Health experiences of first-time myocardial infarction: Factors influencing women's and men's health-related quality of life after five months

Fatigue, Depression and Health-Related Quality of Life in Patients with Post-Myocardial Infarction during the COVID-19 Pandemic: Results from the Augsburg Myocardial Infarction Registry

The interplay between fatigue and depression and their association with health-related quality of life (HRQoL) after acute myocardial infarction (AMI) has received little attention during the COVID-19 pandemic. Therefore, this study evaluated the frequency of fatigue and depression in post-AMI patients during the COVID-19 pandemic and investigated the cross-sectional associations between fatigue, depression and HRQoL.

METHODS

The analysis was based on population-based Myocardial Infarction Registry Augsburg data. All survivors of AMI between 1 June 2020 and 15 September 2021 were included (n = 882) and received a postal questionnaire containing questions about fatigue (Fatigue Assessment Scale), depression (Patient Health Questionnaire), and HRQoL (MacNew Heart Disease HRQoL questionnaire) on 17 November 2021. The questionnaire was returned by 592 patients (67.1%), and 574 participants could be included in the analysis. Multivariable linear regression models were performed to investigate the associations between fatigue and depression (both exposures) and HRQoL (outcome).

RESULTS

Altogether, 273 (47.6%) participants met the criteria for the presence of fatigue, about 16% showed signs of moderate to severe depression. Both fatigue and depression were significantly associated with a decreased HRQoL (total score and emotional, social, and physical subscales; all p-values < 0.0001). In particular, a combined occurrence of fatigue and depression was associated with a significantly reduced HRQoL.

CONCLUSIONS

It seems necessary to screen post-MI patients for the presence of fatigue and depression in clinical practice on a routine basis to provide them with adequate support and treatment and thus also to improve their HRQoL.

Prevalence, correlates, and network analysis of depression and its association with quality of life in survivors with myocardial infarction during the COVID-19 pandemic

BACKGROUND

Depression is common among myocardial infarction (MI) survivors and is strongly associated with poor quality of life (QOL). The aim of this study was to examine the prevalence, correlates and the network structure of depression, and its association with QOL in MI survivors during the COVID-19 pandemic.

METHODS

This cross-sectional study evaluated depression and QOL in MI survivors with the Chinese version of the nine-item Patient Health Questionnaire (PHQ-9) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) respectively. Univariable analyses, multivariable analyses, and network analyses were performed.

RESULTS

The prevalence of depression (PHQ-9 total score ≥ 5) among 565 MI survivors during the COVID-19 pandemic was 38.1 % (95 % CI: 34.1-42.1 %), which was significantly associated with poor QOL. Patients with depression were less likely to consult a doctor regularly after discharge, and more likely to experience more severe anxiety symptoms and fatigue. Item PHQ4 "Fatigue" was the most central symptom in the network, followed by PHQ6 "Guilt" and PHQ2 "Sad mood". The flow network showed that PHQ4 "Fatigue" had the highest negative association with QOL.

CONCLUSION

Depression was prevalent among MI survivors during the COVID-19 pandemic and was significantly associated with poor QOL. Those who failed to consult a doctor regularly after discharge or reported severe anxiety symptoms and fatigue should be screened for depression. Effective interventions for MI survivors targeting central symptoms, especially fatigue, are needed to reduce the negative impact of depression and improve QOL.

Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization

In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients. 230 patients (60 female) with coronary artery disease were assessed before, and two weeks, three months and six months after coronary revascularization. Disease-specific HRQoL was measured with the Short-Form Seattle Angina Questionnaire. Physical and mental health was measured with the Short-Form Health Survey. Comorbidity burden was assessed by the total number of identified comorbidity conditions and by the Charlson comorbidity score. Linear mixed models were used to estimate the effects of time, gender and comorbidity burden on HRQoL. Whereas HRQoL improved after coronary revascularization in all patients, female patients reported poorer physical health and disease-specific HRQoL and their physical health improved more slowly than male patients. A higher comorbidity burden was related with poorer physical health and disease-specific HRQoL in male patients, but not in female patients. A higher comorbidity burden was associated with slower improvement in HRQoL for both female and male patients. Female patients reported poorer HRQoL and their physical health improved more slowly after coronary revascularization, irrespective of comorbidity burden. Higher comorbidity burden was associated with poorer physical health and disease-specific HRQoL in male patients only. Our results indicate that female and male patients recover differently after coronary revascularization. These findings highlight the importance of comorbidity- and gender-specific approaches for evaluating coronary artery disease and coronary revascularization procedures.

