Factors influencing quality of life in older women with heart disease

Comparison of Lean Mass in Women With and Without Heart Disease

PURPOSE

This proof-of-concept study compared lean mass (LM) between women with heart disease (HD) and without HD.

METHODS

Fifty-six community-dwelling women were pair-matched by age. Heart disease was defined using criteria from the US Behavioral Risk Factor Surveillance System. Body composition was measured using multifrequency bioelectrical impedance analysis. Relative LM was calculated against height (kg/m2) as the lean mass index (LMI). Sarcopenia was defined as an LMI <15.0 kg/m2. Strength was measured with a handgrip dynamometer, arm curl test, and chair stand test.

RESULTS

Those with HD had significantly less absolute (38.2 ± 0.8 vs 43.5 ± 1.0 kg; P < .001) and relative (15.3 ± 0.3 vs 16.2 ± 0.3 kg/m2, P = .015) LM compared with those without HD. Body mass was significantly greater for those without HD (76.1 ± 2.1 vs 68.4 ± 2.1 kg; P = .013) and there were no differences in fat mass. Upper body strength was significantly less and lower body strength was diminished but not significantly different in those with HD compared to those without HD (handgrip: P = .016; arm curl: P < .001; chair stand: P = .066).

CONCLUSIONS

In this group of community-dwelling women, those who reported a diagnosis of HD had significantly less LM than those without HD. Although neither group was classified as sarcopenic, women with HD were at greater risk due to lower relative LM. Based on our findings, during cardiac rehabilitation clinicians should counsel women regarding resistance exercise for maintenance of LM in addition to strength.

Identifying cut-off scores for interpretation of the Heart Failure Impact Questionnaire

AIMS

Heart failure (HF) influences health-related quality of life. However, the factors that contribute to health-related quality of life remain unclear in Taiwan. We aim to identify the factors influencing health-related quality of life in HF patients.

METHODS

Hospitalized HF (N = 225) patients were included from April 2011 to April 2014. Health-related quality of life was assessed by using the 36-Item Short-Form Health Survey (SF-36) and the Minnesota Living with Heart Failure Questionnaire. A new cut-off was conducted based on the combination of SF-36 and Minnesota Living with Heart Failure questionnaire.

RESULTS

There were significant differences between good and poor quality groups on age, gender, education levels, occupational classification caregiver, New York Heart Association classes, and the numbers of comorbidities. The logistic regression analysis showed that the number of comorbidities was more than three and New York Heart Association class IV were significantly associated with health-related quality of life.

Lifestyle and Health Status Differ over Time in Long-Term Heart Transplant Recipients

Objective

To describe differences in lifestyle and health status across 5 posttransplant periods.

Methods

The sample consisted of 126 heart transplant recipients (87% men) grouped by time after transplantation: group 1, 12 to 24 months (n = 13); group 2, 25 to 48 months (n = 19); group 3, 49 to 72 months (n = 24); group 4, 72 to 96 months (n = 27); and group 5, ≥ 97 months (n = 43). Data were obtained using demographic and health status evaluation forms and the Lifestyle Profile-II, which measures physical activity, nutrition, health responsibility, interpersonal relationships, stress management, and spiritual growth.

Results

Most often reported lifestyle attributes were spiritual growth and interpersonal relationships. Least often reported was physical activity. Pairwise comparisons revealed that groups 3 (χ2= 16.4; SD = 4.8; P = .03) and 4 (χ2 = 16.6; SD = 5.8; P = .04) had lower physical activity than group 2 (χ2 = 21.3; SD = 5.2). Health status evaluation revealed that there were no group differences in systolic ( P = .46) or diastolic ( P = .77) blood pressure. Although creatinine was elevated, there were no group differences ( P = .86). High-density lipoprotein was higher than 42 mg/dL in all groups, but there were differences across groups in low-density lipoprotein ( P = .003). Groups 1 (χ2 = 139.2; SD = 38.5) and 2 (χ2 = 141.0; SD = 47.8) were different than group 5 (χ2 = 112.9; SD = 36.1; P = .05). There were group differences in cholesterol ( P = .002), with lower levels in groups 4 (χ2 = 190.5; SD = 38.6) and 5 (χ2 = 186.3; SD = 37.7) as compared to group 2 (χ2 = 230.8; SD = 66.5).

