Perceived coping, social support, and quality of life 1 month after myocardial infarction: a comparison between Swedish women and men

Health-related quality of life in elderly cardiac patients undergoing cardiac rehabilitation and the association with exercise capacity: the EU-CaRE study

AIMS

The ability to be physically active is pivotal to the quality of life in elderly patients. This study aims to describe the association between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression following an exercise-based cardiac rehabilitation (CR) programme in elderly cardiac patients.

METHODS AND RESULTS

Patients aged ≥65 years with acute and chronic coronary syndrome or heart valve surgery were consecutively included from eight CR centres in seven European countries. Exercise capacity [VO2peak(mL/kg/min)] was assessed with a cardiopulmonary exercise test (97%) or a 6-min walk test. Outcome variables included HRQoL [36-item Short-Form Health Survey physical and mental component scores (PCS and MCS)], anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9). Mixed models were used to address the association between baseline and the development in VO2peak, and outcome variables stratified on sex, and adjusted for baseline values, age, and CR centre. A total of 1633 patients were included (T0), 1523 (93%) completed end-of-CR assessment (T1), and 1457 (89%) were available for 1-year follow-up (T2). Women had higher percentage of predicted VO2peak but poorer scores in HRQoL, anxiety, and depression at all time points. All scores improved in both sexes at follow-up. We found significant associations between VO2peak at baseline as well as development in VO2peak and all outcome variables at T1 and T2 in men (all P < 0.001). In women, VO2peak was only associated with PCSs (P < 0.001).

CONCLUSION

Improvements in exercise capacity were strongly associated with improvements in HRQoL and mental health, however, with stronger associations in men. The results highlight the importance of physical fitness for HRQol and mental health. The findings from this study might be useful to better target individual CR programmes.

How gender-specific are predictors of post-MI HRQoL? A longitudinal study

Purpose

Extant research shows that health-related quality of life (HRQoL) differs between female and male survivors of myocardial infarction (MI), but the reasons for this are not fully understood. We aimed to examine the predictors of HRQoL in female and male survivors during the first year after MI.

Methods

At timepoints 1 and 2, the sample comprised 222 MI survivors (59 women and 163 men; mean age 53.84 years, range 24–65) referred for in-patient cardiac rehabilitation. This number dropped to 140 participants (42 women and 98 men) at the third timepoint, approximately one year after the MI. We examined the gender differences in various predictors of physical and mental HRQoL: demographic factors (e.g., age, education, marital status), disease-related factors (pre- and post-MI), personality and coping with stress.

Results

Initially, both physical and mental HRQoL were lower in women than men, but the differences disappeared at timepoint 3. Stepwise regressions performed separately for men and women revealed that the factors shaping HRQoL were different in both genders; they also changed over time. Substantially fewer factors predicted physical HRQoL in women than in men. Trait anxiety seems to play a similarly negative role in both genders.

Conclusions

The psychosocial resources that influence HRQoL were different for women and men. There were also differences concerning predictors of HRQoL dimensions. Further studies with a different or broader range of predictors are needed, especially among women.

Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study

PURPOSE

The aim of the present study was to investigate relationships between sense of coherence, emotion-focused coping, problem-focused coping, coping efficiency, and mental quality of life (QoL) in patients with chronic illness. A model based on Lazarus' and Folkman's stress and coping theory tested the specific hypothesis: Sense of coherence has a direct and indirect effect on mental QoL mediated by emotion-focused coping, problem-focused coping, and coping efficiency in serial adjusted for age, gender, educational level, comorbidity, and economic status.

METHODS

The study used a cross-sectional and correlational design. Patients (n = 292) with chronic diseases (chronic heart failure, end-stage renal disease, multiple sclerosis, stroke, and Parkinson) completed three questionnaires and provided background data. Data were collected in 2012, and a serial multiple mediator model was tested using PROCESS macro for SPSS.