Factors associated with adoption of coping strategies among Chinese patients with heart failure in ethnic minority regions

AIMS AND OBJECTIVES

To examine the coping strategies in patients with heart failure (HF) in the ethnic minority regions of China and to explore the factors affecting the adoption of coping strategies.

BACKGROUND

Effective coping with illness is an important element that influences the adaptation and increases the patient quality of life. Although different factors have been proposed to be determinants of coping strategy, findings are inconclusive, especially when it comes to the cultural background.

DESIGN

A cross-sectional study was performed.

METHODS

A total of 360 HF patients in four districts of Xinjiang were enrolled. All participants completed the Medical Coping Modes Questionnaire, the Minnesota Living with HF Questionnaire and self-management Questionnaire.

RESULTS

Heart failure patients had lower scores in confrontation and higher scores in avoidance and acceptance resignation than patients in the Chinese norm. The multiple regression analysis revealed several factors that indicate confrontation coping including symptom management, employment status and psychological and social management, whereas religion (R2), disease duration, employment status and payment system (P2) were identified as indicators of avoidance coping. In addition, ethnicity (E1), disease duration and employment status were indicators of acceptance resignation coping.

CONCLUSIONS

Our findings from this study suggest that HF patients in the ethnic minority regions may use less confrontation coping and more avoidance and acceptance resignation coping than patients in the Chinese norm. Moreover, the cultural background, duration of disease, quality of life and self-management play important roles in the selection of HF coping strategy.

RELEVANCE TO CLINICAL PRACTICE

The disparities of racial/ethnic exist in coping strategy. Healthcare providers are required to better understand the role of religion in the coping process and how it contributes to the selection of coping strategies.

Correlates of health-related quality of life in patients with myocardial infarction: A literature review

BACKGROUND

By the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population.

OBJECTIVES

This study aimed to identify correlates of HRQoL in patients with MI.

DESIGN

A literature review of the factors that affect HRQoL in patients with MI (1995-2016).

DATA SOURCES

Three main databases-CINAHL, MEDLINE and PsychINFO-were searched to retrieve relevant peer-reviewed articles published in English.

REVIEW METHODS

In consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories.

RESULTS

A total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors.

CONCLUSIONS

Identifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI.

Dimensions of the Somatic Health Complaints Questionnaire (SHCQ) in a Sample of Myocardial Infarction Patients

A short health complaints measure may provide information on the degree of recovery from acute myocardial infarction. The present study therefore evaluated a questionnaire-called the Somatic Health Complaints Questionnaire (SHCQ)-that includes 13 items concerning health problems common in cardiac patients. The sample included 114 patients in total, 37 women and 77 men, who had suffered a first-time myocardial infarction 5months prior to the testing. Confirmatory factor analysis was performed to examine whether the factor structure replicated the hypothesized hierarchical model. The results indicated that SHCQ represents four dimensions: breathlessness, fatigue, pain and unrest. It was also found that SHCQ may be treated as one general concept. It is a brief and easily administered questionnaire and may therefore be a useful tool in secondary prevention work, identifying patients at risk for possible negative consequences of a first-time myocardial infarction.

Interventions that improve health-related quality of life in patients with myocardial infarction

PURPOSE

Patients with myocardial infarction (MI) often report lower health-related quality of life (HRQoL) than those without MI. Interventions can affect HRQoL of these patients. The purpose of this review was to identify effective strategies for improving HRQoL among individuals with MI.

METHODS

Three electronic databases were searched and limited to articles peer-reviewed and published in English between 1995 and 2015. We screened titles and abstracts of the retrieved articles for studies that examined effectiveness of interventions to improve HRQoL in patients with MI.

