Task Force III: Assessment of psychological status in patients with ischemic heart disease

Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure

BACKGROUND

Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person's point of view as its central focus.

AIM

The aim of this study was to describe patients' experiences of living with advanced heart failure.

METHODS

The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006.

RESULTS

Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence.

CONCLUSIONS

The findings suggest that there may be an illogical but enduring ethos of 'cure' pervading health care worker's attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis

OBJECTIVE

The purpose of this study was to describe the nature and intensity of anxiety felt by patients awaiting coronary artery bypass surgery.

DESIGN

A prospective, cross-sectional study design was used, with a qualitative interview and State Trait Anxiety Inventory.

SETTING

Study took place in 2 large tertiary referral hospitals in Northern Ireland.

PARTICIPANTS

Seventy patients were randomly selected within 4 weeks of their referral for cardiac surgery.

RESULTS

Participants in this study cited 5 main sources of anxiety: chest pain, uncertainty, fear of the operation, physical incapacity, and dissatisfaction with the care offered to them. The State Trait Anxiety Inventory scores of this sample were high at all stages of data collection. There was a statistically significant relationship (P<or=.01) between increasing angina and state and trait anxiety.

CONCLUSION

This study identifies the major sources of anxiety described by this sample. In doing so it may facilitate greater understanding of the needs of these patients and assist in the development of specific interventions to help alleviate this problem.

Comparison of intensive outpatient cardiac rehabilitation to standard outpatient care in veterans: effects on quality of life

BACKGROUND

Examination of the effect of cardiac rehabilitation (CR) on quality of life has been relatively limited. The current study examined existing clinical data, which had been obtained during the course of program evaluation. Changes in quality of life for patients who participated in an intensive rehabilitation program and those who had received standard outpatient care only were compared.

METHODS

Quality-of-life changes in cardiac patients (n = 87) from two treatment groups were compared. Patients had either participated in an 8-week intensive CR program (n = 45) consisting of monitored exercise 3 days weekly and inter-disciplinary education sessions, or routine outpatient clinic services (n = 42).

RESULTS

Patients in the intensive CR program demonstrated significant (P < 0.05-< 0.001) improvement in all areas of quality of life assessed. In contrast, patients that received routine outpatient care did not demonstrate any areas of improvement, while Vitality was significantly (P < 0.05) poorer at posttest.

CONCLUSIONS

Our results suggest that provision of more intensive outpatient CR can improve quality of life more than standard outpatient care.

Personality and appointment--keeping adherence in cardiac rehabilitation

PURPOSE

Literature reviews typically have concluded that personality factors are unrelated to adherence to treatment programs, including adherence to exercise prescribed in cardiac rehabilitation. This study constitutes a reconsideration of this conclusion. Using the California Psychological Inventory (CPI), a well-validated inventory of general personality tendencies, personality variables, and appointment-keeping in cardiac rehabilitation were examined.

METHODS

Forty-nine men entering a cardiac rehabilitation program completed the CPI. Exercise capacity was measured on entry into the 4-month phase II/III program and at completion. Adherence indicators were appointment-keeping and completion or non-completion of the program. General appointment-keeping and hospital admissions during the subsequent year were tracked.

RESULTS

Appointment-keeping accounted for 35% of the variance in posttreatment exercise capacity, controlling for pretreatment exercise capacity. Scores on the CPI scales that were significantly related to appointment-keeping were Well-Being (perception of physical/emotional health), Socialization (acceptance of rules and regulations), and Communality (view of self as similar to others). These correlations ranged from 0.49 to 0.38. Those who completed the program (n = 39) had higher scores than those who did not (n = 10) on nearly all of the CPI scales. The differences were significant on the Socialization and Good Impression scales (desire for others to have a favorable impression of oneself). The Socialization score was correlated with keeping appointments in the follow-up year.

CONCLUSION

Personality variables were associated with appointment-keeping adherence. The consistency of our results with those of other recent studies of personality and adherence is discussed, along with implications for cardiac rehabilitation.

Psychosocial factors: role in cardiac risk and treatment strategies

Recent epidemiologic research has identified several psychosocial factors that impact unfavorably on prognosis among patients with established coronary heart disease (CHD). Several biologic and behavioral characteristics have been identified in patients with these psychosocial risk factors that are biologically plausible mediators of their adverse impact on prognosis. Several small-scale clinical trials offer encouraging evidence that both behavioral and pharmacologic interventions have the potential to ameliorate the health-damaging effects of psychosocial risk factors in patients with CHD. In this article we review the evidence on these points and offer recommendations as to how incorporation of this new knowledge into clinical care of the patient with CHD can lead to reduced mortality and morbidity rates in this population.

Cardiovascular complaints following the uprising of December 1989 in Romania

The cardiovascular system may react to stress either by coronary events, such as angina pectoris or myocardial infarction, or by non-coronary responses, such as rises in blood pressure or non-specific circulatory disorders and chest pain. There is contradictory information about the cardiovascular reactions to war stress. The aim of this study was to investigate the effects of stress produced by the uprising of December 1989 in Romania on the cardiovascular system. Cases referred from 21 to 31 December 1989 to the emergency department of the largest university clinic of the Cluj district, and those admitted there, were analysed and compared with cases referred in the same periods in 1988, 1990 and 1991 and from 1 to 10 January 1990. There was a significant increase in non-coronary cardiovascular complaints referred for consultation in the first 10 days from the beginning of the uprising in Cluj and a non-significant increase in the following 10 days, but no increase in consultations for complaints of coronary origin due to unstable angina and acute myocardial infarction or changes in hospital admissions. In conclusion, the stress produced by the uprising in Romania was correlated with a higher incidence of non-coronary cardiovascular complaints but no alteration in coronary events (unstable angina, acute myocardial infarction), or in hospital admissions for cardiovascular complaints.