RESULTS

The test of the conceptual model confirmed the hypothesis. There was a significant direct and indirect effect of sense of coherence on mental QoL through the three mediators. The model explained 39% of the variance in mental QoL.

CONCLUSIONS

Self-perceived effective coping strategies are the most important mediating factors between sense of coherence and QoL in patients with chronic illness, which supports Lazarus' and Folkman's stress and coping theory.

Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients

BACKGROUND

The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.

METHODS

A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 111 persons were randomly assigned to either a CBT ( n=56) or a treatment as usual (TAU) group ( n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).

RESULTS

At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group -0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group -0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence ( z=2.07, P=0.04).

CONCLUSIONS

A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients.

Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT)

While divorced or living alone, patients with stable cardiovascular disease are at increased risk for adverse cardiovascular events. The importance of marital status following a myocardial infarction (MI) is less clear. We hypothesized that marital status may affect cardiovascular outcomes following MI. We analyzed outcomes among patients with MI who underwent percutaneous coronary intervention from the Canadian Observational Antiplatelet Study (COAPT). Marital status was categorized into 3 groups: married/common-law patients living together; never married; and divorced, separated, or widowed patients. Patients were followed for 15 months and our primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of mortality, repeat acute MI, stroke, or urgent coronary revascularization. Multivariable logistic regression models were performed, with married/common-law patients living together considered the reference group. Among 2100 patients included in analyses, 1519 (72.3%) were married/common-law patients living together, 358 (17.1%) were separated/divorced/widowed, and 223 (10.6%) patients were never married. Dual antiplatelet therapy use after 15 months was similar across groups (75.4%, 77.8%, and 73.6%, respectively). The risk of MACE after 15 months was similar among married patients living together (12.7%; referent) compared with patients who were never married (13.9%; adjusted odds ratio: 1.09, 95% confidence interval: 0.58-2.07, P = 0.79) and patients separated/divorced/widowed (14.3%; adjusted odds ratio: 0.71, 95% confidence interval: 0.40-1.25, P = 0.23). Similarly, the risk of individual endpoints, including mortality, was similar across the 3 groups. Among patients stabilized following an MI, we found no association between marital status and 15-month outcomes.

A comparative correlational study of coping strategies and quality of life in patients with chronic heart failure and the general Swedish population

AIM

The aim was to compare coping strategies and quality of life (QoL) in patients with chronic heart failure (CHF) with such strategies and QOL in persons from two general Swedish populations and to investigate relationships between personal characteristics and coping strategies.

DESIGN

A cross-sectional, comparative and correlational design was used to examine data from three sources.

METHODS

The patient group (n = 124), defined using ICD-10, was selected consecutively from two hospitals in central Sweden. The population group (n = 515) consisted of persons drawn randomly from the Swedish population. Data were collected with questionnaires in 2011; regarding QoL, Swedish population reference data from 1994 were used.

RESULTS

Overall, women used more coping strategies than men did. Compared with the general population data from SF-36, patients with CHF rated lower QoL. In the regression models, perceived low "efficiency in managing psychological aspects of daily life" increased use of coping. Other personal characteristics related to increased use of coping strategies were higher education, lower age and unsatisfactory economic situation.

Correlates of health-related quality of life in patients with myocardial infarction: A literature review

BACKGROUND

By the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population.

OBJECTIVES

This study aimed to identify correlates of HRQoL in patients with MI.

DESIGN

A literature review of the factors that affect HRQoL in patients with MI (1995-2016).

DATA SOURCES

Three main databases-CINAHL, MEDLINE and PsychINFO-were searched to retrieve relevant peer-reviewed articles published in English.

REVIEW METHODS

In consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories.

RESULTS

A total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors.

CONCLUSIONS

Identifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI.

Sex-specific effects of stress on metabolic and cardiovascular disease: are women at higher risk?