RESULTS

Twenty-three studies were found that examined the effects of behavioural interventions-cardiac rehabilitation programmes (CRP), education and counselling programmes, and other psychological and cognitive interventions-to improve HRQoL in patients with MI. The studies included were mainly randomised controlled trials (14 studies) with a wide age range of participants (18-80 years) and a mean age group of 50-70 years. CRPs, including home- and hospital-based CRPs, regular weekly aerobic training programmes, and group counselling mostly resulted in improvement of HRQoL in patients with MI.

CONCLUSION

Most CRPs and other interventions were beneficial to MI patients. Therefore, patients with MI should be encouraged to participate in programmes that can help promote their HRQoL.

A Prospective Study of the Effects of Psychological Resources and Depression in Essential Hypertension

This study examined the influence of perceived health competence (PHC) and coping strategies in hypertension. Depressive mood state and dimensions of quality of life (QOL) (social support, satisfaction, well-being and free time) were also considered. One hundred and fifty participants were surveyed cross-sectionally and prospectively. Regression analysis revealed that the main predictors of the dimensions of QOL were PHC and depressive mood state. Emotional coping negatively predicted well-being. Unexpectedly, task-focused coping was unrelated to QOL domains. Longitudinal analyses did not support these relations. The data suggest that, in hypertension, PHC constitutes an important resource, whereas depressive mood state deteriorates QOL.

Fatigue in Older Adults Postmyocardial Infarction

OBJECTIVE

The purpose of this study was to comprehensively examine putative factors that may independently contribute to fatigue and subsequent persistence of fatigue in elderly adults 6-8 months post-myocardial infarction (MI). Studies suggest cardiac function, comorbidities, daytime sleepiness, depression, anemia, interleukins, and social support are correlates of fatigue; however, no studies have systematically examined these factors 6 months post-MI in an aging population.

METHODS

Study participants included 49 women and men (N = 98) ages 65-91 who were 6-8 months post-MI. Data collection included the demographic health status questionnaire (heart rate, blood pressure, body mass index, and medications), fatigue-related comorbidity scale, revised Piper fatigue scale, Epworth sleepiness scale, geriatric depression scale, social provisions scale, and venous blood tests (B-natriuretic peptide, hemoglobin, and interleukin-6).

RESULTS

Fatigue persisted after MI in 76% of older men and women with no difference by sex. Only depression scores (P trend = 0.0004) and mean arterial pressure (P trend = 0.015) were found to be linearly independent predictors for fatigue, controlling for age, Il-6 levels, and body mass index.

CONCLUSION

Post-MI depression and mean arterial blood pressure are important to assess when examining fatigue post-MI in older populations.

Fatigue and physical activity after myocardial infarction

BACKGROUND

Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions.

OBJECTIVE

This study compared PA in 34 men and 38 women, aged 65 and older, 6-8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample.

METHODS

Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide.

RESULTS

There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001).

CONCLUSION

The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.

Critical review of factors predicting health-related quality of life in newly diagnosed coronary artery disease patients

BACKGROUND

Newly diagnosed coronary heart disease patients can experience significant negative changes in their health-related quality of life (HRQoL). No existing literature review was found related to factors predicting HRQoL in newly diagnosed coronary heart disease patients.

PURPOSE

The aim of this study was to identify factors predicting HRQoL in newly diagnosed coronary heart disease patients.

REVIEW METHODS

We searched studies published between 1997 and 2009 with combinations of key words including factors, predictor, health-related quality of life, quality of life, first diagnosed coronary heart disease patients, and coronary heart disease patients. Data sources were ProQuest, ScienceDirect, CINAHL, PsychINFO, PubMed, and Scopus. Seventeen studies were identified that primarily examined HRQoL from 6 weeks to 12 months after diagnosis.

