Exploring Potential Associations Between Rurality and Hopelessness in IHD Patients

Hopelessness is associated with 3.4 times increased risk of mortality or nonfatal myocardial infarction in patients with ischemic heart disease (IHD), independent of depression. Hopelessness has been identified in 27-52% of patients with IHD and can persist for up to 12 months after hospital discharge. Hopelessness, a negative outlook and sense of helplessness toward the future, can be a temporary response to an event (state) or a habitual outlook (trait). Hopelessness is associated with decreased physical functioning and lower physical activity (PA) levels in individuals with IHD. Low levels of PA independently contribute to increased death and adverse events in patients with IHD. Rates of PA in IHD patients continue to be unacceptably low in both hospital-based cardiac rehabilitation and home settings. Compounding this issue is often the symptom of hopelessness. The links among hopelessness, PA and mortality and morbidity for patients with IHD remain largely unknown, especially in rural and minority IHD patients. The purpose of this study is to delineate differences in hopelessness between urban and rural patients with IHD, as well as between racial minority, including Hispanic and Native American, and White patients with IHD. Potential mediation of urbanicity and race/ethnicity by social connectedness, a key variable in rural settings, will also be examined. A 6-month longitudinal study will be conducted at Sanford Heart Hospital and Avera Health in Sioux Falls, South Dakota. Hopelessness will be measured using the State-Trait Hopelessness Scale. The results of this study have potential to transform nursing practice by providing a better understanding of hopelessness in IHD patients and informing future exercise rehabilitation studies and interventions in rural and minority populations.

Study Overview

• Status: Completed
• Conditions: Cardiac Disease; Mental Health Issue
• Intervention / Treatment: Other: Rurality; Ethnicity; Exercise; Hopelessness

• Study Type: Observational
• Enrollment (Actual): 125

Contacts and Locations

Study Locations

• United States
  • South Dakota
    • Sioux Falls, South Dakota, United States, 57108
      • Avera Health
    • Sioux Falls, South Dakota, United States, 57108
      • Sanford Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Hospitalized individuals

Description

Inclusion Criteria:

• Myocardial infarction or unstable angina or having undergone a percutaneous coronary intervention or coronary artery bypass surgery
• ≥ 18 years
• planned discharge home
• cognitive and physical ability to complete the study measures.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with IHD; No intervention	Other: Rurality; Ethnicity; Exercise; Hopelessness; Observational study exploring rurality, ethnicity, exercise and hopelessness patterns cross-sectionally and longitudinally

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State and Trait levels of Hopelessness	State-Trait Hopelessness Scale (values range from 1-4 on both subscales with larger values meaning more hopelessness)	Six-month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participation (yes/no) and Levels (frequency; vigor) of Exercise	CREPT measurement tool for self-reported home and hospital exercise participation (yes/no) and levels (frequency/vigor) of exercise	Six-month

Collaborators and Investigators

• Sponsor: Dordt University
• Collaborators: University of Illinois at Chicago; Avera McKennan Hospital & University Health Center; Sanford Health
• Investigators: Principal Investigator: Nathan Tintle, Dordt University

Publications and helpful links

General Publications

• Bomgaars D, Jensen GA, White LL, Van De Griend KM, Visser AK, Goodyke MP, Luong A, Tintle NL, Dunn SL. Investigating Rurality as a Risk Factor for State and Trait Hopelessness in Hospitalized Patients With Ischemic Heart Disease. J Am Heart Assoc. 2021 Sep 7;10(17):e020768. doi: 10.1161/JAHA.121.020768. Epub 2021 Sep 1.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2018
• Primary Completion (Actual): August 1, 2020
• Study Completion (Actual): August 1, 2020

Study Registration Dates

• First Submitted: July 28, 2020
• First Submitted That Met QC Criteria: July 30, 2020
• First Posted (Actual): August 5, 2020

Study Record Updates

• Last Update Posted (Actual): May 18, 2021
• Last Update Submitted That Met QC Criteria: May 17, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: Rurality
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases
• Other Study ID Numbers: Hopelessness-Rurality

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No