Cardiovascular disease (CVD) has traditionally been viewed as a male disease; however, the relative risk for obesity and hypertension morbidity and mortality, major risk factors for CVD, is higher for women in the United States. Emerging epidemiological data strongly support stressful experiences as a modifiable risk factor for obesity, insulin resistance, and heart disease in women at all ages. Therefore, primary prevention of these diseases may be associated with both identifying and increasing the knowledge regarding the sex differences in emotional functioning associated with physiological responses to stress. The purpose of this review is to highlight the growing body of clinical and experimental studies showing that stress, obesity-associated metabolic disturbances, and CVD comorbidities are more prevalent in females. Overall, this review reveals the need for investigations to decipher the early origins of these comorbidities. Targeting the sources of behavioral/emotional stress through the trajectory of life has the potential to reduce the alarming projected rates for chronic disease in women.

Interventions that improve health-related quality of life in patients with myocardial infarction

PURPOSE

Patients with myocardial infarction (MI) often report lower health-related quality of life (HRQoL) than those without MI. Interventions can affect HRQoL of these patients. The purpose of this review was to identify effective strategies for improving HRQoL among individuals with MI.

METHODS

Three electronic databases were searched and limited to articles peer-reviewed and published in English between 1995 and 2015. We screened titles and abstracts of the retrieved articles for studies that examined effectiveness of interventions to improve HRQoL in patients with MI.

RESULTS

Twenty-three studies were found that examined the effects of behavioural interventions-cardiac rehabilitation programmes (CRP), education and counselling programmes, and other psychological and cognitive interventions-to improve HRQoL in patients with MI. The studies included were mainly randomised controlled trials (14 studies) with a wide age range of participants (18-80 years) and a mean age group of 50-70 years. CRPs, including home- and hospital-based CRPs, regular weekly aerobic training programmes, and group counselling mostly resulted in improvement of HRQoL in patients with MI.

CONCLUSION

Most CRPs and other interventions were beneficial to MI patients. Therefore, patients with MI should be encouraged to participate in programmes that can help promote their HRQoL.

Biopsychosocial predictors of coping strategies of patients postmyocardial infarction

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.

Type D Personality and Coronary Plaque Vulnerability in Patients With Coronary Artery Disease: An Optical Coherence Tomography Study

OBJECTIVE

To investigate the association between Type D personality and higher incidence of major adverse cardiac events, we used in vivo optical coherence tomography (OCT) to evaluate the association between Type D with coronary plaque characteristics.

METHODS

A total of 109 patients who had culprit coronary plaque (s) were included in the study. The Type D construct was analyzed using both the categorized and the continuous approaches. Plaque vulnerability of culprit lesions was measured by OCT.

RESULTS

After adjusting for demographic and clinical factors, multivariate analysis demonstrated that Type D was associated with lipid plaque (odds ratio [OR] = 4.87, 95% confidence interval [CI] = 1.41-11.14, p = .025), thin cap fibroatheroma (OR = 3.84, 95% CI = 1.36-10.85, p = .011), and fibrous cap thickness (β = -1.43, standard error = 0.04, p = .001) analyzed by categorical approach. When analyzing Type D as continuous variable, the negative affectivity component was significantly related to plaque vulnerability, including lipid plaque (OR = 3.43, 95% CI = 1.23-9.52, p = .018), thin cap fibroatheroma (OR = 2.20, 95% CI = 1.10-4.40, p = .026), and fibrous cap thickness (β = -0.05, standard error = 0.02, p = .030), whereas no associations between the negative affectivity by social inhibition interaction term with OCT indices were found.

CONCLUSIONS

The results suggest that plaque characteristics in Type D have more features of plaque vulnerability. The negative affectivity component seems to drive the associations between Type D and vulnerable plaques. These findings provide new insights into the mechanism involved in the association between Type D and major adverse cardiac event.

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

OBJECTIVES

To evaluate the effectiveness of interventions used to support self-management, and to explore patients' experiences after acute coronary syndrome in relation to self-management.

