartum hemorrhage after vaginal birth by labor phenotype. Journal of Midwifery & Womens Health. 65(5), pp. 609-620. https://doi.org/10.1111/jmwh.13104
Identifying unique profiles of perceived dyspnea burden in heart failure
Faulkner, Kenneth M., Jurgens, Corrine Y., Denfeld, Quin E., Lyons, Karen S., Harman Thompson, Jessica and Lee, Christopher S.. (2020). Identifying unique profiles of perceived dyspnea burden in heart failure. Heart & Lung: the journal of acute and critical care. 49(5), pp. 488-494. https://doi.org/10.1016/j.hrtlng.2020.03.026
Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure
Denfeld, Quin E., Bidwell, Julie T., Gelow, Jill M., Mudd, James O., Chien, Christopher V., Hiatt, Shirin O. and Lee, Christopher S.. (2020). Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure. Heart & Lung: the journal of acute and critical care. 49(2), pp. 151-157. https://doi.org/10.1016/j.hrtlng.2019.11.004
Caregiver strain and heart failure patient clinical event risk : An extension of previous work
Bidwell, Julie T., Lee, C., Higgins, Melinda K., Reilly, Carolyn M., Clark, Patricia C. and Dunbar, Sandra B.. (2020). Caregiver strain and heart failure patient clinical event risk : An extension of previous work. Journal of Cardiovascular Nursing. 35(3), pp. 262-267. https://doi.org/10.1097/JCN.0000000000000665
Predictors of emergency medical services use by adults with heart failure; 2009–2017
Pressler, Susan J., Jung, Miyeon, Lee, Christopher S., Arkins, Thomas P., O'Donnell, Daniel, Cook, Ryan, Bakoyannis, Giorgos, Newhouse, Robin, Gradus-Pizlo, Irmina and Pang, Peter S.. (2020). Predictors of emergency medical services use by adults with heart failure; 2009–2017. Heart and Lung. 49(5), pp. 475-480. https://doi.org/10.1016/j.hrtlng.2020.03.002
Understanding the family care dyad: A comparison of two multilevel models
Karen S. Lyons and Christopher S. Lee. (2020). Understanding the family care dyad: A comparison of two multilevel models. European Journal of Cardiovascular Nursing. 19(2), pp. 178-184. https://doi.org/10.1177/1474515120902368
Identifying subgroups: Part 2: Trajectories of change over time
Christopher Lee, Kenneth M. Faulkner and Jessica H. Thompson. (2020). Identifying subgroups: Part 2: Trajectories of change over time. European Journal of Cardiovascular Nursing. 19(5), pp. 444-450. https://doi.org/10.1177/1474515120911330
Identifying subgroups: Part 1: Patterns among cross-sectional data
Christopher.Lee, Kenneth M. Faulkner and Jessica H. Thompson. (2020). Identifying subgroups: Part 1: Patterns among cross-sectional data. European Journal of Cardiovascular Nursing. 19(4), pp. 359-365. https://doi.org/10.1177/1474515120911323
The Association of Dyadic Symptom Appraisal With Physical and Mental Health Over Time in Care Dyads Living With Lung Cancer
Karen S. Lyons and Chris Lee. (2020). The Association of Dyadic Symptom Appraisal With Physical and Mental Health Over Time in Care Dyads Living With Lung Cancer. Journal of Family Nursing. 26(1), pp. 15-25. https://doi.org/10.1177/1074840719889967
Role of Spirituality on the Association between Depression and Quality of Life in Stroke Survivor-Care Partner Dyads
Gianluca Pucciarelli, Ercole Vellone, Tatiana Bolgeo, Silvio Simeone, Rosaria Alvaro, Christopher S. Lee and Karen S. Lyons. (2020). Role of Spirituality on the Association between Depression and Quality of Life in Stroke Survivor-Care Partner Dyads. Circulation: Cardiovascular Quality and Outcomes. 13(6), pp. 300-308. https://doi.org/10.1161/CIRCOUTCOMES.119.006129
A longitudinal comparison of health‐related quality of life in rural and urban recipients of left ventricular assist devices
Windy W. Alonso, Kenneth M. Faulkner, Bunny Pozehl, Judith E. Hupcey, Lisa Kitko and Chris Lee. (2020). A longitudinal comparison of health‐related quality of life in rural and urban recipients of left ventricular assist devices. Research in Nursing and Health. 43(4), pp. 396-406. https://doi.org/10.1002/nur.22052
Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma : Systematic review of 42 studies published 2008-2018
