Debra Moser

• DNSc, RN, FAAN
• Chair at University of Kentucky

Background: Depressive symptoms, anxiety, and inadequate social support are predictors of health-related quality of life (HRQoL) in persons with heart failure, but the prediction of HRQoL is multifaceted, and mechanisms underlying association are unknown. Self-care maintenance may moderate associations among these predictors, which is essential to...

Complexity of care is the inevitable consequence of an aging population and is particularly true in instances where patients are managing chronic conditions such as heart failure with reduced ejection fraction (HFrEF). HFrEF itself is complex, with an undulating course of illness, increased risk of sudden cardiac death, and myriad accompanying trea...

Background Cognitive impairment and limited health literacy are prevalent among patients with heart failure, particularly those residing in rural areas, and are linked to poor health outcomes. Little is known about the intricate relationships among cognitive function, health literacy, and rehospitalization and death in rural patients with heart fai...

The social determinants of health (SDOH) have been recognized as an important contributor to an individual's health status. A valid and reliable instrument is needed for researchers and clinicians to measure SDOH. However, there is considerable variability in the screening methodologies, as well as a lack of standardization in definitions and metho...

The number of older adults experiencing homelessness (OAEH) is growing. This vulnerable population is exposed to harsh conditions and fragmented healthcare, making even the most treatable health conditions life-threatening. Understanding seriously ill OAEH preferences for prognostic communication and illness-related care are needed research areas....

Background Older adults (≥ 65 years) (OAs) with heart failure (HF) are at high risk of functional impairment and co-morbid depression. The impact on morbidity and mortality of these comorbidities in OAs with HF has not been well-studied. OBJECTIVE: To determine the extent to which functional status and depression predicted event-free survival (i.e....

Introduction: Caregivers are at high risk of cardiovascular disease (CVD) and depression compared to non-caregivers. Food security has been suggested to be a risk factor for depression. Depression may be connected to poor self-care. Studies exploring food security, depression and its relationship to adherence to CVD risk reduction measures among ru...

Background: Patients with heart failure (HF) frequently experience poor sleep quality and multiple HF symptoms, both of which are linked to diminished functional status. Poor sleep quality can manifest as prolonged latency, short duration, low efficiency, or difficulty staying asleep. HF symptoms encompass different dimensions: presence, frequency,...

Background: Black patients with heart failure (HF) have a higher physical and psychological distress which disproportionately worsens their health and quality of life (QOL) than those from other racial/ethnic groups. Black patients less commonly receive optimal therapy for HF than white patients, which can result in poorer functional status. Black...

Background: Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psycho...

Introduction: Caregivers are at high risk of cardiovascular disease (CVD), depression, and mortality compared to non- caregivers. Patient activation- one's knowledge, skills and confidence to manage their own health-is associated with improved self-management behaviors for several chronic conditions. Studies exploring patient activation among rural...

Introduction: Maintaining a heart-healthy lifestyle is crucial for good cardiovascular health. However, the moderating effects of age and gender on the relationship of diet quality, smoking status, and exercise to cardiovascular health are unknown. The purpose of this proposed study was to investigate the moderating effects of age and gender on the...

Introduction: Given the substantial evidence that adults who provide informal care for their chronically ill families are at high risk of poor health, including the development of cardiovascular disease (CVD), engagement in and maintenance of healthy behaviors are critical. Furthermore, rural caregivers living in socioeconomically austere healthcar...

Background: Depressive symptoms (DS) are highly prevalent in patients with cardiovascular diseases (CVD). Sedentary behavior is associated with DS, and together they worsen CVD health outcomes. Rural patients exhibit greater incidence of DS and physical inactivity than their urban counterparts. While females and younger adults are more likely to ex...

Background: Over the past decade over 27,000 patients have been implanted with a left ventricular assist device (LVAD) for the treatment of advanced heart failure (HF). Technology has advanced greatly over this time with 1-year mortality rates around 14% for the newer devices. Up to 75% of the HF population is thought to have mild cognitive impairm...

Introduction: Given the well-documented benefits of yoga on the cardiovascular system and improvement of exercise tolerance and quality of life, the American Heart Association recently recommended yoga as a safe and well-tolerated adjunctive therapy for patients with heart failure (HF). However, most studies have focused on testing yoga with modera...

Introduction: Rural areas experience marked disparities in cardiac and mental health and access to health care. Rural cardiac patients with depressive symptoms (DS) do not receive needed therapy because of lack of mental health providers, worries about stigma, and difficulty accessing mental health care. Cognitive behavioral therapy (CBT) reduces D...