DESIGN

Scoping review.

DATA SOURCES

Keyword search of CINAHL Plus, Medline, the Cochrane Library, and PsycINFO databases for studies conducted with adult population and published in English between 1993 and 2014.

REVIEW METHODS

From title and abstract review, duplicated articles and obviously irrelevant studies were removed. The full texts of the remaining articles were assessed against the selection criteria. Studies were included if they were original research on: (1) effectiveness of self-management interventions among individuals following acute coronary syndrome; or (2) patients' experience of self-managing recovery from acute coronary syndrome.

RESULTS

44 articles (19 quantitative and 25 qualitative) were included. Most studies were conducted in western countries and quantitative studies were UK centric. Self-management interventions tended to be complex and include several components, including education and counselling, goal setting and problem solving skills which were mainly professional-led rather than patient-led. The review demonstrated variation in the effectiveness of self-management interventions in main outcomes assessed - anxiety and depression, quality of life and health behavioural outcomes. For most participants in the qualitative studies, acute coronary syndrome was unexpected and the recovery trajectory was a complex process. Experiences of making adjustment and adopting lifestyle changes following acute coronary syndrome were influenced by subjective life experiences and individual, sociocultural and environmental contexts. Participants' misunderstandings, misconceptions and confusion about disease processes and management were another influential factor. They emphasised a need for ongoing input and continued support from health professionals in their self-management of rehabilitation and recovery, particularly during the initial recovery period following hospital discharge.

CONCLUSIONS

Evidence of the effectiveness of self-management interventions among people with acute coronary syndrome remains inconclusive. Findings from the patients' experiences in relation to self-management following acute coronary syndrome provided important insights into what problems patients might have encountered during self-managing recovery and what support they might need, which can be used to inform the development of self-management interventions. Theoretical or conceptual frameworks have been minimally employed in these studies and should be incorporated in future development and evaluation of self-management interventions as a way of ensuring clarity and consistency related to how interventions are conceptualised, operationalised and empirically studied. Further research is needed to evaluate self-management interventions among people following acute coronary syndrome for sustained effect and within different health care contexts.

Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis

AIMS

We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease, given that aggressive symptom control is a cornerstone of care in those with known coronary disease.

METHODS AND RESULTS

A total of 3501 acute myocardial infarction patients (2349 women) aged 18-55 years were enrolled from 103 US/24 Spanish hospitals (2008-2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic (Short Form-12, EuroQoL) and disease-specific (Seattle Angina Questionnaire) measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men (Short Form-12 physical health = 43 ± 12 vs. 46 ± 11 and mental health = 44 ± 13 vs. 48 ± 11); EuroQoL utility index = 0.7 ± 0.2 vs. 0.8 ± 0.2 and visual analog scale = 63 ± 22 vs. 67 ± 20, P < 0.0001 for all. Their disease-specific health status was also worse, with more angina (Seattle Angina Questionnaire angina frequency = 83 ± 22 vs. 87 ± 18), worse physical function (physical limitation = 78 ± 27 vs. 87 ± 21) and poorer quality of life (55 ± 25 vs. 60 ± 22, P<0.0001 for all). In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior coronary artery disease was not significant in any of the health status outcomes.

CONCLUSION

Young women have worse pre-event health status as compared with men, regardless of their coronary artery disease history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for acute myocardial infarction.

Health-related quality of life in premature acute coronary syndrome: does patient sex or gender really matter?

Background

Limited data exist as to the relative contribution of sex and gender on health‐related quality of life (HRQL) among patients with acute coronary syndrome (ACS). This study aims to evaluate the effect of sex and gender‐related variables on long‐term HRQL among young adults with ACS.