MacDonald, Karen M., Kavati, Abhishek, Ortiz, Benjamin, Alhossan, Abdulaziz, Lee, Christopher S. and Abraham, Ivo. (2019). Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma : Systematic review of 42 studies published 2008-2018. Expert Review of Clinical Immunology. 15(5), pp. 553-569. https://doi.org/10.1080/1744666X.2019.1574571
Sympathetic markers are different between clinical responders and nonresponders after left ventricular assist device implantation
Denfeld, Quin E., Lee, Christopher S., Woodward, William R., Hiatt, Shirin O., Mudd, James O. and Habecker, Beth A.. (2019). Sympathetic markers are different between clinical responders and nonresponders after left ventricular assist device implantation. Journal of Cardiovascular Nursing. 34(4), pp. E1-E10. https://doi.org/10.1097/JCN.0000000000000580
Physiologic childbirth and active management of the third stage of labor : A latent class model of risk for postpartum hemorrhage
Erickson, Elise N., Lee, Christopher S., Grose, Emily and Emeis, Cathy. (2019). Physiologic childbirth and active management of the third stage of labor : A latent class model of risk for postpartum hemorrhage. Birth : Issues in perinatal care. 46(1), pp. 69-79. https://doi.org/10.1111/birt.12384
Patterns, relevance, and predictors of dyadic mental health over time in lung cancer
Lee, Christopher S. and Lyons, Karen S.. (2019). Patterns, relevance, and predictors of dyadic mental health over time in lung cancer. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. 28(8), pp. 1721-1727. https://doi.org/10.1002/pon.5153
Quality of life trajectories among stroke survivors and the related changes in caregiver outcomes : A growth mixture study
Pucciarelli, Gianluca, Lee, Christopher S., Lyons, Karen S., Simeone, Silvio, Alvaro, Rosaria and Vellone, Ercole. (2019). Quality of life trajectories among stroke survivors and the related changes in caregiver outcomes : A growth mixture study. Archives of Physical Medicine and Rehabilitation. 100(3), pp. 433-440.e1. https://doi.org/10.1016/j.apmr.2018.07.428
Hispanic hospice utilization : Integrative review and meta-analysis
Rising, Margaret L., Hassouneh, Dena S., Lutz, Kristin F., Berry, Pat and Lee, C.. (2019). Hispanic hospice utilization : Integrative review and meta-analysis. Journal of Health Care for the Poor and Underserved. 30(2), pp. 468-494. https://doi.org/10.1353/hpu.2019.0042
Heart failure symptom biology in response to ventricular assist device implantation
Lee, Christopher S., Mudd, James O., Lyons, Karen S., Denfeld, Quin E., Jurgens, Corrine Y., Aouizerat, Bradley E., Gelow, Jill M., Chien, Christopher V., Aarons, Emily and Grady, Kathleen L.. (2019). Heart failure symptom biology in response to ventricular assist device implantation. Journal of Cardiovascular Nursing. 34(2), pp. 174-182. https://doi.org/10.1097/JCN.0000000000000552
Benefits and Harms of Omalizumab Treatment in Adolescent and Adult Patients with Chronic Idiopathic (Spontaneous) Urticaria: A Meta-analysis of "real-world" Evidence
Michael D. Tharp, Jonathan A. Bernstein, Abhishek Kavati, Benjamin Ortiz, Karen MacDonald, Kris Denhaerynck, Ivo Abraham and Christopher S. Lee. (2019). Benefits and Harms of Omalizumab Treatment in Adolescent and Adult Patients with Chronic Idiopathic (Spontaneous) Urticaria: A Meta-analysis of "real-world" Evidence. JAMA Dermatology. 155(1), pp. 29-38. https://doi.org/10.1001/jamadermatol.2018.3447
Well-being in dementia: a cross-sectional dyadic study of the impact of multiple dimensions of strain on persons living with dementia and their family care partners
Lyndsey M. Miller, Jeffrey A. Kaye, Karen S. Lyons, Christopher S. Lee, Carol J. Whitlatch and Michael S. Caserta. (2019). Well-being in dementia: a cross-sectional dyadic study of the impact of multiple dimensions of strain on persons living with dementia and their family care partners. International Psychogeriatrics. 31(5), pp. 617-626. https://doi.org/10.1017/S104161021800203X
Care values in dementia: Patterns of perception and incongruence among family care dyads
