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A NIMAL-ASSISTED
THERAPY IN PATIENTS
HOSPITALIZED WITH
HEART FAILURE
By Kathie M. Cole, RN, MN, CCRN, Anna Gawlinski, RN, DNSc, Neil Steers, PhD,
and Jenny Kotlerman, MS
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Groups
Variable Volunteer-dog (n = 26) Volunteer-only (n = 25) Control (n = 25) P
a Calculated as cardiac output in liters divided by body surface area in meters squared.
b To convert to picomoles per liter, multiply by 5.911.
c To convert to picomoles per liter, multiply by 5.459.
inhibitors (62%), and β-blockers (38%). A total of in dependent variables were detected between the
58% of the patients were current dog owners. The volunteer-dog group and the control group. Compared
only difference among the groups at baseline was with the control group, patients in the volunteer-
PCWP. It was significantly higher in the patients dog group had significantly greater decreases in sys-
who received a visit from the volunteer-dog team tolic PAP (mean difference, -4.32 mm Hg; P = .03)
than in the other 2 groups (P = .02, Table 1). and PCWP (mean difference, -2.74 mm Hg; P =.01).
Similar baseline-during differences were
Mixed Models detected between the volunteer-dog group and the
Adjusted mean baseline-during differences for the volunteer-only group (Table 2). Compared with the
3 groups are presented in Table 2. Several differences volunteer-only group, the volunteer-dog group had
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Groups
Volunteer-dog Volunteer-dog Volunteer-only
vs vs vs
Variable controla volunteer-onlyb controlc
significantly greater decreases in systolic PAP (mean (mean difference, -4.31 mm Hg; P = .001). Decreases in
difference, -5.48 mm Hg; P = .01), PCWP (mean dif- epinephrine and norepinephrine were similar for the
ference, -3.30 mm Hg; P = .003), epinephrine levels 2 groups. However, compared with the control group,
(mean difference, -15.86 pg/mL; P = .04; to convert the volunteer-dog group had greater reductions in
to picomoles per liter, multiply by 5.459), and nor- state anxiety (mean difference, -9.13 units; P < .001).
epinephrine levels (mean difference, -232.36 pg/mL; Most of the baseline-during differences between
P = .02). In addition, patients in the volunteer-dog the volunteer-dog group and the volunteer-only
group had greater decreases in RAP (mean difference, group also were found for baseline-after differ-
-1.87 mm Hg; P = .01) and diastolic PAP (mean dif- ences (Table 3). Compared with the volunteer-only
ference, -2.78 mm Hg; P = .05). group, the volunteer-dog group had significantly
Adjusted mean baseline-after differences for the greater decreases in systolic PAP (mean difference,
3 groups are presented in Table 3. Two of the mean -5.34 mm Hg; P = .002), PCWP (mean difference,
baseline-during differences between the volunteer- -3.10 mm Hg; P = .02); epinephrine levels (mean
dog group and the control group also were found difference, -17.54 pg/mL; P = .04), and norepineph-
for mean baseline-after differences. Compared with rine levels (mean difference, -240.29 pg/mL; P = .02).
the control group, the volunteer-dog group had However, decreases in RAP and diastolic PAP in the
significantly greater decreases in systolic PAP (mean volunteer-dog group were not significantly greater
difference, -5.78 mm Hg; P = .001) and PCWP than those in the volunteer group. In addition, the
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Groups
Volunteer-dog Volunteer-dog Volunteer-only
vs vs vs
Variable controla volunteer-onlyb controlc
a Adjusted mean difference = mean decreases in the volunteer-dog group minus mean decreases in the control group. Negative values indicate greater
decreases in the volunteer-dog group; positive values indicate greater decreases in the control group.
b Adjusted mean difference = mean decreases in the volunteer-dog group minus mean decreases in the volunteer-only group. Negative values indicate
greater decreases in the volunteer-dog group; positive values indicate greater decreases in the volunteer-only group.
c Adjusted mean difference = mean decreases in the volunteer-only group minus mean decreases in the control group. Negative values indicate greater
decreases in the volunteer-only group; positive values indicate greater decreases in the control group.
d P ≤ .05.
e Calculated as cardiac output in liters divided by body surface area in meters squared.
f To convert to picomoles per liter, multiply by 5.911.
g To convert to picomoles per liter, multiply by 5.459.
volunteer-dog group had significantly greater decreases Therefore, the baseline-during and baseline-
in state anxiety (mean difference, -6.65 units, P = .002) after values for systolic PAP and PCWP decreased
than did the volunteer-only group. significantly more in the volunteer-dog group than
Because PCWP was the only variable at base- in the volunteer-only and control groups. Similarly,
line that differed significantly between the 3 groups, baseline-during and baseline-after values for epi-
we explored this variable further. Using the box- nephrine and norepinephrine levels decreased sig-
plot method, we calculated the distance 1.5 times nificantly more in the volunteer-dog group than in
the interquartile range (ie, the distance between the volunteer-only group. The baseline-after decrease
the 75th and 25th percentiles of the data). Any in state anxiety was greater in the volunteer-dog
value more than this distance away from the median group than in the other 2 groups.