Methods and Results

GENESIS‐PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond‐Premature Acute Coronary SYndrome) is a multicenter, prospective cohort study (January 2009 to August 2013) of adults aged 18 to 55 years, hospitalized with ACS. HRQL was measured at baseline, 1, 6, and 12 months using the Short Form‐12 and Seattle Angina Questionnaire (SAQ) among 1213 patients. Median age was 49 years. Women reported worse HRQL than men over time post‐ACS, both in terms of physical and mental functioning. Gender‐related factors were more likely to be predictors of HRQL than sex. Femininity score, social support, and housework responsibility were the most common gender‐related predictors of HRQL at 12 months. We observed an interaction between female sex and social support (β=0.44 [95% confidence interval, 0.01, 0.88]; P=0.047) for the physical limitation subscale of the SAQ.

Conclusions

Young women with ACS report significantly poorer HRQL than young men. Gender appears to be more important than sex in predicting long‐term HRQL post‐ACS. Specific gender‐related factors, such as social support, may be amenable to interventions and could improve the HRQL of patients with premature ACS.

A study of two generic health-related quality of life questionnaires--Nottingham Health Profile and Short-Form 36 Health Survey--and of coping in patients with sensory hyperreactivity

BACKGROUND

Sensory hyperreactivity (SHR) is one explanation for airway symptoms induced by chemicals and scents. Little is known about health-related quality of life (HRQOL) and coping, in this group of patients. A study was done in patients with SHR to (1) compare the Nottingham Health Profile (NHP) and the Short-Form 36 Health Survey (SF-36) in regard to their suitability, validity, reliability, and acceptability; (2) evaluate how the patients cope with the illness; (3) assess whether there are differences between women and men with respect to HRQOL and coping; and (4) assess whether there are differences between patients and normative data with respect to HRQOL and coping.

METHODS

A total of 115 patients (91 women) with SHR were asked to answer five questionnaires: a study-specific questionnaire, the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), the NHP, the SF-36, and the Jalowiec Coping Scale-60.

RESULTS

Eighty-three patients (72%; 70 women) completed all questionnaires. The SF-36 scores were less skewed and more homogeneously distributed and showed fewer floor and ceiling effects than the NHP scores. The SF-36 was also discriminated better between patients with high and low CSS-SHR scores. The reliability standard for both questionnaires was satisfactory. There were no gender differences in HRQOL. Patients with SHR had significantly lower HRQOL scores than the normative data in comparable domains of the NHP and the SF-36: emotional reactions/mental health, energy/vitality, physical mobility/functioning, and pain/bodily pain. In social isolation/functioning, the results were different; the NHP scores were similar to the normative data and the SF-36 scores were lower. The most commonly used coping styles were optimistic, self-reliant, and confrontational. Women used optimistic coping more than men. Compared with the normative group, patients with SHR used confrontational and optimistic coping more and emotive coping less.

CONCLUSIONS

The current findings showed that both the NHP and the SF-36 were reliable instruments; but the results suggest that the SF-36 is a more sensitive instrument than the NHP for elucidating HRQOL in patients with SHR. Patients with SHR experienced a poor HRQOL and they followed the Western tradition of preferring problem-focused coping strategies to palliative and emotive strategies.

The contribution of psychosocial factors to secondary risk prevention for myocardial infarction in young adults

The aim of this study was to explore and identify the contribution of complex psychosocial factors to secondary risk prevention for Myocardial Infarction (MI) among adults under 55 years. Participants included 30 MI patients who were admitted to St. Vincent's Health in Melbourne. A repeated measures mixed measures methodology was used to examine demographic information, depressive symptomatology, physical and emotional wellbeing, and social functioning during hospitalization and at 3 and 6 months post discharge. Participants demonstrated severe depression at initial assessment but this reduced significantly post discharge. Depression at initial assessment aligned with reports of intense fear of increased mortality. The reduction in depression scores at 3 and 6 months aligned with emotional management of the crisis and improvements in general health, and physical and social functioning. The majority of patients did not participate in community rehabilitation, naming informal supports as the most significant. These results lend support to the use of crisis intervention and empowerment strategies as key elements of cardiac rehabilitation programs, to improve physical functioning and attend to depressive symptomatology in a proactive way, to improve secondary risk prevention among young patients who experience an MI event.