Lyndsey M Miller, Carol J Whitlatch, Christopher S Lee and Michael S Caserta. (2019). Care values in dementia: Patterns of perception and incongruence among family care dyads. Gerontologist. 59(3), pp. 509-518. https://doi.org/10.1093/geront/gny008
Device-detected congestion is associated with worse patient-reported outcomes in heart failure
Jonathan P Auld, James O Mudd, Jill M Gelow, Karen S Lyons, Shirin O Hiatt and Chris Lee. (2019). Device-detected congestion is associated with worse patient-reported outcomes in heart failure. Heart & Lung: the journal of acute and critical care. 48(3), pp. 208-214. https://doi.org/10.1016/j.hrtlng.2018.12.003
Factors influencing nurses’ willingness to lead
Sulaiman D. Al Sabei, Amy Miner Ross and Chris Lee. (2019). Factors influencing nurses’ willingness to lead. Journal of Nursing Management. 27(2), pp. 278-285. https://doi.org/10.1111/jonm.12698
Development of an instrument for measuring self-care behaviors after left ventricular assist device implantation
Kato, Naoko P., Jaarsma, Tiny, Casida, Jesus M., Lee, Christopher S., Strömberg, Anna and Ben Gal, Tuvia. (2019). Development of an instrument for measuring self-care behaviors after left ventricular assist device implantation. Progress in Transplantation. 29(4), pp. 335-343. https://doi.org/10.1177/1526924819874358
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor
Tilden, Ellen L., Phillippi, Julia C., Ahlberg, Mia, King, Tekoa L., Dissanayake, Mekhala, Lee, Christopher S., Snowden, Jonathan M. and Caughey, Aaron B.. (2019). Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor. Birth. 46(4), pp. 592-601. https://doi.org/10.1111/birt.12428
Comparative symptom biochemistry between moderate and advanced heart failure
Lee, Christopher S., Denfeld, Quin E., Aouizerat, Bradley E., Jurgens, Corrine Y., Chien, Christopher V., Aarons, Emily, Gelow, Jill M., Hiatt, Shirin O. and Mudd, James O.. (2019). Comparative symptom biochemistry between moderate and advanced heart failure. Heart and Lung. 47(6), pp. 565-575. https://doi.org/10.1016/j.hrtlng.2018.09.002
Integrative review of the literature on hispanics and hospice
Rising, Margaret L., Hassouneh, Dena S., Lutz, Kristin F., Lee, Chris S. and Berry, Pat. (2018). Integrative review of the literature on hispanics and hospice. American Journal of Hospice and Palliative Care. 35(3), pp. 542-554. https://doi.org/10.1177/1049909117730555
The theory of dyadic illness management
Lyons, Karen S. and Lee, Christopher S.. (2018). The theory of dyadic illness management. Journal of Family Nursing. 24(1), pp. 8-28. https://doi.org/10.1177/1074840717745669
The influence of β-adrenergic receptor kinase-1 on stroke-induced immunodeficiency syndrome
Ross, Amy Miner, Lee, Christopher S., Lutsep, Helmi and Clark, Wayne M.. (2018). The influence of β-adrenergic receptor kinase-1 on stroke-induced immunodeficiency syndrome. Journal of Cardiovascular Nursing. 33(4), pp. E3-1E10. https://doi.org/10.1097/JCN.0000000000000481
Self-care moderates the relationship between symptoms and health-related quality of life in heart failure
Auld, Jonathan P., Mudd, James O., Gelow, Jill M., Hiatt, Shirin O. and Lee, Christopher S.. (2018). Self-care moderates the relationship between symptoms and health-related quality of life in heart failure. Journal of Cardiovascular Nursing. 33(3), pp. 217-224. https://doi.org/10.1097/JCN.0000000000000447
Psychometric analysis of the leadership environment scale (LENS) : Outcome from the Oregon research initiative on the organisation of nursing (ORION)
Ross, Amy M., Ilic, Kelley, Kiyoshi-Teo, Hiroko and Lee, Christopher S.. (2018). Psychometric analysis of the leadership environment scale (LENS) : Outcome from the Oregon research initiative on the organisation of nursing (ORION). Journal of Nursing Management. 26(4), pp. 467-476. https://doi.org/10.1111/jonm.12572
Patient and caregiver determinants of patient quality of life and caregiver strain in left ventricular assist device therapy
Bidwell, Julie T., Lyons, Karen S., Mudd, James O., Grady, Kathleen L., Gelow, Jill M., Hiatt, Shirin O., Chien, Christopher V. and Lee, Christopher S.. (2018). Patient and caregiver determinants of patient quality of life and caregiver strain in left ventricular assist device therapy. Journal of the American Heart Association. 7(6), p. e008080. https://doi.org/10.1161/JAHA.117.008080