Conclusions

Identifying posttransplant periods in which healthy behaviors and health status may be vulnerable to decline is important for providing ongoing education and psychological support to transplant recipients who manage a complex regimen.

Perceptions and Experiences of Heart Disease: A Literature Review and Identification of a Research Agenda in Older Women

BACKGROUND

Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease. This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease.

METHODS

The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women.

RESULTS

Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs.

CONCLUSION

Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.

Systematic review of health-related quality of life models

Background

A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models.

Methods

Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria.

Results

Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice.

Conclusions

Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.

Clinical correlates of health-related quality of life among opioid-dependent patients

PURPOSE

Previous work suggests that opioid users have lower health-related quality of life (HRQOL) than patients with more prevalent chronic illnesses such as hypertension or diabetes. Although comparisons with population norms are informative, studies of the correlates of HRQOL for opioid users are needed to plan clinical services.

METHODS

We tested a conceptual model of the pathways between physiologic factors and symptoms in relation to HRQOL among 344 opioid users in a clinical trial. Physical and mental HRQOL were measured by the Short-Form (SF)-36; withdrawal signs, symptoms, and functioning were also measured with validated instruments. Using structural equation modeling, we tested hypotheses that medical history directly predicts withdrawal signs and symptoms, and that medical history, withdrawal signs and symptoms, and functioning predict the physical and mental HRQOL latent variables of the SF-36.

RESULTS

Most hypothesized relationships were significant, and model fit was good. The model explained 36% of the variance in mental HRQOL and 34% of the variance in physical HRQOL.

CONCLUSIONS

The conceptual framework appears valid for explaining variation in the physical and mental HRQOL of opioid users undergoing medically managed withdrawal. Analysis of longitudinal data would help to evaluate more rigorously the adequacy of the model for explaining HRQOL in opioid withdrawal.

Stress, social support and housing are related to health status among HIV-positive persons in the deep south of the United States

Self-report health status measures are consistently associated with medical outcomes and are cost-effective. Studies using such measures find that those who live in rural areas or have limited access to support experience poorer health status and poorer outcomes. A survey addressing these issues was administered to 401 HIV-positive persons throughout Alabama. Hierarchical regression models examined the relation of housing stability, stress, substance use and other variables to physical (PCS) and mental (MCS) health status. The sample was 34% female and 66% African-American. Most were receiving antiretroviral medications, and nearly 20% were in unstable housing. Age showed a significant negative relationship to health status. CD4 cell count (p < 0.01) was positively associated with PCS; perceived general stress (p < 0.02) and housing stability (p < 0.04) were negatively associated. The model accounted for 14% of the variance in PCS (p < 0.001). For MCS, general stress (p < 0.001) was negatively associated and substance use tended towards a negative association (p < 0.075). Social support (p < 0.02) was positively associated with MCS. The model accounted for nearly 31% of the MCS variance (p < 0.001). Health status among HIV-positive persons may be improved by assessing and addressing social issues such as social isolation, life stressors and housing.

Sense of coherence--a determinant of quality of life over time in older female acute myocardial infarction survivors

AIMS

To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up.

BACKGROUND

Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant.

DESIGN

Survey.

METHODS

A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used.

RESULTS

We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up.

CONCLUSION

Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life.

RELEVANCE TO CLINICAL PRACTICE

These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.