Assessing acute coronary syndrome patients' cardiac-related beliefs, motivation and mood over time to predict non-attendance at cardiac rehabilitation

AIM

This research protocol describes and justifies a study to assess patients' cardiac-related beliefs (i.e. illness representations, knowledge/misconceptions, cardiac treatment beliefs), motivation and mood over time to predict non-attendance at a cardiac rehabilitation programme by measuring weekly/monthly changes in these key variables.

BACKGROUND

Heart disease is the UK's leading cause of death. Evidence from meta-analyses suggests that cardiac rehabilitation facilitates recovery following acute cardiac events. However, 30-60% of patients do not attend cardiac rehabilitation. There is some evidence from questionnaire studies that a range of potentially modifiable psychological variables including patients' cardiac-related beliefs, motivation and mood may influence attendance.

DESIGN

Mixed-methods.

METHODS

In this study, during 2012-2013, electronic diary data will be gathered weekly/monthly from 240 patients with acute coronary syndrome from discharge from hospital until completion of the cardiac rehabilitation programme. This will identify changes and interactions between key variables over time and their power to predict non-attendance at cardiac rehabilitation. Data will be analysed to examine the relationship between patients' illness perceptions, cardiac treatment beliefs, knowledge/misconceptions, mood and non-attendance of the cardiac rehabilitation programme. The qualitative component (face-to-face interviews) seeks to explore why patients decide not to attend, not complete or complete the cardiac rehabilitation programme.

DISCUSSION

The identification of robust predictors of (non-)attendance is important for the design and delivery of interventions aimed at optimizing cardiac rehabilitation uptake. Funding for the study was granted in February 2011 by the Scottish Government Chief Scientist Office (CZH/4/650).

Validation and test-retest reliability of a health measure, health as ability of acting, based on the welfare theory of health

The aim of this study was to conduct a validation and assess the test-retest reliability of the health questionnaire based on Nordenfelt's Welfare Theory of Health (WTH). The study used a questionnaire on health together with the Short Form 12-Item Health Survey (SF-12) questionnaire, and 490 pupils at colleges for adult education participated. The results of the study are in accordance with Nordenfelt's WTH. Three hypotheses were stated, and the first was confirmed: People who were satisfied with life rated higher levels than those who were dissatisfied with life concerning both mental and physical health, measured with the SF-12. The second hypothesis was partially confirmed: People with high education were more often satisfied with life than those with low education, but they were not healthier. The third hypothesis, that women are unhealthy more often than men, was not confirmed. The questionnaire on health showed acceptable stability.

Electrocardiogram lead selection using critical thinking: concerning women and heart disease and a case of wellens syndrome

When a patient enters the acute or critical care environment, it is imperative that the nurse select the best lead for monitoring the patient based on initial interpretation of the 12-lead electrocardiogram. Understanding that significant electrocardiogram changes can occur in the absence of chest pain presents a challenge, supporting the need for ongoing vigilant monitoring throughout the critical care stay. The purposes of this article were to (1) discuss the leading cause of death in the United States, (2) highlight the significance related to the population of women, and (3) present the physiology of Wellens syndrome along with monitoring recommendations to prevent unexpected outcomes for this patient population. A case study of Wellens syndrome is included.

Relationships between coping, coping resources and quality of life in patients with chronic illness: a pilot study

OBJECTIVES

The original purpose of the study was to determine differences between two groups of patients with chronic illness (ESRD and CHF) regarding the following study variables: coping, sense of coherence (SOC), self-efficacy and quality of life (QOL). Following this, the aim was to explore the relationships between demographic variables (sex, age, educational level and living area) and QOL as well as between coping, SOC, self-efficacy and QOL for the combined sample of patients with ESRD and CHF.