in either direction was considered an outlier. The
volunteer-dog group had 2 outlier values. After Discussion
eliminating these outlier values, we repeated the In this study, patients hospitalized with advanced
analysis for differences in PCWP between groups. heart failure who received a visit from a volunteer
The results showed similar differences between and dog had lower cardiopulmonary pressures,
groups in PCWP with and without the outliers neurohormone levels, and anxiety levels than did
(Tables 2 and 3). patients visited by a volunteer only and patients
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1. A stress-induced increase in epinephrine level directly facilitates release of 8. Measurements of which dependent variable were completed twice rather than the
which neurohormone? 3 times accomplished for the other variables?
a. Aldosterone c. Angiotensin a. Cardiac index
b. Dopamine d. Norepinephrine b. Pulmonary capillary wedge pressure
c. State anxiety
2. Which of the following most contributes to progression of heart failure to d. Systemic vascular resistance
advanced heart failure?
a. Chronic neurohormonal activation 9. Which of the following f indings would have excluded a patient’s participation in
b. Deleterious activation of the parasympathetic nervous system this study?
c. Chronic hypertension a. Pre-study presence of an indwelling pulmonary artery catheter
d. Left ventricular dysfunction b. Fear of dogs
c. White blood cell count of less than 4500 cells/μL or greater than 11 000 cells/μL
3. What is the most signif icant potential hazard associated with animal-assisted d. Significantly advanced coronary artery disease
therapy (AAT)?
a. Patients’ perception of the animal as a source of stress 10. Which baseline parameter was the only one to differ signif icantly between
b. Transmission of zoonotic infections groups of patients in this study?
c. Patients’ indifference to the animal a. Dog ownership
d. An allergen-antibody response to the therapy animal b. Pulmonary capillary wedge pressure
c. Numbers and types of medications currently being taken
4. What measure was implemented to ensure validity and reliability of the plasma d. Patients’ class according to the New York Heart Association functional classification
levels of epinephrine and norepinephrine specif ically?
a. All measuring instruments were leveled, zeroed, and calibrated prior to each use. 11. Which of the following is a hallmark of the deleterious neuroendocrine cascade
b. Blood samples were collected by specially trained laboratory personnel. that occurs in patients with advanced heart failure?
c. Intravenous infusions of drugs were not manipulated and oral medications were not a. Increased myocardial cell death
given 1 hour before or after blood sampling. b. Loss of balance between the release of hormones from sympathetic nerve terminals and
d. Patients were supine with the head of the bed elevated 45° for 15 minutes prior to and their reuptake and degradation
during blood sample collection. c. Blunted inotropic effects of endogenous catecholamines
d. Increased plasma levels of catecholamines
5. Which of the following is true regarding the data collectors used in this study?
a. They were specifically trained in collection of hemodynamic variables. 12. Which of the following is the most accurate explanation for the improved
b. They were non-nurse research professionals. hemodynamic and neuroendocrine measurements found in patients who
c. They used specific scripting to provide explanations to each patient. received AAT?
d. They worked in pairs consisting of a research assistant and the study’s coinvestigator. a. AAT provides patients a meaningful stimulus and diverts attention away from the
immediate stressors.
6. Advanced heart failure is indicated by which of the following? b. AAT heightens arousal of the autonomic nervous system.
a. Elevated physiological stress of living with a chronic life-threatening illness and frequent c. AAT elevates cardiovascular reactivity in patients with cardiovascular disorders.
hospitalizations d. AAT stimulates the release of brain neuropeptides, which in turn decrease heart rate and
b. Accompanying pulmonary hypertension blood pressure.
c. Presence of ischemic cardiomyopathy
d. Systolic and diastolic left ventricular dysfunction 13. Limitations of this research study include which of the following?
a. Study population size and patient fluid limitations
7. Blood pressure was measured automatically by using a bedside monitor for what b. Number of facilities where study conducted and percentage of patients in the study
reason? population who were dog owners
a. Manual blood pressure measurements are too time consuming. c. Patients’ fluid limitations and percentage of patients in the study population who were dog
b. Reliability and validity of noninvasive automatic blood pressure measurements have been owners
established. d. Number of facilities where study conducted and amount of time patients were exposed to
c. Disparities in measurements due to data collector variances are avoided when AAT
automatic monitor measurements are used.
d. Manual blood pressure measurements themselves have been shown to increase
state anxiety.
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