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MD3001 > Impact of Heart Disease on Quality of Life > Flashcards

Impact of Heart Disease on Quality of Life Flashcards

1
Q

What are some ways in which health status can be measured ?

A

– 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

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2
Q

Why is quality of life a good measurment of health status ?

A

Because it takes into consideration all the aspects of health, namely:

  • Physical function
  • Mental health
  • Social function
  • Perceived health
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3
Q

Define QOL.

A

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

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4
Q

Why do we need to measure QOL ?

A 
To measure: 
– Improvement in survival rates 
– Persistence of symptoms
– Cost-effectiveness
– Benefits of interventions
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5
Q

What are the different types of measurements of QOL ?

A

• Uni-dimensional

• Multidimensional
– Generic
– Disease specific

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6
Q

Give an example of unidimensional measurement of QOL.

A

General health questionnaire, aims to identify minor psychiatric disorders in the general population

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7
Q

Give an example of multidimensional generic measurement of QOL. How is it multidimensional ?

A

Medical Outcomes Study 36-Item Short Form Health Survey

It looks at 8 aspects of QOL.

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8
Q

Give an example of multidimensional specific measurement of QOL

A

Seattle Angina Questionnaire (5 aspects but specific to angina)

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9
Q

What are the determinants of QOL in Heart Disease ?

A
  • Physical functioning
  • Psychological functioning
  • Social functioning
  • Occupational functioning
  • Perception of health status
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10
Q

True or False: Cardiac and gastrointestinal disease have the greatest impact on Quality of Life compared to other chronic disease.

A

True

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11
Q

How does physical functioning affect QOL in CV disease ?

A

• Positive impact on QoL if:
– Minimal/no physical symptoms
– Able to carry out usual physical activities
– Healthy sexual relationships

Vice Versa

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12
Q

How does psychological functioning affect QOL in CV disease ?

A
  • 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
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13
Q

What is psychological distress following CABG/MI a risk factor for ?

A 
– 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
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14
Q

What are general psychological challenges associated with cardiac disease ?

A
  • 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
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15
Q

What might cause a cardiac patient to become anxious?

A
  • 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
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16
Q

What are key symptoms, and associated symptoms of anxiety ?

A

• 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
17
Q

Describe the vicious cycle of anxiety post-cardiac event.

A

• 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

18
Q

What are aspects of social functioning which lead to improved QOL ?

A

– 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

19
Q

What are aspects of occupational functioning which lead to improved QOL ?

A
  • 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
20
Q

What is the perception of health status influenced by ?

A 
– 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
21
Q

Define illness behavior.

A

“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.

22
Q

Give examples of illness behaviours.

A
  • 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

23
Q

Identify significant losses associated with cardiac disease.

A
  • 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!

24
Q

What percentage of post-MI patients are depressed ?

A

15-45%

25
Q

What is post-cardiac event depression predictive of ?

A

– Poor mortality, social and functional outcomes (hence poor QOL)
– relapse

26
Q

What are symptoms of depression ?

A

• 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.

27
Q

What are the associated symptoms of depression ?

A
  • 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
28
Q

How can we assess the severity of depression ?

A

• 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

29
Q

Give an example of an assessment tool for depression in hospitals.

A

HADS (Hospital Anxiety and Depression Scale)
– NOT a diagnostic tool
– Information self-reported
– Gives indication as to level of psychological distress

30
Q

How may we treat depression following a cardiac event ?

A

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

31
Q

Describe the important of cardiac rehabilitation for QOL.

A
  • Positive impact on psychological health / adjustment and QoL
  • Reduces mortality (both all-cause and cardiac mortality)
  • Reduces healthcare hosts
32
Q

What are examples of positive psychological adjustments which can be made following a cardiac event (which cardiac rehab can help with) ?

A
  • Relationships improve
  • Low anxiety
  • Motivated to change
  • High internal locus of control
  • Sex life improves

MD3001 (75 decks)

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