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Heart failure continues to be a major public health problem in the United States, with more than 5 million diagnoses of heart failure and nearly 500,000 new cases reported annually.1 The 12-month mortality rate is 10% to 20% for all patients with heart failure and 50% for patients with advanced, or New York Heart Association class IV, heart failure.1 Heart failure is a leading cause of hospitalization for elderly patients and costs millions of dollars in health care annually.1 Importantly, the health-related quality of life (HRQL) of these patients is poor because of the many troublesome signs and symptoms they experience.2–6 To improve survival, enhance HRQL, and reduce costly hospitalizations, patients with heart failure must adhere to complex medication, dietary, and self-care regimens; this adherence often requires the assistance of the patients’ family caregivers.7,8 Most of the care provided to patients with major chronic illnesses such as heart failure is performed by family caregivers. Farran9 estimates that 90% of care of patients with chronic illness care in the United States is delivered by family caregivers. Indeed, supporting family caregivers in order to provide ongoing quality care for chronically ill individuals is a national health priority.10 In the landmark Caregiver Health Effects Study,11 after 4 years, with controls for demographic and common clinical diseases, 392 elderly caregivers (66–96 years old) of patients with disability had a significantly higher mortality rate than did the 427 noncaregivers. Furthermore, caregivers who reported having emotional strain as a result of caregiving were 63% more likely to die compared with the noncaregivers.11 In other studies, 11–14 caregivers of chronically ill patients have reported stress, burden, depression, anxiety, and poor physical and emotional health. Caregivers of patients with heart failure have reported problems similar to those of caregivers of patients with other chronic illnesses, although some differences within the context of heart failure may present unique challenges.15 For example, the frequent periods of exacerbation leading to hospitalizations may contribute to caregivers’ stressors among those who care for patients with heart failure. The need to monitor signs and symptoms to prevent decompensation may be a challenge to caregivers of heart failure patients that does not occur with other disorders. The cognitive impairments that occur in 25% to 50% of patients with heart failure may also increase caregivers’ stress.16 Recent advances in medical therapies, such as the implantation of defibrillators and ventricular assist devices, may further contribute to caregivers’ stressors and burden because of increased needs for care of these devices and increased health care visits. Overall, caregivers of patients with heart failure report high stress, burden (defined as the overall demands of caregiving), depressive symptoms, and poor emotional and physical health.15, 17–21 Guided by the theoretical and empirical literature on family caregiving stress, burden, and other outcomes11,15,17–25 we conducted this study to investigate predictors of family caregiving outcomes in heart failure. Our primary purpose was to determine predictors of family caregiving outcomes among caregivers of patients with heart failure. We hypothesized that caregivers’ medical health condition, age, family functioning, perceived control, depressive symptoms, anxiety, and perceived caregiving stress at baseline would be predictive of self-reported caregiving outcomes and physical and emotional HRQL at 4 and 8 months after collection of baseline data. Our secondary purposes were to identify the tasks caregivers report as most difficult and most negative self-reported caregiving outcomes.

To establish dosage recommendations, moxalactam elimination kinetics were studied in six anephric patients during hemodialysis and in four anephric patients during the interdialytic period. After a single 1-g intravenous bolus injection, moxalactam elimination half-life was 18.0 plus or minus 0.6 h with a volume of distribution of 20.2 plus or minus 3.6 liters and a plasma clearance of 12.8 plus or minus 2.0 ml/min in four nondialyzed patients. Moxalactam elimination half-life was decreased to 2.7 plus or minus 0.2 h during hemodialysis in six patients. After 4 h, 48.5% of the dose was recovered in the dialysate. The maintenance dose of moxalactam should be decreased to 15% of a normal dose in patients with creatinine clearances less than 10 ml/min, and 50% of a loading dose should be given after hemodialysis.