Background: Depressive symptoms are prevalent in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) has been shown to be effective at improving depressive symptoms in patients with CHD and HF. Traditional CBT is not accessible to m...

Background: Heart failure (HF) is not a homogeneous condition, and comorbidities, such as renal dysfunction, commonly complicate the clinical picture. However, differences in patient-centered outcomes (PCO), such as depressive symptoms, health-related quality of life, functional status, adherence, and self-care behaviors, have not been explored in...

Background: Whether there are disparities in cognitive function in individuals living in rural areas compared to urban areas is unknown. Some investigators have found that rural residents have better cognitive function, while others report the opposite. Sedentary behavior is a major risk factor for cognitive health in patients with cardiac diseases...

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clini...

There is currently a limited understanding of what nurses in nursing homes view as the key education priorities to support their ability to provide the appropriate care for residents with heart failure (HF). A modified Delphi technique was utilized to gain a consensus on the key education priorities for nurses working in nursing homes in Northern I...

BACKGROUND About 3.5 million trauma patients are hospitalized every year, but 35%–40% require further care after discharge. Nurses’ ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospi...

Background The occurrence of cardiac dysrhythmias during ventilatory weaning and its impact on the length of ventilation and occurrence of complications have not been systematically investigated. Objectives The aim of this study was to evaluate the association between cardiac dysrhythmias during weaning and the duration of ventilation and complica...

Background Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients’ values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to...

Black adults bear disproportionate obesity and Type 2 Diabetes.Group-based translation of the Diabetes Prevention Program is the gold standard with Black participants in these interventions having the lowest weight loss. Weight loss in the early intervention weeks predicts post-treatment outcomes. One limitation of these group-based interventions i...

Background Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non‐caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self‐care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether he...

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clini...

Background Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability...

Background Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients’ values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to...

Background Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL. Objective The aim of this study was to determine whether depressive symptoms and sleep qualit...

Background Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nu...

Background Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake. Objective The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation...

Individuals in their late 50s and 60s constitute the fastest growing cohort of homeless adults; homelessness among the older adult population is expected to triple by 2030 (Culhane et al., 2019). Older adults find themselves homeless due to systemic (e.g., unaffordable housing, structural racism, increasing healthcare costs) and individual factors...

Background Patients with heart failure (HF) must engage in self-care, yet their self-care is often poor. Cognitive function commonly is impaired in HF and is associated with poor self-care. Heart failure knowledge and self-care confidence also are needed to preform self-care. Few investigators have examined mediators of the association of cognitive...

Background: Adverse childhood experiences (ACEs), defined as abuse, household dysfunction, and neglect before age 18, increase the risk of depressive symptoms and cardiovascular disease (CVD). Fifty-two percent of people have reported 1 ACE with 6.2% reporting 4 or more. People in rural environments experience higher levels of stress and depressive...

Introduction: Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID...

Background: Metabolic syndrome is associated with a two-fold increase in cardiovascular disease (CVD) outcomes. Chronic stress is related to poor diet and development of metabolic syndrome. Inflammation plays an essential role in metabolic syndrome and can be moderated by diet. Hypothesis: Diet quality mediates the relationship between chronic stre...

Introduction: Patients with heart failure (HF) experience multiple physical and psychological symptoms that are associated with poor quality of life (QoL) for patients and family caregivers. Perceived control is known to buffer the adverse consequences of symptom burden on QoL among patients and caregivers at the individual level. However, there is...

Background: Depressive symptoms are common in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) can effectively improve depressive symptoms in patients with CHD and HF, however, traditional CBT is not accessible to most rural indi...

Introduction: Mild cognitive impairment (MCI) and depressive symptoms (DS) are common comorbidities in patients with heart failure (HF). MCI and DS are known to be related from cross-sectional studies, but the trajectory of DS over time is unknown in patients with HF and MCI. Objective: To compare the trajectory of DS over a 2-year period based on...

Background: Most patients with heart failure (HF) exhibit a broad symptom profile, sporadically marked by periods of acute exacerbation and readmission that can be prevented by symptom monitoring and adequate self-care. Yet, patients are frequently unable to adhere to appropriate self-care measures. Reasons for non-adherence are multifactorial incl...

Background: Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL). Goal: The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) o...

Background: Informal caregivers are at greater risk for cardiovascular disease (CVD) than non-caregivers. This risk is higher for older caregivers who often have chronic illnesses, especially those living in a rural environment. Yet caregivers, particularly rural caregivers, are usually “hidden patients” in a caregiver-patient dyad as they commonly...

Background: Black patients experience disparities in heart failure (HF) outcomes compared to their White counterparts. Differences in diet quality, dietary inflammatory potential, and micronutrient deficiencies may contribute to these disparities. Aims: To compare the inflammatory potential of diet, dietary micronutrient insufficiencies, and diet q...