Involvement of hospitalized persons with dementia in everyday decisions : A dyadic study
Miller, Lyndsey M., Lee, Christopher S., Whitlatch, Carol J. and Lyons, Karen S.. (2018). Involvement of hospitalized persons with dementia in everyday decisions : A dyadic study. Gerontologist. 58(4), pp. 644-653. https://doi.org/10.1093/geront/gnw265
Implant strategy-specific changes in symptoms in response to left ventricular assist devices
Lee, Christopher S., Gelow, Jill M., Chien, Christopher V., Hiatt, Shirin O., Bidwell, Julie T., Denfeld, Quin E., Grady, Kathleen L. and Mudd, James O.. (2018). Implant strategy-specific changes in symptoms in response to left ventricular assist devices. Journal of Cardiovascular Nursing. 33(22), pp. 144-151. https://doi.org/10.1097/JCN.0000000000000430
Identifying a relationship between physical frailty and heart failure symptoms
Denfeld, Quin E., Winters-Stone, Kerri, Mudd, James O., Hiatt, Shirin O. and Lee, Christopher S.. (2018). Identifying a relationship between physical frailty and heart failure symptoms. Journal of Cardiovascular Nursing. 33(1), pp. E1-E7. https://doi.org/10.1097/JCN.0000000000000408
Depressive symptoms in couples living with heart failure : the role of congruent engagement in heart failure management
Lyons, Karen S., Hiatt, Shirin O., Gelow, Jill M., Auld, Jonathan, Mudd, James O., Chien, Christopher V. and Lee, Christopher S.. (2018). Depressive symptoms in couples living with heart failure : the role of congruent engagement in heart failure management. Aging and Mental Health. 22(12), pp. 1585-1591. https://doi.org/10.1080/13607863.2017.1381945
The role of dyadic confidence on engagement in heart failure care behaviors
Lyons, Karen S., Gelow, Jill M., Hiatt, Shirin O., Mudd, James O., Auld, Jonathan, Chien, Christopher V. and Lee, Christopher S.. (2018). The role of dyadic confidence on engagement in heart failure care behaviors. The Gerontologist. 58(4), pp. 635-643. https://doi.org/10.1093/geront/gnx030
Patterns of heart failure symptoms are associated with self-care behaviors over 6 months
Auld, Jonathan P., Mudd, James O., Gelow, Jill M., Lyons, Karen S., Hiatt, Shirin O. and Lee, Christopher S.. (2018). Patterns of heart failure symptoms are associated with self-care behaviors over 6 months. European Journal of Cardiovascular Nursing. 17(6), pp. 543-551. https://doi.org/10.1177/1474515118759074
Exploring the relationship between β-adrenergic receptor kinase-1 and physical symptoms in heart failure
Denfeld, Quin E., Mudd, James O., Hasan, Wohaib, Gelow, Jill M., Hiatt, Shirin O., Winters-Stone, Kerri and Lee, Christopher S.. (2018). Exploring the relationship between β-adrenergic receptor kinase-1 and physical symptoms in heart failure. Heart and Lung. 47(4), pp. 281-284. https://doi.org/10.1016/j.hrtlng.2018.05.003
Role of prophylactic oxytocin in the third stage of labor : Physiologic versus pharmacologically influenced labor and birth
Erickson, Elise N., Lee, Christopher L. and Emeis, Cathy L.. (2017). Role of prophylactic oxytocin in the third stage of labor : Physiologic versus pharmacologically influenced labor and birth. Journal of Midwifery & Womens Health. 62(4), pp. 418-424. https://doi.org/10.1111/jmwh.12620
The prevalence of frailty in heart failure : A systematic review and meta-analysis
Denfeld, Quin E., Winters-Stone, Kerri, Mudd, James O., Gelow, Jill M., Kurdi, Sawsan and Lee, Christopher S.. (2017). The prevalence of frailty in heart failure : A systematic review and meta-analysis. International Journal of Cardiology. 236, pp. 283-289. https://doi.org/10.1016/j.ijcard.2017.01.153
Roles of changing physical function and caregiver burden on quality of life in stroke : A longitudinal dyadic analysis
Pucciarelli, Gianluca, Vellone, Ercole, Savini, Serenella, Simeone, Silvio, Ausili, Davide, Alvaro, Rosaria, Lee, Christopher S. and Lyons, Karen S.. (2017). Roles of changing physical function and caregiver burden on quality of life in stroke : A longitudinal dyadic analysis. Stroke. 48(3), pp. 733-739. https://doi.org/10.1161/STROKEAHA.116.014989
