Impact of HD on quality of Life

Question 1

WHO definition of QOL

Answer 1

‘individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.’

Question 2

NICE of QOL

Answer 2

‘a combination of a person’s physical, mental and social wellbeing; not merely the absence of disease

Question 3

Why measure QOL

Answer 3

– Improvement in survival rates – Persistence of symptoms
– Cost-effectiveness
– Benefits of interventions

Question 4

QOL: Measure types

Answer 4

• Uni-dimensional
• Multidimensional
– Generic
– Disease specific

Question 5

• Uni-dimensional:

Answer 5

General Health Question

– mental wellbeing

Question 6

• Multidimensional Generic:

Answer 6

Medical Outcomes Study 36-Item Short Form Health Survey (8 dimensions)

Question 7

• Multidimensional disease specific:

Answer 7

Seattle Angina Questionnaire (SAQ) (5 dimensions)

Question 8

Determinants of QOL in Heart Disease

Answer 8

• Physical functioning
• Psychological functioning
• Social functioning
• Occupational functioning
• Perception of health status

Question 9

Physical Functioning

Answer 9

• Positive impact on QoL if:
– Minimal/no physical symptoms
– Able to carry out usual physical activities – Healthy sexual relationships
• And VICE VERSA
• But physical functioning not the only factor

Question 10

Psychological Functioning

Answer 10

Impacts on disease process
 May also impact on treatment concordance
 Patients subjected to prolonged stress; need coping strategies and psychological resilience
 Impacts on ability to retain and understand information
 Psychological distress is a predictor of hospitalisation
 Psychological distress → Poor quality of life

Question 11

Psychological Functioning and Relationships

Answer 11

 Psychological function important in building rapport
 Psychological distress can impede social support
 Psychological distress can impair personal relationships (including sexual)
 Psychological distress can create problems in relationships with health professionals

Question 12

Psychological Distress following MI/CABG

Answer 12

• Riskfactorfor:
– Early mortality
– Low return to work
– Difficulty making lifestyle changes
– Problems with concordance with medical care 
– Increased use of health services
– Post-traumatic Stress Disorder (PTSD)
– Readmission to hospital
→ poor Quality of Life

Question 13

Psychological Challenges of Cardiac Disease

Answer 13

• Fear/reduced life expectancy
• Anxiety
• Depression (most significant negative impact on QOL)
• Lossofcontrol
• Loss of independence/financial status
• Denial
• Anger
• Hopelessness
• Being treated differently by others
• Impact of making/failing to make desired lifestyle changes
• Sense of failure
• Potential impaired cognitive function impacting on memory and confidence

Question 14

What might cause a cardiac patient to become anxious?

Answer 14

• CAD diagnosis
• Fear of further event
• Being in hospital, treatment, health professionals
• Being away from partner, familiar surroundings
• Chest sensations
• Return to the situation of the MI-shock, panic, anxious
• Return to activities –work, marital strain, arguments

Question 15

Anxiety: negative determinant of QOL Symptoms of anxiety

Answer 15

• Key symptoms
– excessive anxiety and worry about a number of events or activities
– difficulty controlling the worrying
• Associated symptoms
– restlessness
– being easily fatigued
– difficulty concentrating
– irritability
– muscle tension
– disturbed sleep

Question 16

Vicious Cycle of Anxiety

Answer 16

• Worrying thoughts can produce adrenaline
• When no danger to run away from:
– Physical effects: dizziness, dry mouth, shortness of breath, heart racing, butterflies in stomach, hyperventilation
– Cognitive effects: racing thoughts, anxious thoughts, preoccupation with and catastrophizing about bodily sensations

Question 17

Social Functioning

Answer 17

• “Good” social functioning has a positive effect on QOL
• For example:
– Good family/friend support and the ability to maintain and develop these relationships

Question 18

Occupational Functioning

Answer 18

• Ability to return to work (links to self worth and self esteem)
• Returning to work and performing well
• Financial reward associated with work and stability
• Significant positions/roles outside of work

Question 19

Perception of Health Status

Answer 19

• Very variable: patients with the same pathophysiology will perceive their health differently
• Influenced by:
– an individual’s experience as a child, family relationships, occupational status, social support and wider community or culture
– previous experience of health services
– mental health and depression
– personal understanding of the illness
– denial

Question 20

Impact of “Illness Behaviour”

Answer 20

• Evaluating symptoms, seeking medical help to bring relief and seeking support from family
• Defines a social role with expectations for both the sick and the healer
• Can bring secondary gains through sick role
– increased sympathy and attention
– special favours
– being waited on
– no school/work/duties
• Can prolong illness behaviour and negatively impact on perception of health status and therefore on Quality of Life
• Patient perception cannot undertake normal activities

Question 21

Symptoms of Depression

Answer 21

• persistent sadness or low mood; and/or

• marked loss of interests or pleasure
At least one of these, most days, most of the time for at least 2 weeks.

Question 22

Symptoms of Depression

Answer 22

• disturbedsleep
• decreased or increased appetite and/or weight
• fatigue or loss of energy
• agitation or slowing of movements
• poor concentration or indecisiveness
• feelings of worthlessness or excessive or inappropriate guilt
• suicidal thoughts or acts

Question 23

Assessing Severity of Depression

Answer 23

• Subthreshold depressive symptoms: – Fewer than 5 symptoms
• Mild depression:
– Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment
• Moderate depression:
– Symptoms or functional impairment are between ‘mild’ and ‘severe”
• Severe depression:
– Most symptoms, and the symptoms markedly interfere with functioning

Question 24

Assessment tools OF DEPRESSION

Answer 24

• Different assessment tools available
• Including HADS:
– Hospital Anxiety and Depression Scale
– NOT a diagnostic tool
– Information self-reported
– Gives indication as to level of psychological distress

Question 25

Treating Depression following Cardiac Event

Answer 25

– Psychological therapy
– Lifestyle advise and self-help
– Maximising physical health / status – Drug treatments
– Specialist mental health services
• Importance of CARDIAC REHABILITATION