Beyond fun and friendship: the Red Hat Society as a coping resource for older women

How older women cope with challenges and losses in later life influences not only their physical health but also their psychological wellbeing and quality of life. The purpose of the analysis reported in this paper was to understand how participation in a women's leisure-based social group – the Red Hat Society® – serves as a coping resource for older women. The Society is an international organisation of women aged 50 or more years and has the mission to ‘celebrate the silliness of life’. The Society currently has an estimated one million members in 30 countries. To understand the ways that social group participation may contribute to older women's health and wellbeing, this paper examines the dynamics of leisure-based coping with positive emotions as the focus. Based on an analysis of responses to an open-ended question about meaningful experiences associated with being involved in the Red Hat Society, the sample of 272 members identified the main reasons for their involvement as chronic and acute stressors, challenging life transitions and daily hassles. In addition, they described four ways that participation helped them to manage these stressors: as a context for social support, emotional regulation, sustaining coping efforts, and meaning-focused coping. The results are discussed in relation to theory and previous evidence on the role of positive emotions and leisure in coping.

Testing the applicability of a conceptual model of oral health in housebound edentulous older people

OBJECTIVES

The aim of the study was to test prospectively Wilson and Cleary's (1) conceptual model of the direct and mediated pathways between symptom burden, functional status and health perceptions in relation to the oral health of housebound elderly edentulous people.

METHODS

The data were collected as part of a community based randomized control trial of a domiciliary denture service for older people. Measures of self-reported symptoms, functional status and global oral and general health perceptions were collected from 133 participants prior to treatment and at 3-month follow-up.

RESULTS

The results indicated support for the dominant direct and indirect pathways within the model; worse patient reported symptoms predicted a lower functional status; worse daily functioning predicted lower global oral health perceptions. In addition, the impact of symptom status on oral health perceptions was mediated by patient reported functioning. The treatment (domiciliary denture service) significantly improved functional status and global oral health perceptions. All relationships were significant prospectively that is, from baseline, prior to the intervention, to 3-month follow-up, with the exception of between symptoms functioning.

CONCLUSION

The results support Wilson and Cleary's conceptual model of patient outcomes as applied to elderly edentulous people. They highlight the importance of assessing a range of patient-orientated variables in order to help gain a greater understanding of how oral health impacts on individuals' daily lives and well-being. Further conceptual development of the model is discussed, particularly the role of individual difference factors.

Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography - a cross sectional study

Background

In patients with suspected coronary artery disease (CAD), the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL) using a modified version of the Wilson and Cleary model.

Methods

Using a cross-sectional design, 753 patients (74% men), mean age 62 years, referred for elective cardiac catheterisation were included. The measures included 1) physiological factors 2) symptoms (disease severity, self-reported symptoms, anxiety and depression 3) self-reported functional status, 4) coping, 5) perceived disease burden, 6) general health perception and 7) overall quality of life. To analyse relationships, we performed linear and ordinal logistic regressions.

Results

CAD and left ventricular ejection fraction (LVEF) were significantly associated with symptoms of angina pectoris and dyspnea. CAD was not related to symptoms of anxiety and depression, but less depression was found in patients with low LVEF. Angina pectoris and dyspnea were both associated with impaired physical function, and dyspnea was also negatively related to social function. Overall, less perceived burden and better overall QOL were observed in patients using more confronting coping strategy.

Conclusion

The present study demonstrated that data from cardiac patients to a large extent support the suggested model by Wilson and Cleary.

Assessing HRQL among Chinese patients with coronary heart disease: angina, myocardial infarction and heart failure

OBJECTIVE

To perform a psychometric evaluation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) in Chinese patients with coronary heart disease.

DESIGN AND SETTING

Patients with angina (n=162), MI (n=124) or heart failure (n=95) were recruited from a regional university-affiliated hospital. The Chinese version of the MIDAS (C-MIDAS), the Hospital Anxiety and Depression Scale (HADS) and the Short-Form 36 Health Survey (SF-36) were administered to all patients at baseline and the C-MIDAS was also administered seven day (n=92) and three months (n=363) later.