Quality of life, depression, and anxiety in ventricular assist device therapy : longitudinal outcomes for patients and family caregivers
Bidwell, Julie T., Lyons, Karen S., Mudd, James O., Gelow, Jill M., Chien, Christopher V., Hiatt, Shirin O., Grady, Kathleen L. and Lee, Christopher S.. (2017). Quality of life, depression, and anxiety in ventricular assist device therapy : longitudinal outcomes for patients and family caregivers. The Journal of Cardiovascular Nursing. 32(5), pp. 455-463. https://doi.org/10.1097/JCN.0000000000000378
Patterns, relevance and predictors of heart failure dyadic symptom appraisal
Lee, Christopher S., Mudd, James O., Auld, Jonathan, Gelow, Jill M., Hiatt, Shirin O., Chien, Christopher V., Bidwell, Julie T. and Lyons, Karen S.. (2017). Patterns, relevance and predictors of heart failure dyadic symptom appraisal. European Journal of Cardiovascular Nursing. 16(7), pp. 595-604. https://doi.org/10.1177/1474515117700760
Patient-reported barriers to the prekidney transplant evaluation in an at-risk population in the United States
Lockwood, Mark B., Saunders, Milda R., Nass, Rachel, McGivern, Claire L., Cunningham, Patrick N., Chon, W. James, Josephson, Michelle A., Becker, Yolanda T. and Lee, Christopher S.. (2017). Patient-reported barriers to the prekidney transplant evaluation in an at-risk population in the United States. Progress in Transplantation. 27(2), pp. 131-138. https://doi.org/10.1177/1526924817699957
Frequency of and significance of physical frailty in patients with heart failure
Denfeld, Quin E., Winters-Stone, Kerri, Mudd, James O., Hiatt, Shirin O., Chien, Christopher V. and Lee, Christopher S.. (2017). Frequency of and significance of physical frailty in patients with heart failure. The American Journal of Cardiology. 119(8), pp. 1243-1249. https://doi.org/10.1016/j.amjcard.2016.12.024
Caregiver well-being and patient outcomes in heart failure a meta-analysis
Bidwell, Julie T., Lyons, Karen S. and Lee, Christopher S.. (2017). Caregiver well-being and patient outcomes in heart failure a meta-analysis. Journal of Cardiovascular Nursing. 32(4), pp. 372-382. https://doi.org/10.1097/JCN.0000000000000350
Brief report : Patient activation among urban hospitalized patients with heart failure
Masterson Creber, Ruth, Chen, Ting, Wei, Chao and Lee, Christopher S.. (2017). Brief report : Patient activation among urban hospitalized patients with heart failure. Journal of Cardiac Failure. 23(11), pp. 817-820. https://doi.org/10.1016/j.cardfail.2017.08.452
“Real-life” effectiveness studies of omalizumab in adult patients with severe allergic asthma : Meta-analysis
Alhossan, Abdulaziz, Lee, Christopher S., MacDonald, Karen and Abraham, Ivo. (2017). “Real-life” effectiveness studies of omalizumab in adult patients with severe allergic asthma : Meta-analysis. Journal of Allergy and Clinical Immunology: In Practice. 5(5), pp. 1362-1370. https://doi.org/10.1016/j.jaip.2017.02.002
Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study
Lissi Hansen, Karen S Lyons, Nathan F. Dieckmann, Michael F. Chang, Shirin O Hiatt, Emma Solanki and Christopher S. Lee. (2017). Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study. Research in Nursing and Health. 40(5), pp. 398-413. https://doi.org/10.1002/nur.21807
Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI)
Dickson, Victoria, Lee, Christopher, Yehle, Karen S., Mola, Ana, Faulkner, Kenneth M. and Riegel, Barbara. (2017). Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI). Research in Nursing and Health. 40(1), pp. 15 - 22. https://doi.org/10.1002/nur.21755
Non-biological barriers to referral and the pre-kidney transplant evaluation among African Americans in the United States : A systematic review
Lockwood, Mark B., Bidwell, Julie T., Werner, Debra . and Lee, Christopher S.. (2016). Non-biological barriers to referral and the pre-kidney transplant evaluation among African Americans in the United States : A systematic review. Nephrology Nursing Journal. 43(3), pp. 225-239.