CONCLUSIONS

Factors predicting HRQoL in newly diagnosed coronary heart disease patients can be divided into 3 groups: sociodemographic, clinical, and psychosocial. Characteristics in each category most strongly predictive of HRQoL in newly diagnosed coronary heart disease patients were: Sociodemographic positive predictors were baseline HRQoL, education level, and marital status; sociodemographic negative predictors included number of cardiovascular risks and female gender. Age was an inverse predictor. Clinical negative predictors included angina, physical functioning, and fatigue. Psychosocial positive predictors included social support and a sense of coherence, whereas depression, anxiety and depression, overall psychosocial characteristics or mood disturbance, anxiety, and hostility were negative predictors.

CLINICAL IMPLICATIONS

This review identifies predictors of HRQoL and shows the importance of assessing factors that predict HRQoL at baseline and throughout the trajectory of this chronic illness because the concept of HRQoL changes over time but the predictors remain constant.

I've lost the person I used to be--experiences of the consequences of fatigue following myocardial infarction

Fatigue has been found to be the most frequent and bothersome symptom after myocardial infarction (MI), influencing health-related quality of life negatively. Moreover, fatigue after MI has been described as incomprehensible due to its unpredictable occurrence and lack of relationship to physical effort. The aim of this study is therefore to explore persons’ experiences of consequences of fatigue and their strategies for dealing with it 2 months after MI. In total, 18 informants, aged 42–75 years, participated in the study. Interviews were conducted and analysed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category, was: I’ve lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Furthermore, attempts to relieve fatigue were limited. These findings indicate that patients with symptoms of fatigue should be supported in developing relief strategies, for example, rest and sleep hygiene as well as physical activity. In conclusion, the results show that fatigue can be understood in light of the concepts “comprehensibility” and “manageability.” They also indicate that, working from a person-centered perspective, health-care professionals can support patients experiencing post-MI fatigue by giving them opportunities to straighten out the question marks and by inviting them to discuss involuntary thoughts and feelings of being restricted in their daily life functioning.

The experience of younger adults following myocardial infarction

The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.

Gender differences and determinants of health related quality of life in coronary patients: a follow-up study

Background

The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes.

Methods

A follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed.

Results

Follow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency.

Conclusions

There are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.

Relationships between coping, coping resources and quality of life in patients with chronic illness: a pilot study

OBJECTIVES

The original purpose of the study was to determine differences between two groups of patients with chronic illness (ESRD and CHF) regarding the following study variables: coping, sense of coherence (SOC), self-efficacy and quality of life (QOL). Following this, the aim was to explore the relationships between demographic variables (sex, age, educational level and living area) and QOL as well as between coping, SOC, self-efficacy and QOL for the combined sample of patients with ESRD and CHF.

METHODS

A comparative and correlative design was used with a sample of 100 patients (n = 41 ESRD, n = 59 CHF). The data were collected during 2004, using four standardized questionnaires and regression analyses were conducted.

RESULTS

No significant differences were found between the two groups. Positive correlations were identified between SOC, general self-efficacy and QOL, whereas negative correlations emerge between emotion-focused coping, SOC, general self-efficacy and QOL. SOC, general self-efficacy and emotion-focused coping explained 40% of the variance in QOL. Those with low SOC and general self-efficacy showed negative correlations between emotion-focused coping and QOL, whereas no such correlations were shown for those with high values on SOC and general self-efficacy.

CONCLUSIONS

The present results on coping and QOL correspond with previous research regarding how other groups with chronic illness handled their daily life. Preliminary results indicate that how individuals tackle their present situation is more important than which chronic illness they have. Women used more emotion-focused coping than men, which constitute an important finding for further research.

Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS)

STUDY OBJECTIVES

Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time.

DESIGN

Prospective cohort study. Data were from the Sleep Heart Health Study.

SETTING

Multicenter study.

PARTICIPANTS

Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included.

MEASUREMENTS

The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep.

RESULTS

Mean respiratory disturbance index increased from 8.1 +/- 11 SD at baseline to 10.9 +/- 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life.

CONCLUSIONS

A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life.

Illness consequences after myocardial infarction: problems with physical functioning and return to work

AIM

This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work.

BACKGROUND

A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society.

METHODS

A convenience sample was recruited of 88 patients, <or=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work.

