The role of concealment and relationship quality on patient hospitalizations, care strain and depressive symptoms in heart failure dyads

Background: Heart failure is one of the most common reasons for hospitalization among older adults and negatively influences person-reported outcomes of patients and their care partners. Moreover, the majority of heart failure research examines patients and care partners separately, ignoring the interdependent nature of the heart failure dyad. Aims: The aim of this study was to examine the interpersonal factors associated with depressive symptoms of heart failure patients and spouse care partners, patient hospitalizations over the last 12 months and care strain. Methods: A descriptive, cross-sectional design was used to examine 60 community-dwelling adults with heart failure and their spouse care partners. Multilevel modeling controlled for the interdependent nature of the dyadic data. Results: Patients had significantly worse depressive symptoms than their spouse care partners. More patient concealment (i.e. hiding concerns/worries) and worse relationship quality were significantly associated with greater depressive symptoms for patients, but not spouse care partners. Better relationship quality (reported by spouse care partners) was significantly associated with lower levels of care strain, whereas better relationship quality (reported by patients) was significantly associated with worse care strain. Patients who had one or more hospitalizations over the past 12 months were significantly more likely to report higher levels of concealment; relationship quality was not associated with patient hospitalizations. Conclusion: Findings highlight the interdependent nature of heart failure and the complexity of the interpersonal context. Greater focus on how the heart failure dyad navigates illness as a unit over time is needed to design and tailor innovative lines of clinical intervention to optimize dyadic and individual health.