Impact of heart disease on quality of life Flashcards
Lecture objectives
- Define quality of life and its measurement in heart disease
- Describe the determinants of quality of life in heart disease
- Describe the relationship between depression and heart disease
What factors play into quality of life for patients
Mental health \+ Perceived health As well as physical function and social function to a lesser extent • Occupational functioning too
What are the measure types for QOL?
• Uni-dimensional (General Health Question)
• Multidimensional (Medical Outcomes Study, Seattle Angina Questionnaire etc)
– Generic
– Disease specific
Discuss physical functioning as an impact on QoL
• Positive impact on QoL if:
– Minimal/no physical symptoms
– Able to carry out usual physical activities – Healthy sexual relationships
• And VICE VERSA
Discuss psychological functioning as a determinant of QoL
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
RELATIONSHIPS
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
Discuss psychological distress following MI/CABG
• 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
Discuss psychological challenges of cardiac disease
- 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
What might cause a cardiac patient to become anxious ?
- CADdiagnosis
- 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
• 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
Discuss vicious cycle of anxiety post cardiac event
• 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
Discuss social functioning as a determinant of QoL
• “Good” social functioning has a positive effect on QOL
• Forexample:
– Good family/friend support and the ability to maintain and develop these relationships
– Having a meaningful role within society – Being able to take part in social activities
Discuss occupational functioning as a determinant of QoL
• 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
Improved QoL
Discuss perception of health status as a determinant of QoL
• 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
Discuss impact of illness behaviour
What is “Illness Behaviour”?:
• 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
Discuss depresso expresso and heart disease
- Low mood is a normal reaction to a heart problem / to a significant negative event
- It will usually pass and is not severe
- But some patients may have more persistent or severe reaction → depression
• Epidemiology:
– Estimated 15-45% affected after MI
– 41% higher health care costs than in non-depressed patients
• Predictive of:
– Poor mortality, social and functional outcomes
– Depression is the most common/significant feature of poor QOL
– Depression is a major risk factor for relapse in cardiac patients
What are symptoms of depression
Key symptoms:
• 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.
Associated symptoms: • disturbed sleep • 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