RESULTS

Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases (R2=0.344).

CONCLUSION

Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning.

Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery

BACKGROUND

Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue after their surgery.

OBJECTIVE

The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiologic functioning, and physical activity) over time (6 weeks and 3 months) among older adult subjects, age 65 years and older, after CABG surgery. Comparison groups were those subjects who had fatigue at 3 weeks after surgery and nonfatigued subjects.

DESIGN

A prospective, comparative design was used for this secondary analysis study.

SAMPLE

Subjects in this study were drawn from the control group of subjects enrolled in the larger parent study. Subjects (N = 119) were dichotomized into fatigue (n = 66) and nonfatigued (n = 53) groups on the basis of their 3-week self-reports of postoperative fatigue.

RESULTS

At 6 weeks after surgery, fatigued subjects had significantly (P < .05) more impaired psychosocial functioning (role-emotional [t = 1.9], social [t = 2.6], and mental [t = 1.9] functioning) on the basis of the Medical Outcome Study Short Form 36. They had significantly (P < .005) higher mean hospital anxiety (t = -3.6) and depression (t = -2.9) subscale scores, respectively. Anxiety (t = -2.3, P < .05) remained significantly (P < .05) impaired at 3 months. At 6 weeks, role physical functioning, measured by the Medical Outcome Study Short Form 36, was significantly impaired (t = 2.4, P < .01). There were no significant differences in physical activity variables as measured by an RT3 accelerometer (Stayhealthy, Inc., Monrovia, CA) and self-report diary.

CONCLUSIONS

Persistent fatigue can hamper early recovery after CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes.

Quality of life in female myocardial infarction survivors: a comparative study with a randomly selected general female population cohort

Background

A substantial burden associated with MI has been reported. Thus, how survivors experience their quality of life (QOL) is now being given increasing attention. However, few studies have involved women and a comparison with the general population. The aims of this study were to determine the QOL of female MI survivors, to investigate whether their QOL differed from that of the general population, and to evaluate the clinical significance of the findings.

Methods

Two cross-sectional surveys were performed; on female MI survivors and the general Norwegian population. The MI survey included women aged 62–80 years, three months to five years after their MI. One hundred and forty-five women responded, yielding a response rate of 60%. A subset of women in the same age range (n = 156) was drawn from a study of 1893 randomly selected Norwegian citizens. QOL was measured in both groups with the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF).

Results

The majority (54%) of the female MI survivors presented with ST-elevation in their ECG, 31% received thrombolysis, and 38% had reduced left ventricular ejection fraction. Female MI survivors reported significantly lower satisfaction with general health (p = 0.020) and overall QOL (p = 0.017) than women from the general population. This was also the case for the physical and environmental QOL domains (p < 0.001), but not for the psychological and social relationship domains. Estimated effect sizes between the two groups of participants ranged from 0.1 to -0.6.

Conclusion

The burden of MI significantly affects the physical health of elderly women. Still, female MI survivors fare as well as the general female population on psychosocial QOL domains. Action should be taken not only to support women's physical needs but also to reinforce their strengths in order to maintain optimal QOL.

Trajectories of recovery of quality of life in women after an acute cardiac event

OBJECTIVES

Female cardiac patients' health-related quality of life (HRQoL) during the first year after an acute cardiac event was compared with age-weighted Australian population norms. The impact of age, event type and cardiac rehabilitation (CR) programme attendance on recovery was assessed.

METHODS

The short form 36-item health survey (SF-36) was administered to 229 women aged from 36 to 84 years consecutively admitted to 4 hospitals after acute myocardial infarction (AMI) or to undergo coronary artery bypass graft surgery (CABGS). Data were collected at 4 time points over 12 months. SF-36 subscale scores were compared with age-weighted norms for Australian women. Mplus was used to analyse growth trajectories for SF-36 subscales.