METHODS

A comparative and correlative design was used with a sample of 100 patients (n = 41 ESRD, n = 59 CHF). The data were collected during 2004, using four standardized questionnaires and regression analyses were conducted.

RESULTS

No significant differences were found between the two groups. Positive correlations were identified between SOC, general self-efficacy and QOL, whereas negative correlations emerge between emotion-focused coping, SOC, general self-efficacy and QOL. SOC, general self-efficacy and emotion-focused coping explained 40% of the variance in QOL. Those with low SOC and general self-efficacy showed negative correlations between emotion-focused coping and QOL, whereas no such correlations were shown for those with high values on SOC and general self-efficacy.

CONCLUSIONS

The present results on coping and QOL correspond with previous research regarding how other groups with chronic illness handled their daily life. Preliminary results indicate that how individuals tackle their present situation is more important than which chronic illness they have. Women used more emotion-focused coping than men, which constitute an important finding for further research.

Higher comorbidity of depression and cardiovascular disease in women: a biopsychosocial perspective

OBJECTIVES

The present paper aims at offering a synthesis of possible reasons of the higher comorbidity of cardiovascular disease (CVD) and depression in women from a biopsychosocial perspective.

METHOD

The available literature is reviewed under sex/gender aspects related to the link between depression and CVD and common pathways to depression and CVD associated with chronic stress experiences including pathophysiological mechanisms and behavioural, cognitive, psychosocial and sociological risk factors/predictors.

RESULTS

There is considerable evidence that greater exposure to chronic stressors in women, interpersonal stress responsiveness, and internalizing coping styles are associated with an elevated risk of CVD and/or depression through behavioural and pathophysiological mechanisms including alterations in HPA axis functioning and autonomic nervous system which appear to be specific for women.

CONCLUSION

Women seem to be more strongly affected by psychosocial stressors related to CVD and depression as well as by direct and indirect effects of chronic stress compared to men. More evidence in understanding these differences within the biological, psychosocial and sociostructural determinants and pathways is essential for promoting women's health.

Factor structure of the revised Jalowiec Coping Scale in patients admitted for elective coronary angiography

OBJECTIVES

The way patients cope with their illness may influence their well-being, and for the assessment of coping relevant and valid instruments are required. The objective of the present study was to investigate the psychometric properties of the frequently used Jalowiec Coping Scale (JCS) in patients admitted for elective coronary angiography. We examined the original eight-factor model of the 60-item revised JCS and two three-factor models later proposed in the literature.

METHODS

Using a cross-sectional design the JCS was completed by outpatients with suspected coronary artery disease 1-4 days prior to angiography. Item analyses and confirmatory factor analysis (CFA) for each model were performed, for those among the 647 participating patients that completed at least half the questions in the JCS. Exploratory post hoc analyses based on modification indices were performed in the case of unsatisfactory model fit.

RESULTS

Neither of the proposed structures had satisfactory fit without modifications allowing some items to load on more than one factor. However, one of the two three-factor models performed well in item analysis and the CFA performed mostly satisfactory after some modifications.

CONCLUSION

As for most coping scales reported in the literature, the CFA in the present study showed problems with all three proposed models of the JCS. Despite these problems one of the models may be used with caution. Further improvement of the quality of coping instruments, including CFA based on large samples is recommended.

Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study

OBJECTIVE

To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status.

DESIGN

Multicentre study with a prospective short-term follow-up design.

SETTING

A university hospital, a central hospital and a district hospital in southern Sweden.

SUBJECTS

Consecutive sample of 246 patients with a suspect or manifest myocardial infarction.

MAIN MEASURES

The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables.

RESULTS

Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence.

CONCLUSIONS

Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.