The influence of group versus individual prenatal care on phase of labor at hospital admission
Tilden, Ellen L., Emeis, Cathy L., Caughey, Aaron B., Weinstein, Sarah R., Futernick, Sarah B. and Lee, Christopher S.. (2016). The influence of group versus individual prenatal care on phase of labor at hospital admission. Journal of Midwifery & Womens Health. 61(4), pp. 427-434. https://doi.org/10.1111/jmwh.12437
The effect of childbirth self-efficacy on perinatal outcomes
Tilden, Ellen L., Caughey, Aaron B., Lee, Christopher S. and Emeis, Cathy. (2016). The effect of childbirth self-efficacy on perinatal outcomes. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 45(4), pp. 465-480. https://doi.org/10.1016/j.jogn.2016.06.003
'Real-life' effectiveness studies of omalizumab in adult patients with severe allergic asthma : Systematic review
Abraham, I., Alhossan, A., Lee, C. S., Kutbi, H. and MacDonald, K.. (2016). 'Real-life' effectiveness studies of omalizumab in adult patients with severe allergic asthma : Systematic review. Allergy. 71(5), pp. 593-610. https://doi.org/10.1111/all.12815
Influence of gender and age on the peripheral immune response in stroke
Ross, Amy Miner, Lee, Christopher S. and Lutsep, Helmi. (2016). Influence of gender and age on the peripheral immune response in stroke. The Journal of Cardiovascular Nursing. 31(4), pp. 331-355. https://doi.org/10.1097/JCN.0000000000000252
Incongruent perceptions of the care values of hospitalized persons with dementia : A pilot study of patient-family caregiver dyads
Miller, Lyndsey M., Whitlatch, Carol J., Lee, Christopher S. and Lyons, Karen S.. (2016). Incongruent perceptions of the care values of hospitalized persons with dementia : A pilot study of patient-family caregiver dyads. Aging and Mental Health. 22(4), pp. 489-496. https://doi.org/10.1080/13607863.2017.1280766
Usefulness of cognitive dysfunction in heart failure to predict cardiovascular risk at 180 days
Gelow, Jill M., Mudd, James O., Chien, Christopher V. and Lee, Christopher S.. (2015). Usefulness of cognitive dysfunction in heart failure to predict cardiovascular risk at 180 days. American Journal of Cardiology. 115(6), pp. 778-782. https://doi.org/10.1016/j.amjcard.2014.12.040
Symptom-hemodynamic mismatch and heart failure event risk
Lee, Christopher S., Hiatt, Shirin O., Denfeld, Quin E., Mudd, James O., Chien, Christopher and Gelow, Jill M.. (2015). Symptom-hemodynamic mismatch and heart failure event risk. Journal of Cardiovascular Nursing. 30(5), pp. 394-402. https://doi.org/10.1097/JCN.0000000000000175
Physical and psychological symptom biomechanics in moderate to advanced heart failure
Denfeld, Quin E., Mudd, James O., Gelow, Jill M., Chien, Christopher, Hiatt, Shirin O. and Lee, Christopher S.. (2015). Physical and psychological symptom biomechanics in moderate to advanced heart failure. Journal of Cardiovascular Nursing. 30(4), pp. 346-350. https://doi.org/10.1097/JCN.0000000000000171
Gender-specific physical symptom biology in heart failure
Lee, Christopher S., Hiatt, Shirin O., Denfeld, Quin E., Chien, Christopher V., Mudd, James O. and Gelow, Jill M.. (2015). Gender-specific physical symptom biology in heart failure. Journal of Cardiovascular Nursing. 30(6), pp. 517-521. https://doi.org/10.1097/JCN.0000000000000191
Determinants of frequent internet use in an urban kidney transplant population in the United States : Characterizing the digital divide
Lockwood, Mark, Saunders, Milda, Josephson, Michelle A., Becker, Yolanda T. and Lee, Christopher. (2015). Determinants of frequent internet use in an urban kidney transplant population in the United States : Characterizing the digital divide. Progress in Transplantation. 25(1), pp. 9-17. https://doi.org/10.7182/pit2015957
The problem with Cronbach's alpha: Comment on Sijtsma and van der Ark (2015)