RESULTS

Patients had impaired HRQoL at baseline (except in general health), with progressive improvement over time. Recovery to normative levels was fastest in the areas of bodily pain and mental health (by 2 months) and slowest in the area of physical functioning, and physical and emotional role limitations (by 12 months). By 4 months, general health scores had surpassed population norms. For all scales, most improvement occurred in the first 2 months, with little subsequent improvement. CABGS patients showed significantly more improvement than AMI patients in several areas, partly due to the poorer functioning of CABGS patients at baseline. Rate of improvement was not influenced by patients' age or frequency of CR attendance.

CONCLUSIONS

Impairment of HRQoL in female cardiac patients is most pronounced at the time of the event, with most recovery occurring during early convalescence and full recovery in all domains by 12 months post-event.

Readjustment 5 months after a first-time myocardial infarction: reorienting the active self

AIM

This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.

BACKGROUND

Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.

METHOD

Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.

FINDINGS

Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.

CONCLUSION

Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

Changes in Health Related Quality of Life 3 months after an acute coronary syndrome

Background

The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes.

Methods

HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable.

Results

There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors.

Conclusion

The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.

Prevalence of depression in survivors of acute myocardial infarction

OBJECTIVES

To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence.

DATA SOURCES

MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE.

REVIEW METHODS

A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded if only an abstract was provided, if not in English, or if depression was not measured by a validated method.

RESULTS

Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points.

CONCLUSIONS

Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

Health-related quality of life in women and men one year after acute myocardial infarction

The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.

Depression Following Acute Myocardial Infarction: A Prospective Relationship With Ongoing Health and Function

The relationship between baseline depression and health-related quality of life were examined in a cohort of patients after hospitalization due to acute myocardial infarction (N=196). Patients were assessed for presence of mood disturbance, anxiety, and quality of life at the time of hospitalization and again 4 months later. Baseline assessment was used to assign subjects to a depressed or a nondepressed group. Adjusting for preinfarction quality of life, in-hospital anxiety, and demographic variables, depression was prospectively and independently related to reduced global health at 4 months as well as reduced overall mental health-including vitality, psychological health, and social function-and increased role interference from psychological problems.

Perceived coping, social support, and quality of life 1 month after myocardial infarction: a comparison between Swedish women and men

OBJECTIVE

The study objective was to compare coping, social support, and quality of life in Swedish women and men 1 month after myocardial infarction.

DESIGN

The study design was cross-sectional and descriptive-comparative.

SETTING

The study took place in 1 hospital service area in the middle of Sweden.

SUBJECTS

The sample consisted of 74 women and 97 men.

INSTRUMENTS

The Jalowiec Coping Scale, the Social Network and Social Support Questionnaire, the Short Form-36 Health Survey, and the Quality of Life Index-Cardiac Version were used.

RESULTS

Compared with men, women used more evasive and supportive coping and rated psychologic aspects of the heart disease as more problematic to manage. More women perceived available support from friends and grandchildren, and more men perceived available support from their partner. Women rated lower levels in physical and psychologic dimensions of quality of life.

CONCLUSION

The first month after myocardial infarction is a susceptible period especially for women. They used more evasive and supportive coping and experienced a lower quality of life compared with men.

Fatigue and physical activity in older women after myocardial infarction

BACKGROUND

Within 6 years of a myocardial infarction (MI) more women (35%) than men (18%) will have another MI. Participation in physical activity is one of the most effective methods to reduce cardiac risks; however, few older women participate. One of the most frequently reported barriers to physical activity is fatigue.

OBJECTIVES

The specific aims of this study were to (1) describe factors related to fatigue in older women after MI and (2) examine the relationship of fatigue to physical activity in older women after MI.

METHODS

This descriptive correlational study examined the effects of age, body mass index, comorbidities, sleep, beta-blocker medication, depression, and social support on fatigue and physical activity in women (N = 84), ages 65 to 88 years old, 6 to 12 months post-MI. All women had their height and weight measured and completed (1) a health form on comorbidities, physical activity, and medication history; (2) the Geriatric Depression Scale; (3) the Epworth Sleepiness Scale; (4) the Revised Piper Fatigue Scale; and (5) the Social Provisions Scale.