Psychosocial factors during the first year after a coronary heart disease event in cases and referents. Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)

Background

A large number of studies have reported on the psychosocial risk factor pattern prior to coronary heart disease events, but few have investigated the situation during the first year after an event, and none has been controlled. We therefore performed a case-referent study in which the prevalence of a number of psychosocial factors was evaluated.

Methods

Three hundred and forty-six coronary heart disease male and female cases no more than 75 years of age, discharged from hospital within the past 12 months, and 1038 referents from the general population, matched to the cases by age, sex and place of living, received a postal questionnaire in which information on lifestyle, psychosocial and quality of life measures were sought.

Results

The cases were, as expected, on sick leave to a larger extent than the referents, reported poorer fitness, poorer perceived health, fewer leisure time activities, but unexpectedly reported better social support, and more optimistic views of the future than the referents. There were no significant case-referent differences in everyday life stress, stressful life events, vital exhaustion, depressive mood, coping or life orientation test. However, women reported less favourable situations than men regarding stressful life events affecting others, vital exhaustion, depressive mood, coping, self-esteem, sleep, and symptom reporting, and female cases reported the most unfavourable situation of all groups.

Conclusion

In this first controlled study of the situation during the first year after a CHD event disease and gender status both appeared to be determinants of psychological well-being, with gender status apparently the strongest. This may have implications for cardiac rehabilitation programmes.

Living alone, patient sex and mortality after acute myocardial infarction

BACKGROUND

Psychosocial factors, including social support, affect outcomes of cardiovascular disease, but can be difficult to measure. Whether these factors have different effects on mortality post-acute myocardial infarction (AMI) in men and women is not clear.

OBJECTIVE

To examine the association between living alone, a proxy for social support, and mortality postdischarge AMI and to explore whether this association is modified by patient sex.

DESIGN

Historical cohort study.

PARTICIPANTS/SETTING

All patients discharged with a primary diagnosis of AMI in a major urban center during the 1998-1999 fiscal year.

MEASUREMENTS

Patients' sociodemographic and clinical characteristics were obtained by standardized chart review and linked to vital statistics data through December 2001.

RESULTS

Of 880 patients, 164 (18.6%) were living alone at admission and they were significantly more likely to be older and female than those living with others. Living alone was independently associated with mortality [adjusted hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0-2.5], but interacted with patient sex. Men living alone had the highest mortality risk (adjusted HR 2.0, 95% CI 1.1-3.7), followed by women living alone (adjusted HR 1.2, 95% CI 0.7-2.2), men living with others (reference, HR 1.0), and women living with others (adjusted HR 0.9, 95% CI 0.5-1.5).

CONCLUSIONS

Living alone, an easily measured psychosocial factor, is associated with significantly increased longer-term mortality for men following AMI. Further prospective studies are needed to confirm the usefulness of living alone as a prognostic factor and to identify the potentially modifiable mechanisms underlying this increased risk.

Significance of fellow patients for patients with myocardial infarction

The purpose of the study was to present both positive and negative experiences with respect to the significance of fellow patients for patients with myocardial infarction (MI), both inside and outside the hospital. Five focus group sessions were carried out, each having between four and six participants. A total of 25 patients with MI at an age of 40-71 participated. The analysis was carried out by the moderator and co-moderator of the focus groups. The results, which are elucidated by theories of social support, show a great amount of positive support in the interactions of patients, such as support from others in the same situation, a lot of humour, encountering true understanding and consideration, getting practical assistance, and benefiting from other patients' knowledge and experience as well as experiencing an increase in motivation. The participants also discussed negative experiences such as dramatic situations when fellow patients got worse and sometimes even died. Many patients were bothered by various kinds of noise and other disturbances. Insight into the significance of fellow patients will make health personnel able to encourage a patient environment that will strengthen positive and reduce negative effects of fellow patients on the health of each individual patient. One relevant measure would be involving former patients or starting up physical activity in groups. The findings show that the informal patient community among fellow patients is an important part of their social support system and thereby also may contribute to health and well-being.