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MD3001 > the impact of heart disease on quality of life > Flashcards

the impact of heart disease on quality of life Flashcards

1
Q

what is quality of life?

A

a combination of a person physical, mental and social well being, not merely the absence of disease

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2
Q

what are the determinants of quality of life in heart disease?

A
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3
Q

what is the relationship between depression and heat disease?

A
  • loss of self worth
  • loss of confidence
  • loss of independence
  • persistent severe reaction to health problem = depression
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4
Q

what are 3 different ways to measure the health of individuals and populations?

A
  • mortality rates
  • morbidity rates
  • measures of function
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5
Q

describe QOL as a concept?

A

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.

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6
Q

describe the bio physiological model of QOL?

A

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

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7
Q

QALYS?

A

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.

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8
Q

how does QALYs work?

A
  • 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.
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9
Q

calculation for QALY?

A

quality of life x time

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10
Q

what are the different measure types for QOL?

A

uni-dimensional
multidimensional (generic or disease specific)

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11
Q

uni dimensional?

A

general health question
- mental wellbeing

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12
Q

multideminsional generic?

A

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?

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13
Q

multidimensional disease specific ?

A

Seattle angina questionare (5 dimensions)

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14
Q

what are the 5 determinants of QOL in heart disease?

A

1- physical functioning
2- physiological functioning
3- social functioning
4- occupational functioning
5- perception of health status

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15
Q

what 2 diseases have the greatest impact on QOL?

A

cardiac and gastrointestinal disease

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16
Q

physical functioning

A

positive impact if:
- minimal/no physical symptoms
- able to carry out usual physical activities
- healthy sexual relationships

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17
Q

psychological functioning

A

-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

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18
Q

what is the relationship between psychological functioning and relationships?

A
  • 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
19
Q

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

A
  • 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
20
Q

what things might cause a cardiac patient to become anxious?

A
  • being away from partner
  • fear of further event
  • chest sensations
  • returning to activities
  • being in hospital
21
Q

first stage of psychological challenges of cardiac disease?

A
  • fear
  • anxiety
  • depression
  • loss of control
  • loss of independence
  • denial
22
Q

second stage of psychological challenges of cardiac disease?

A
  • anger
  • hopelessness
  • sense of failure
  • potential impaired cognitive function impacting on memory and confidence
23
Q

what are key symptoms of anxiety?

A
  • excessive anxiety and worrying
  • difficulty controlling the worrying
24
Q

what are associated symptoms of anxiety ?

A
  • restlessness
  • being easily fatigued
  • irritability
  • muscle tension
  • difficulty concentrating
  • disrupted sleep
25
Q

describe how there is a viscous cycle of anxiety post cardiac event?

A
  • 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.

26
Q

social functioning?

A

this has a positive effect on QOL
- goof friends and family support
- meaningful role in society

27
Q

occupational functioning?

A
  • ability to return to work
  • rerunning to work and performing well
  • financial reward
  • significant positions and roles outside of work
    = improved QOL
28
Q

perception of health status

A

very variable = patients with the same pathophysiology will perceive their health differently

29
Q

what is perception of health influenced by?

A
  • individual experience as a child, family relationships, occupational status
  • previous experience of health services
    -mental health and depression
  • personal understanding of the illness
  • denial
30
Q

what is illness behaviour?

A

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

31
Q

describe the impact of illness behaviour?

A
  • 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
32
Q

epidemiology of depression and heart disease?

A
  • 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
33
Q

key symptoms of depression?

A
  • persistent sadness or low mood
  • marked loss of interest or pleasure
34
Q

what are sub threshold depression symptoms?

A
35
Q

symptoms of mild depression?

A

few if any symptoms in excess of the 5 required to make a diagnosis, and symptoms will result in only minor functional impairment

36
Q

symptoms of moderate depression?

A

symptoms or functional impairment are between mild and severe

37
Q

symptoms of severe depression?

A

most symptoms, and they will markedly interfere with functioning

38
Q

what is HADS assessment tool for depression?

A
  • hospital anxiety and depression scale
  • not a diagnostic tool
  • informed self report
  • gives an indication as to a level of psychological distress
39
Q

how do you treat depression following a cardiac event?

A

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

40
Q

describe the impact of cardiac rehabilitation?

A

positive impact on psychological health/adjustment of QOL

41
Q

what are the reduced rates after cardiac rehabilitation?

A
  • 20% reduction in all cause mortality
  • 27% reduction in cardiac mortality
  • reduced health care costs
42
Q

what are the positive effects following a cardiac event that is aided by cardiac rehabilitation?

A
  • relationships improve
  • low anxiety
  • motivated to change
  • high internal locus of control
  • sex life improves
43
Q

what are the challenges to using QALYs?

A
  • 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.

MD3001 (56 decks)

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