RESULTS

The majority (67%) of the women reported fatigue that they perceived as different from fatigue before their MI. Moderately strong correlations were noted among depression, sleep, and fatigue, and multivariate analysis indicated that depression and sleep significantly accounted for 32.7% of the variance in fatigue. Although only 61% of the women reported participating in physical activity for exercise, most were meeting minimal kilocalories per week for secondary prevention. Fatigue was not significantly associated with participation in physical activity.

CONCLUSION

Describing correlates to fatigue and older women's participation in physical activity after MI are important to develop interventions targeted at increasing women's participation in physical activity, thus decreasing their risk for recurrent MIs.

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction

BACKGROUND

The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men.

AIM

The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners.

METHODS

Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub-themes were then extracted from the text.

RESULTS

The first theme was 'living in a changed life situation' with the sub-themes: 'showing consideration', 'taking responsibility', 'living side by side' and 'desiring what to do'. The second theme was 'looking to the future' with the sub-themes: 'feeling uncertain', 'feeling powerless', 'feeling limited' and 'feeling hope'.

CONCLUSIONS

The results revealed that couples lived in a changed life situation, somewhat in 'discordance', and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this 'discordance', couples may experience loneliness, in that they may not share feelings about the event and the situation it causes.

RELEVANCE TO CLINICAL PRACTICE

Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.

Myocardial infarction: gender differences in coping and social support

AIM

The aim of this review is to summarize current knowledge about gender differences in perceptions of coping and social support among patients who have experienced myocardial infarction.

RATIONALE

Women with coronary heart disease have physical, social and medical disadvantages compared with their male counterparts, which can influence their perception of recovery after cardiac events. No review has been found which focuses on gender differences in coping and social support in myocardial infarction patients.

METHOD

A computerized search was conducted using the keywords 'myocardial infarction', 'coping', 'gender differences' and 'social support'. Forty-one articles, published between 1990 and October 2002, were scrutinized.

FINDINGS

Two studies report that women used more coping strategies than men. Several qualitative studies found that women used a variety of coping strategies. Women minimized the impact of the disease, tended to delay in seeking treatment and did not want to bother others with their health problems. Household activities were important to them and aided their recovery. Men were more likely to involve their spouses in their recovery, and resuming work and keeping physically fit were important to them. Women tended to report that they had less social support up to 1 year after a myocardial infarction compared with men. They received less information about the disease and rehabilitation and experienced lack of belief in their heart problems from caregivers. Further, they received less assistance with household duties from informal caregivers. Men tended to report more support from their spouses than did women.

CONCLUSIONS

Traditional gender-role patterns may influence the recovery of patients who have experienced myocardial infarction. Caregivers may need to be more sensitive to gender-specific needs with regard to risk profiles, social roles, and the patient's own role identity. For many women, especially older ones, household duties and family responsibilities may be an opportunity and a base for cardiac rehabilitation.

Quality of life in physical health domains predicts adherence among myocardial infarction patients even after adjusting for depressive symptoms

OBJECTIVE

To prospectively study the relationship of quality of life (QOL) to adherence among myocardial infarction (MI) patients and also to determine if either QOL or depressive symptoms (DEP) has a primary role in predicting adherence.

METHODS

Acute-MI patients (N=285) were administered questionnaires on QOL, DEP, and adherence in-hospital and 4 months post-MI. The seven adherence behaviors measured included (1). following a low-salt diet, (2). following a low-fat or weight loss diet, (3). taking prescribed medication, (4). exercising regularly, (5). decreasing stress, (6). carrying medical supplies for self-care, and (7). trying to socialize more with others. Hierarchical regression analyses examined cross-sectional and prospective relations between adherence and both physical and mental health QOL domains. Each QOL domain was modeled as "adherence=QOL domain+DEP."

RESULTS

Physical health QOL was related to adherence using cross-sectional and prospective approaches even with DEP independently still related to adherence. Conversely, in separate models using cross-sectional and prospective approaches, mental health QOL was not related to adherence while DEP was related to adherence.

CONCLUSION

Focused attention on those with low scores in physical health QOL or greater DEP may be an efficient approach to improve adherence in patients recovering from an MI.