the impact of heart disease on quality of life Flashcards
what is quality of life?
a combination of a person physical, mental and social well being, not merely the absence of disease
what are the determinants of quality of life in heart disease?
what is the relationship between depression and heat disease?
- loss of self worth
- loss of confidence
- loss of independence
- persistent severe reaction to health problem = depression
what are 3 different ways to measure the health of individuals and populations?
- mortality rates
- morbidity rates
- measures of function
describe QOL as a concept?
it is a concept that aims to capture the well being, (wether a population or individual), regarding both positive and negative elements within the entirely of their existence at a specific point in time.
describe the bio physiological model of QOL?
biological = often associated with the relationship of disease and bodily health
social = interpersonal factors such as social interactions and community activities
psychological = the aspects of mental and emotional wellness that also relate to behaviour
QALYS?
It is a measure used in. health care and health economics to assess the value and effectiveness of different medical treatments and interventions.
- they are used to quantify the impact of a medical condition or treatment on a persons overall quality of life and life expectancy.
how does QALYs work?
- measured on a scale of 0 to 1
- 0= a state equivelant to death
1= perfect health - between them represents varying degrees of health degrees
- considers the amount of time a persons spends in a particular health state.
calculation for QALY?
quality of life x time
what are the different measure types for QOL?
uni-dimensional
multidimensional (generic or disease specific)
uni dimensional?
general health question
- mental wellbeing
multideminsional generic?
medical outcomes study 36 item short survey.
eg - in general, how would you say your health is?
compared to one year ago, how would you are your health now?
multidimensional disease specific ?
Seattle angina questionare (5 dimensions)
what are the 5 determinants of QOL in heart disease?
1- physical functioning
2- physiological functioning
3- social functioning
4- occupational functioning
5- perception of health status
what 2 diseases have the greatest impact on QOL?
cardiac and gastrointestinal disease
physical functioning
positive impact if:
- minimal/no physical symptoms
- able to carry out usual physical activities
- healthy sexual relationships
psychological functioning
-impacts on disease processes
- may also impact treatment concordance
- patients subject to long period of stress, coping strategies
- impacts on the ability to retain and understand information
- psychological stress is a predictor of hispitilsation
- physiological stress = poor QOL
what is the relationship between psychological functioning and relationships?
- psychological functioning is important in building a rapport
- psychological distress can impede social support
- psychological distress can impair personal relationships
- it can create problems with relationships with health professionals
what is the psychological distress following MI/CABG a risk factor for?
- early mortality
- low return to work
- difficulty making lifestyle changes
- problems with concordance in medical care
- increased use of health services
- PTSD
- readmission to hosp
what things might cause a cardiac patient to become anxious?
- being away from partner
- fear of further event
- chest sensations
- returning to activities
- being in hospital
first stage of psychological challenges of cardiac disease?
- fear
- anxiety
- depression
- loss of control
- loss of independence
- denial
second stage of psychological challenges of cardiac disease?
- anger
- hopelessness
- sense of failure
- potential impaired cognitive function impacting on memory and confidence
what are key symptoms of anxiety?
- excessive anxiety and worrying
- difficulty controlling the worrying
what are associated symptoms of anxiety ?
- restlessness
- being easily fatigued
- irritability
- muscle tension
- difficulty concentrating
- disrupted sleep
describe how there is a viscous cycle of anxiety post cardiac event?
- worrying thoughts can produce adrenaline
- when there is no danger to run away from:
physical effects = dizziness, dry mouth, shortness of breathe, heart racing, butterflies In stomach, hyperventilation
cognitive effects = racing thoughts, anxious thoughts, preoccupation with catastrophising about bodily sensations.
social functioning?
this has a positive effect on QOL
- goof friends and family support
- meaningful role in society
occupational functioning?
- ability to return to work
- rerunning to work and performing well
- financial reward
- significant positions and roles outside of work
= improved QOL
perception of health status
very variable = patients with the same pathophysiology will perceive their health differently
what is perception of health influenced by?
- individual experience as a child, family relationships, occupational status
- previous experience of health services
-mental health and depression - personal understanding of the illness
- denial
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
describe the impact of illness behaviour?
- it can bring about secondary gains through sick role (increased sympathy and attention, special favours)
- can prolong illness behaviour and negatively impact on perception of health status and therefore on QOL
- patient perception cannot undertake normal activities
epidemiology of depression and heart disease?
- estimated 15-45% affected after MI
- 41% higher health care costs than in non depression patients
- poor mortality and social/functional outcomes
- depression is the most common feature of QOL
- major risk factor for relapse
key symptoms of depression?
- persistent sadness or low mood
- marked loss of interest or pleasure
what are sub threshold depression symptoms?
symptoms of mild depression?
few if any symptoms in excess of the 5 required to make a diagnosis, and symptoms will result in only minor functional impairment
symptoms of moderate depression?
symptoms or functional impairment are between mild and severe
symptoms of severe depression?
most symptoms, and they will markedly interfere with functioning
what is HADS assessment tool for depression?
- hospital anxiety and depression scale
- not a diagnostic tool
- informed self report
- gives an indication as to a level of psychological distress
how do you treat depression following a cardiac event?
there will be a likely combination of interventions that will depend on the severity, consider:
- psychological therapy
- lifestyle advise and self help
- maximising physical health/status
- drug treatments
- specialist mental health services
CARDAIC REHABILITATION
describe the impact of cardiac rehabilitation?
positive impact on psychological health/adjustment of QOL
what are the reduced rates after cardiac rehabilitation?
- 20% reduction in all cause mortality
- 27% reduction in cardiac mortality
- reduced health care costs
what are the positive effects following a cardiac event that is aided by cardiac rehabilitation?
- relationships improve
- low anxiety
- motivated to change
- high internal locus of control
- sex life improves
what are the challenges to using QALYs?
- been critiques on technical and ethical grounds
- a salient problem relies on the numerical nature of its constituent parts
- the appropriateness of the arithmetical operation is compromised by the essence of the utility scale: while life years are expressed as 0 means good and the interval scale where 0 is an arbitrary value for death.
- you are assigning a numerical value to a persons quality of life and making difficult decisions about resources allocation in health care.