Introduction: Depressive symptoms, anxiety, and inadequate social support are predictors of quality of life (QOL) in patients with heart failure (HF), but prediction of QOL is multifaceted and mechanisms underlying association are unknown. Essential to better HF outcomes, self-care maintenance (SCM) may moderate associations among these predictors....

Background: Obstructive sleep apnea (OSA), prevalent in patients with heart failure (HF) and those with coronary heart disease (CHD), is associated with poor quality of life (QoL) but underlying mechanisms are not well understood. Depressive symptoms and low perceived control, also common in these patients, may explain associations between OSA and...

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these rel...

Introduction: Diet quality is an important, but often underappreciated part of heart failure (HF) care. Tailoring of dietary interventions must take into consideration how patients with HF eat. Purpose: To identify distinct dietary profiles representing eating patterns in patients with HF. Methods: This was a secondary analysis of data from a rando...

Introduction: The Life Simple 7 (LS7) score, developed by the American Heart Association, is a powerful predictor of an individual's cardiovascular health. It consists of seven key cardiovascular health metrics, including cholesterol levels, blood pressure, blood sugar, body mass index, diet, smoking status, and physical activity levels. In-person...

Background Clinicians and researchers often assume that symptom burden is associated with self-care management (SCM) in patients with heart failure (HF). However, that association is often not borne out in simple regression analyses and may be because another variable mediates the association. Fatalism is an appropriate candidate for mediation and...

Background Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men. Methods We included data f...

Background Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. Objective The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. Methods This secondary analysis included 166 hospitalized patients (mean [SD] age,...

Background Heart failure (HF) affects up to 64.3 million people globally. Advancements in pharmaceutical, device or surgical therapies, have led to patients living longer with HF. Heart failure affects 20% of care home residents, with these individuals presenting as older, frailer, and with more complex needs compared to those living at home. Thus,...

Background: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own...

Background Because heart failure (HF) is a debilitating chronic cardiac condition and increases with age, most patients with HF experience a broad range of coexisting chronic morbidities. Comorbidities present challenges for patients with HF to successfully perform self-care, but it is unknown what types and number of comorbidities influence HF pat...

Background: Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not. Objective: To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehos...

Background: Prevention of heart failure (HF) exacerbations requires that patients carefully self-manage their condition. Symptom perception is a key component in self-care for patients with HF that involves monitoring for HF symptoms and recognizing symptom changes. Heart failure knowledge is a prerequisite for better symptom perception and sympto...

Caregivers support heart failure (HF) self-care with little HF education. The purpose of this study was to evaluate the effectiveness of a caregiver-only educational intervention aimed at improving caregiver self-efficacy, perceived control, and HF knowledge, as well as patient self-care and 30-day cardiac readmission. In total, 37 patients and the...

Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some...

Introduction: The associations of cognition with self-care of heart failure (HF) or with health-related quality of life (HRQL) have not been definitively established, Gender may moderate these associations. The aim of our study was to examine the associations between cognition and (1) HF self-care and (2) HRQL and explore (3) gender as a moderator....

Background: Patients with heart failure (HF) commonly remain symptomatic after medical treatment. Symptoms are associated with rehospitalizations and mortality. We developed a 6-month nutrition intervention targeting the 3 most common HF symptoms: edema, shortness of air, and fatigue. The intervention involves 3 nutrients that target the pathologic...

Background: Consumer-facing mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patient engagement with consumer-facing mHealth apps in real-world settings and the effect of such engagement on HF outcomes. Objectives: This study exam...

BACKGROUND: Black patients have worse quality of life than Whites. Depression and sleep quality are associated with quality of life (QoL). However, the manner in which depression and sleep quality influence the relationship between race and QoL in patients with HF is unclear. Objective: To explore whether depressive symptoms and/or sleep quality me...

Background: Adults with fewer financial resources often have poor self-care. Fatalism is a belief that events in life are determined by outside forces. Rural adults commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about their health. Our aim was to determine whether fatalism mediates the associatio...

I ntroduction: Supportive relationships within dyad members involved in heart failure (HF) self-management are beneficial in improving the outcomes of patients. Perceived control over a health condition and depressive symptoms are known to affect health-related quality of life (QoL). Little is known about how mutual support enhances health-related...

Introduction: Caring for adults with chronic illnesses increases the risk of developing cardiovascular disease (CVD). Engaging in self-care of healthy behaviors is critical for caregivers, but it may be more difficult due to financial hardship and psychological distress among those living in socioeconomically distressed rural areas. The study's pur...

