Impact of Heart Disease on Quality of Life Flashcards
What are some ways in which health status can be measured ?
– Mortality rates
– Morbidity rates (i.e. frequency or proportion with which a disease appears in a population)
– Measures of functioning (e.g. Activities of Daily Living i.e. daily self care activities)
– Quality of life
Why is quality of life a good measurment of health status ?
Because it takes into consideration all the aspects of health, namely:
- Physical function
- Mental health
- Social function
- Perceived health
Define QOL.
‘a combination of a person’s physical, mental and social wellbeing; not merely the absence of disease
Why do we need to measure QOL ?
To measure: – Improvement in survival rates – Persistence of symptoms – Cost-effectiveness – Benefits of interventions
What are the different types of measurements of QOL ?
• Uni-dimensional
• Multidimensional
– Generic
– Disease specific
Give an example of unidimensional measurement of QOL.
General health questionnaire, aims to identify minor psychiatric disorders in the general population
Give an example of multidimensional generic measurement of QOL. How is it multidimensional ?
Medical Outcomes Study 36-Item Short Form Health Survey
It looks at 8 aspects of QOL.
Give an example of multidimensional specific measurement of QOL
Seattle Angina Questionnaire (5 aspects but specific to angina)
What are the determinants of QOL in Heart Disease ?
- Physical functioning
- Psychological functioning
- Social functioning
- Occupational functioning
- Perception of health status
True or False: Cardiac and gastrointestinal disease have the greatest impact on Quality of Life compared to other chronic disease.
True
How does physical functioning affect QOL in CV disease ?
• Positive impact on QoL if:
– Minimal/no physical symptoms
– Able to carry out usual physical activities
– Healthy sexual relationships
Vice Versa
How does psychological functioning affect QOL in CV disease ?
- Impacts on disease process
- Impacts on treatment concordance
- Impacts on ability to retain and understand information
- Patients subjected to prolonged stress; need coping strategies and psychological resilience
- Psychological distress is a predictor of hospitalisation
- Psychological function important in building rapport (so psychological distress can impede social support, impair personal relationships (including sexual), and can create problems in relationships with health professionals)
- Overall, psychological distress → Poor quality of life
What is psychological distress following CABG/MI a risk factor for ?
– 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
What are general psychological challenges associated with cardiac disease ?
- Fear/reduced life expectancy
- Anxiety
- Depression (most significant negative impact on QOL)
- Loss of control
- 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?
- 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
What are key symptoms, and associated symptoms of anxiety ?
• 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
Describe the vicious cycle of anxiety post-cardiac event.
• Worrying thoughts can produce adrenaline, even 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
What are aspects of social functioning which lead to improved QOL ?
– 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
What are aspects of occupational functioning which lead to improved 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
What is the perception of health status 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
Define illness behavior.
“Manner in which individuals monitor their bodies, define and interpret their symptoms, take remedial action, and utilize sources of help as well as the more formal health care system.” Defines a social role with expectations for both the sick and the healer.
Give examples of illness behaviours.
- Evaluating symptoms
- Seeking medical help to bring relief
- Seeking support from family
• 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
Identify significant losses associated with cardiac disease.
- Loss of health
- Loss of self-confidence
- Loss of independence, relationships
- Loss of self-worth
They are often related to cardiac misconceptions and to own perceptions!
What percentage of post-MI patients are depressed ?
15-45%
What is post-cardiac event depression predictive of ?
– Poor mortality, social and functional outcomes (hence poor QOL)
– relapse
What are symptoms of depression ?
• 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.
What are the associated symptoms of depression ?
- 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
How can we assess the severity of depression ?
• 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
Give an example of an assessment tool for depression in hospitals.
HADS (Hospital Anxiety and Depression Scale)
– NOT a diagnostic tool
– Information self-reported
– Gives indication as to level of psychological distress
How may we treat depression following a cardiac event ?
Combination of interventions and dependent on severity:
– Psychological therapy
– Lifestyle advise and self-help
– Maximising physical health / status (e.g. cardiac rehab)
– Drug treatments
– Specialist mental health services
Describe the important of cardiac rehabilitation for QOL.
- Positive impact on psychological health / adjustment and QoL
- Reduces mortality (both all-cause and cardiac mortality)
- Reduces healthcare hosts
What are examples of positive psychological adjustments which can be made following a cardiac event (which cardiac rehab can help with) ?
- Relationships improve
- Low anxiety
- Motivated to change
- High internal locus of control
- Sex life improves