Barbaranelli, Claudio, Lee, Christopher, Vellone, Ercole and Riegel, Barbara. (2015). The problem with Cronbach's alpha: Comment on Sijtsma and van der Ark (2015). Nursing Research. 64(2), pp. 140 - 145. https://doi.org/10.1097/NNR.0000000000000079
Background and design of the profiling biobehavioral responses to mechanical support in advanced heart failure study
Lee, Christopher S., Mudd, James O., Gelow, Jill M., Nguyen, Thuan, Hiatt, Shirin O., Green, Jennifer K., Denfeld, Quin E., Bidwell, Julie T. and Grady, Kathleen L.. (2014). Background and design of the profiling biobehavioral responses to mechanical support in advanced heart failure study. Journal of Cardiovascular Nursing. 29(5), pp. 405-415. https://doi.org/10.1097/JCN.0b013e318299fa09
Symptom incongruence trajectories in lung cancer dyads
Lyons, Karen S., Lee, Christopher S., Bennett, Jill A., Nail, Lillian M., Fromme, Erik, Hiatt, Shirin O. and Sayer, Aline G.. (2014). Symptom incongruence trajectories in lung cancer dyads. Journal of Pain and Symptom Management. 48(6), pp. 1031-1040. https://doi.org/10.1016/j.jpainsymman.2014.02.004
Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses
Franklin, Ashley E., Burns, Paulette and Lee, Christopher S.. (2014). Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses. Nurse Education Today. 34(10), pp. 1298-1304. https://doi.org/10.1016/j.nedt.2014.06.011
Physical and psychological symptom profiling and event-free survival in adults with moderate to advanced heart failure
Lee, Christopher S., Gelow, Jill M., Denfeld, Quin E., Mudd, James O., Burgess, Donna, Green, Jennifer K., Hiatt, Shirin O. and Jurgens, Corrine Y.. (2014). Physical and psychological symptom profiling and event-free survival in adults with moderate to advanced heart failure. Journal of Cardiovascular Nursing. 29(4), pp. 315-323. https://doi.org/10.1097/JCN.0b013e318285968a
Peripheral immune response and infection in first-time and recurrent ischemic stroke or transient ischemic attack
Ross, Amy Miner, Lee, Christopher S. and Brewer, Margaret. (2014). Peripheral immune response and infection in first-time and recurrent ischemic stroke or transient ischemic attack. Journal of Neuroscience Nursing. 46(4), pp. 199-206. https://doi.org/10.1097/JNN.0000000000000061
Effectiveness of simulation for improvement in self-efficacy among novice nurses : A meta-analysis
Franklin Ashley, E. and Lee Christopher, S.. (2014). Effectiveness of simulation for improvement in self-efficacy among novice nurses : A meta-analysis. Journal of Nursing Education. 53(11), pp. 607-614. https://doi.org/10.3928/01484834-20141023-03
Comparison of expert modeling versus voice-over powerpoint lecture and presimulation readings on novice nurses' competence of providing care to multiple patients
Franklin Ashley, E., Sideras, Stephanie, Gubrud-Howe, Paula and Lee Christopher, S.. (2014). Comparison of expert modeling versus voice-over powerpoint lecture and presimulation readings on novice nurses' competence of providing care to multiple patients. Journal of Nursing Education. 53(11), pp. 615-622. https://doi.org/10.3928/01484834-20141023-01
Comorbidity profiles and inpatient outcomes during hospitalization for heart failure : An analysis of the U.S. Nationwide inpatient sample
Lee, Christopher S., Chien, Christopher V., Bidwell, Julie T., Gelow, Jill M., Denfeld, Quin E., Creber, Ruth Masterson, Buck, Harleah G. and Mudd, James O.. (2014). Comorbidity profiles and inpatient outcomes during hospitalization for heart failure : An analysis of the U.S. Nationwide inpatient sample. BMC Cardiovascular Disorders. 14, p. 73. https://doi.org/10.1186/1471-2261-14-73
Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure
Lee, Christopher, Lyons, Karen, Gelow, Jill, Mudd, James, Hiatt, Shirin, Nguyen, Thuan and Jaarsma, Tiny. (2013). Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure. European Journal of Cardiovascular Nursing. 12(2), pp. 214 - 218. https://doi.org/10.1177/1474515112469316