RESULTS

The C-MIDAS conforms to the 7-factor structure as proposed in the original version. It is reliable with Cronbach's alphas from 0.73 to 0.94 and test-retest reliabilities from 0.76 to 0.92. Four of its subscales (physical activity, insecurity, emotional reaction and dependency) correlated significantly with the SF-36 and the HADS in each diagnostic group and had good discriminative properties in terms of gender, emotional disturbance and perceived health deterioration, with responsiveness supported by medium-high effect sizes (0.43-0.83) and standardize response means (0.46-0.82). The other three subscales measuring treatment-related impacts added little to the validity and responsiveness of the C-MIDAS.

CONCLUSION

To render the C-MIDAS a core health-related quality of life measure for Chinese-speaking patients with coronary heart disease, further studies need to clarify the content adequacy and cultural relevancy of those subscales measuring treatment-related impact.

Quality of life and sports activities in patients with haemophilia

Quality of life (QoL) is a multidimensional construct pertaining to an individual's physical, emotional, mental, social and behavioural components of well-being and functioning. QoL can be assessed using both generic and disease-specific instruments. QoL assessment in haemophilia is a relatively new area of study; the first data were published in 1990 using generic QoL questionnaires. Only recently have haemophilia-specific questionnaires been developed, first for children and then for adults. Because sports activities include not only physical and functional aspects, but also have an impact on an individual's self-esteem and social interactions, they should play an essential role in QoL assessment. Until the 1970s, persons with haemophilia were advised to avoid any kind of physical activity because of the risk of bleeds. Nowadays, however, the attitude towards sports for patients with haemophilia has changed, and the World Federation of Haemophilia has formulated recommendations concerning physical activities for patients with haemophilia. Although sports activities are recommended, their importance as an integral element in haemophilia management has not yet been widely recognized. Awareness of the importance of sports activities for this patient group has increased, and several sports projects are ongoing. For example, a twice-annual sports camp for adult patients has been held in Germany for the past 2 years; and physical improvements, QoL and subjective training effects are being measured. Another study is investigating the prevalence of sports activities in Italian children with haemophilia and their attitudes towards sports and is also assessing QoL. In Israel, a study is planned in which haemophilic children will participate in a karate training programme, and a QoL evaluation will be added to the physical assessment. In conclusion, sports activities can improve not only physical well-being, but also the emotional and social well-being of persons with haemophilia and, therefore, should become part of the global approach to haemophilia management.

The role of dispositional resilience in regaining life satisfaction after the loss of a spouse

The purpose of the present study was to examine dispositional resilience in the perceived stress-life satisfaction relation following conjugal loss. The sample included 55 widows, assessed on average, 1 month following the death of a spouse. Results supported dispositional resilience as a mediator (the initial relation between perceived stress and life satisfaction was significant, but reduced to a non-significant level once dispositional resilience was included in the model) and a moderator (the interaction between perceived stress and dispositional resilience significantly predicted life satisfaction) between perceived stress and life satisfaction. This research identifies personality characteristics that may be importantly involved in the adjustment to widowhood and discusses implications of mediators vs. moderators in this process.

Quality of life can both influence and be an outcome of general health perceptions after heart surgery

BACKGROUND

Our aim was to investigate the existence of a reciprocal relationship between patients' assessment of quality of life and their appraisal of health. If present, this relationship will interfere with the interpretation of heart surgery's effect on overall quality of life.

METHODS

Path analysis was used to investigate reciprocal causal relationships between general health perceptions and overall quality of life before and after heart surgery. Longitudinal data from a study of coronary artery bypass surgery were used to model lagged, cross-lagged, and simultaneous paths over four time-points of assessment from before surgery to one year afterwards. The conceptual framework for the analysis was the Wilson and Cleary causal pathway model. General health perceptions were measured with the Short Form 36. Overall quality of life was measured with i) a single question regarding life satisfaction and ii) the multi-item Quality of Life Survey.

RESULTS

Acceptable model fit was obtained for reciprocal causation between general health perceptions and overall quality of life. Regression coefficients changed over different phases of rehabilitation. Serial correlation accounted for much of the variance within variables over time.