Introduction: Mean survival following implantable cardioverter defibrillator (ICD) implantation is 2.5 years with 13% of ICD recipient deaths related to arrhythmic mechanisms and 37% related to end-stage heart failure. Despite the relatively short survival expectancy and potential of death from other causes most ICD recipients do not participate in...

Background: Heart failure (HF) is a clinical syndrome of aging. Many studies compare older (≥65 years) and younger (< 65 years) participants’ HF experiences as younger patients’ HF etiology and psychobehavioral factors are distinct from older patients. Yet, best practice geriatric HF management necessitates understanding of the differences present...

Introduction: Systemic inflammation and inflammatory genotypes have been associated with cardiovascular disease (CVD) risk, with associations between C-reactive protein (CRP), a marker of systemic inflammation, the rs1205 polymorphism on the CRP gene, and CVD risk among the most well-studied. However, little is known about the effect of systemic in...

Background: Lack of physical activity is associated with a higher risk of mortality and rehospitalization for patients with heart failure (HF). Although exercise is recommended to patients with HF to optimize health, engagement in physical activity (EPA) remains poor due to many barriers. There is limited knowledge about whether EPA is a unique pre...

Many veterans do not complete traditional trauma treatments; others may continue to struggle with posttraumatic stress disorder (PTSD) even after completing a full course of therapy (Blasé et al., in Int J Environ Res Public Health 18(7):Article 3329, https://doi.org/10.3390/ijerph18073329, 2016). Heart rate variability (HRV) biofeedback (HRVB) is...

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure; National Research Foundation of Korea grant funded by the Korea government (MEST) Background Most patients with heart failure (HF) have multiple chronic comorbid conditions. For HF patient...

Aims Despite evidence-based recommendations for clinically stable patients with heart failure (HF) to engage in unsupervised exercise, the minimum cumulative dose of exercise per week associated with improvement in HF outcomes, especially in patients with poor functional capacity, has not been examined. We examined whether patients with HF and poor...

BACKGROUND Publicly available patient-focused mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. OBJECTIVE The purpose of this study was to explore pati...

Background Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)–related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. Objective The purpose of this study was to explore patients’ experien...

Background: Antioxidant insufficiency, elevated inflammatory markers, and poor health-related quality of life (HRQOL) are prevalent in patients with heart failure (HF). Objective: The objective of this study was to examine the associations among dietary antioxidant intake, inflammatory markers, and HRQOL in patients with HF. Methods: This was...

Introduction: Heart failure (HF) is a prevalent, serious chronic illness that affects 6.5 million adults in the United States. Among patients with HF, the prevalence of attention impairment is reported to range from 15% to 27%. Although attention is fundamental to human activities including HF self-care, cognitive interventions for patients with H...

Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comor...

The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses wer...

Aims: A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results: A multicentre...

Aims It is recommended that patients and clinicians discuss end-of-life deactivation of their implantable cardioverter defibrillator (ICD) prior to device implantation and throughout the illness trajectory to facilitate shared decision-making. However, such discussions rarely occur, and little is known about patients’ openness to this discussion. T...

Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death for those with a history of or high risk for lethal arrhythmias. In 2016, 105,000 ICDs were implanted in older adults (age ≥ 60) in the US. Approximately 25% of ICD recipients report significant ICD concerns with women reporting higher levels than men. Little is...

BACKGROUND The computing and communication features of mobile devices are increasingly leveraged in mHealth interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF). However, examination of mHealth intervention effectiveness has provided mixed findings. Considering that patient...

Background: Despite the potential of mobile health (mHealth) interventions to facilitate the early detection of signs of heart failure (HF) decompensation and provide personalized management of symptoms, the outcomes of such interventions in patients with HF have been inconsistent. As engagement with mHealth is required for interventions to be eff...

Introduction: Caregivers of patients with chronic conditions are at higher risk for cardiovascular disease (CVD) than their urban counterparts. Despite the burden related to caregiving, caregivers need to be activated for their own health to decrease this risk. Health activation has not been studied in rural caregivers. It is particularly relevant...

Introduction: Adherence to the sodium-restricted diet (SRD) remains poor due to multiple barriers. We developed a dyadic intervention, a gradual taste adaptation to SRD to improve adherence to the SRD by overcoming sensory and family barriers. The purpose was to determine the efficacy of the gradual taste adaptation approach on dietary sodium intak...

Introduction: Gender disparities are well documented in cardiovascular care, and women are underrepresented in cardiovascular studies. Gender differences in experiences and attitudes toward replacement and deactivation of implantable cardioverter defibrillators (ICD) at the end-of-life (EOL) are less well studied. Purpose: To determine if there are...