Determinants of burden in caregivers of heart failure patients: a multicenter study

Literature highlights the importance of caregiver (CG) in the management of many illnesses, in particular for chronic diseases, such as heart failure (HF). Indeed, many studies have emphasized that the caregiver support has positive impact on outcome measures in HF patients. Therefore, the maintenance of healthy condition and the avoidance of burden for CGs have been underlined as topic issues. However, providing care to chronic patients could affect health and quality of life (QoL) of CGs, but only few studies have paid attention to HF CGs. Better understanding of CGs burden and its determinants is essential to support CGs.

The aim of this study was to investigate determinants of CG burden in a cohort of CGs of HF patients, considering socio-demographic, clinical, and psychological variables, measured both for patients and their CGs. 

Using a cross-sectional design, this study enrolled Italian HF patients and their CGs from different outpatient centers in 28 Italian provinces. CG was defined as the unpaid person, inside or outside the family, who provides the most informal care, as well as designated by the patients. The five dimensions of time-dependence, developmental, physical, social and emotional burden were measured using the Caregiver Burden Inventory - CBI (Novak and Guest, 1989). Socio-demographic characteristics, strain, perceived social support, contributions to HF patient’s self-care, and QoL related to the CGs were collected. Moreover, information related to patients' comorbidities, cognitive function, contributions to self-care, QoL, as well as sociodemographic characteristics, duration, severity, number of medications, hospitalization during last year, and type of HF were measured. Multiple regression analyses were conducted to investigate determinants of CG burden. 

In total, 505 HF patients (44.6% female, mean age 75.6 ± 10.7 years) and their CGs (52.2% female, mean age 56.9 ± 14.8 years) were enrolled. Results of regression analyses (see table 1) revealed that: CG gender, physical component of CG QoL, patient age, patient self-care management, and patient mental component of QoL were predictors of time-dependence burden; CG QoL (physical and mental components), patient number of medications, patient self-care management, as well as patient disease severity were predictors of developmental burden; physical and mental components of CG QoL were predictors of developmental burden; CG gender, CG QoL (physical and mental components), patient number of medications, and patient self-care management were predictors of social burden; physical and mental components of CG QoL, and patient cognitive function were predictors of emotional burden. 

Results of this study contribute to understand the predictors of CGs. By knowing the specific predictors of the burden dimensions, might help to identify tailored interventions to reduce burden in CGs of HF patients.