CONCLUSION

The present analysis demonstrates that unidirectional models of causality are inadequate to explain the effect of heart surgery on overall quality of life. Overall quality of life can causally influence as well as be an outcome of health status after coronary artery bypass surgery.

Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life

OBJECTIVES

The aim of the study was to systematically test Wilson and Cleary's [Wilson IB, Cleary PD. JAMA 1995; 273: 59-65] conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to the oral health-related quality of life (OHRQoL) of patients with xerostomia.

METHODS

We collected measures of clinical variables, self-reported symptoms, OHRQoL, global oral health perceptions and subjective well-being from 85 patients attending outpatient clinics.

RESULTS

Structural equation modelling indicated support for the dominant direct pathways between the main levels of the model; more severe clinical signs predicted worse patient reported symptoms; worse symptom perception was associated with a lower functional status as measured by OHRQoL; and lower OHRQoL predicted worse global oral health perceptions. There was no relationship between the final two levels of the model; global oral health perceptions and subjective well-being. Subjective well-being was associated instead with earlier non-adjacent levels; biological variables, symptoms and functional status. These pathways were both direct (salivary flow-well-being, functioning-well-being) and indirect (clinical signs-well being, symptom status-well-being). There were also indirect pathways; most notably, the impact of clinical variables on OHRQoL was mediated by patient reported symptom status.

CONCLUSIONS

The results support Wilson and Cleary's conceptual model of patient outcomes as applied to a chronic oral health condition and highlight the complexity of (inter)relationships between key clinical and non-clinical variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in OHRQoL research are highlighted.

Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey

As individuals live longer, health promotion behaviors become even more important, particularly with regard to maintaining functional independence and improving quality of life (QoL). The purpose of this study was to explore the relationship between health promotion behaviors and QoL in Korean elderly living in the community. This study was a descriptive-correlational study to explore the relationship between health promotion behaviors and QoL among the community-dwelling elderly in Korea. A convenience sample of 2000 community residents who were over 65 years old and cognitively intact were selected from 32 senior centers and 242 public health centers in Korea. A total of 1920 were included in the analyses, following the exclusion of 80 incomplete questionnaires and subject refusals. Participants who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire. The results of the study showed that there were statistically significant differences in QoL of the elderly related to exercise participation, alcohol abstinence and blood pressure (BP) check-up (p<.05). Multiple regression analysis revealed that perceived health status, number of chronic illnesses, activities of daily living, BP checkup, exercise, and gender were statistically significant predictors of QoL. R(2) for this whole regression model was .412, indicating that approximately 41.2% of the variance in QoL was accounted for by the linear combination of these variables. Nurses should enhance the QoL in elderly persons by facilitating health promotion behaviors through formal nursing interventions which will maintain and increase a healthy and active life.

Consequences of chronic obstructive pulmonary disease and chronic heart failure: The relationship between objective and subjective health

This study investigates whether the relationship between objective health parameters and general health perceptions was mediated by symptoms of dyspnoea and physical functioning in patients with chronic obstructive pulmonary disease (COPD) and patients with chronic heart failure (CHF). The different health parameters were organised according to Wilson and Cleary's conceptual model of patient outcomes (Wilson & Cleary (1995). Journal of the American Medical Association, 273, 59-65). Second, we investigated whether perceptions of personal control were related to the health parameters in the model. Consecutive patients with COPD and CHF were included from the outpatient clinics of a university hospital and a general hospital, and from a rehabilitation centre, all in the Netherlands. Ninety-five COPD patients (aged 65.0+/-9.3; forced expiratory volume in 1s (FEV1)<70%) were included and compared with 90 CHF patients (aged 59.6+/-10.0; left ventricular ejection fraction (LVEF)<45%). The relationship between objective health parameters (FEV1 or LVEF) and subjective health (self-reported physical functioning) was not mediated by symptoms of dyspnoea. FEV1 or LVEF and symptoms of dyspnoea were independently related to self-reported physical functioning, which was directly related to general health perceptions. Perceived health competence was related to symptoms of dyspnoea and general health perceptions in patients with either COPD or CHF. Although patients with COPD reported lower levels in all self-reported health parameters in the model than the patients with CHF, this study showed that the relations between the health parameters in the model were comparable for COPD and CHF patients.

Correlates of psychological distress in elderly patients with congestive heart failure

OBJECTIVE

High levels of psychological distress have been reported in patients with congestive heart failure (CHF), resulting in increased morbidity and mortality. Yet, little is known about its associated factors. The purpose of this study is to identify the significant demographic, clinical and psychosocial correlates of psychological distress in CHF patients.

METHODS

Cross-sectional data were obtained from a sample of a consecutive series of hospitalized CHF patients (n = 227) with measures of psychological distress, functional status, symptom status, social support and health perception. Objective clinical variables were obtained from the hospital records.

RESULTS

High levels of psychological distress, in particular, depression, were found in patients with CHF. In hierarchical regression analysis, poorer perceived emotional-informational support, higher levels of fatigue, poorer health perception and not living with family were identified as the significant correlates of psychological distress. These correlates, in total, explained 49% of the variance for the scores of psychological distress. None of the objective clinical variables demonstrated a significant contribution that accounted for psychological distress in CHF patients.

CONCLUSION

The findings highlight the importance of addressing social support for CHF patients. Assisting this vulnerable patient group to cope with fatigue and to cultivate a positive health perception are also highly prioritized treatment goals.

Health-related quality of life in elderly chinese patients with heart failure

Heart failure (HF) has a profound impact on patients' health-related quality of life (HRQL). Little is known about factors relating to HRQL in elderly Chinese HF patients. The objective of this cross-sectional correlational study was to identify the demographic, psychosocial, and clinical factors associated with HRQL in this group of patients. Cross-sectional data were obtained from a consecutive sample of hospitalized HF patients (n = 227) with measures of HRQL, psychological distress, perceived social support, and health perception. Functional status was measured with the New York Heart Association Classification (NYHA). In stepwise regression analysis, four variables, including psychological distress, health perception, NYHA classification, and educational level explained 51.8% (p =.01) of the variance in HRQL. These findings suggest that improving HRQL of HF patients entails improving their psychological status, functional status, and health perception.

Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services

BACKGROUND

Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment.

METHOD

A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham.

RESULTS

38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001).

CONCLUSIONS

Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services.

Self-reported health-related quality of life in persons with HIV infection: results from a multi-site interview project

BACKGROUND

To examine demographic and behavioral associations with self-reported health-related quality of life (HRQOL) among persons with HIV infection or AIDS.

METHODS

Analysis of interviews with persons > or = 18 years of age reported through routine disease surveillance with HIV infection or AIDS to nine state and local health departments from January 1995 through December 1996. Scales were constructed from validated measures of HRQOL, and mean scores were calculated (lower scores signified poorer HRQOL). Measures of HRQOL included Overall Health, Pain, Physical Functioning, Role Functioning, Social Functioning, Mental Health, Energy/Fatigue, and Cognitive Functioning. Differences in HRQOL were examined by various demographic and behavioral factors, including taking antiretroviral medication.

RESULTS

HRQOL data were available for 3778 persons. Factors associated with lower HRQOL scores included older age, female sex, black or Hispanic race/ethnicity, injection drug use, lower education and income, no private health insurance, and lower CD4 count. In multivariate analysis, lower CD4 count was the factor most consistently associated with lower HRQOL. Taking antiretroviral medication was not associated with differences in HRQOL regardless of CD4 count.

CONCLUSIONS

Perception of HRQOL varied in a population with HIV infection or AIDS. On most HRQOL measures, lower CD4 count was associated with lower HRQOL. Measurement of HRQOL can assist in understanding the long-term effects of disease and treatment on persons with HIV.