Perceived health following myocardial infarction: cross-validation of the Health Complaints Scale in Danish patients

The role of sex and gender in somatic complaints among patients with coronary heart disease: A longitudinal study on acute and long-term changes

BACKGROUND

Somatic complaints are persistently reported in patients with coronary heart disease (CHD). Sex and gender influence health and well-being in a variety of ways, but it is unknown how they affect somatic complaints over time after percutaneous coronary intervention (PCI). Therefore, we examined the association between sex and gender on somatic health complaints during the first month (acute) and the first two years (recovery) after PCI.

METHODS

514 patients (Mage = 64.2 ± 8.9, 84.2% male) completed the somatic scale of the Health Complaints Scale (including the subscales: cardiopulmonary complaints, fatigue, sleep problems) at baseline, one, 12-, and 24-months post-PCI. In a follow-up study, they filled in additional questionnaires to gauge gender norms, traits, and identity. Linear mixed modeling analyses were used to assess the influence of sex, gender, their interaction, and covariates on somatic complaints for the acute and recovery phases separately.

RESULTS

A general decline in somatic complaints over time was observed during the acute phase, followed by a stabilization in the recovery phase. Females and individuals with more feminine traits, norms, and identities reported increased somatic complaints. Males with more pronounced feminine norms and females with more masculine norms likewise reported more somatic, cardiopulmonary, and fatigue complaints. Furthermore, age, cardiac history, and comorbid diseases partly explained the associations with somatic complaints.

CONCLUSION

While somatic complaints improve post-PCI, there are still conspicuous sex and gender differences that need to be considered. Future research should further elaborate upon these discrepancies and incorporate sex and gender in prevention and develop tailored interventions to diminish somatic complaints.

Impact of educational programme on patient's health outcomes following open heart surgeries

BACKGROUND

Postcardiac surgery, numerous factors have been shown to predict postoperative harm of QoL, such as age, female sex, history of hypertension, chronic obstructive pulmonary disease, education level, marital status, and also psychological factors such as the presence of mood disorders. So, the essential key to self-management is behavioural change, which is necessary to improve the quality of life of patients and Health outcomes.

AIM

The aim of this study is to evaluate the impact of the education programme on patients' health outcomes following open heart surgeries.

PATIENTS AND METHODS

Quasi-experimental research design carried out in intensive care for open heart surgery in Suez Canal university hospitals at Ismailia Governate on all available both sex patients performing open heart surgery for 6-month period (60) using the following four tools: the first tool for patient's risk stratification model Euro Scale sheet; the second tool New York Heart Association scale for assessing functional abilities; the third tool for health outcomes sheet for assessing patient's quality of life and health status; and the fourth tool for assessing Hospital Anxiety and Depression Scale.

RESULTS

There was no significant difference found in the patient's vital signs before and after the educational programme. On the other hand, there was no statistically significant difference between overall quality of life and socio-demographic characteristics before and after the educational programme.

CONCLUSION

This study concluded that the educational programme has a positive effect on patients' quality of life in patients' educational programme; improve patient's health status as indicated by improved patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

The most important finding was the value of the educational training programme to address the needs of open heart surgery patients, indicating that after heart surgery, patient education by training can be helpful in self-care, and nurses can use a programme containing preparatory information to enhance results, alleviate patients problems, and improve the quality of life in patients with CABG.

Dimensions of the Somatic Health Complaints Questionnaire (SHCQ) in a Sample of Myocardial Infarction Patients

A short health complaints measure may provide information on the degree of recovery from acute myocardial infarction. The present study therefore evaluated a questionnaire-called the Somatic Health Complaints Questionnaire (SHCQ)-that includes 13 items concerning health problems common in cardiac patients. The sample included 114 patients in total, 37 women and 77 men, who had suffered a first-time myocardial infarction 5months prior to the testing. Confirmatory factor analysis was performed to examine whether the factor structure replicated the hypothesized hierarchical model. The results indicated that SHCQ represents four dimensions: breathlessness, fatigue, pain and unrest. It was also found that SHCQ may be treated as one general concept. It is a brief and easily administered questionnaire and may therefore be a useful tool in secondary prevention work, identifying patients at risk for possible negative consequences of a first-time myocardial infarction.

Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease

Purpose

The effectiveness of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD) is moderated by negative emotions and clinical factors, but no studies evaluated the role of positive emotions. This study examined whether anhedonia (i.e. the lack of positive affect) moderated the effectiveness of CR on health status and somatic and cognitive symptoms.

Methods

CAD patients (n = 368) filled out the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at the start of CR, and the Short-Form Health Survey (SF-36) and the Health Complaints Scale (HCS) at the start of CR and at 3 months to assess health status and somatic and cognitive symptoms, respectively.

Results

Adjusting for clinical and demographic factors, health status improved significantly during the follow-up (F(1,357) = 10.84, P = .001). Anhedonic patients reported poorer health status compared with non-anhedonic patients, with anhedonia exerting a stable effect over time (F(1,358) = 34.80, P < .001). Somatic and cognitive symptoms decreased over time (F(1,358) = 3.85, P = .05). Anhedonics experienced more benefits in terms of somatic and cognitive symptoms over time (F(1,358) = 13.00, P < .001).

Conclusion

Anhedonic patients reported poorer health status and higher levels of somatic and cognitive symptoms prior to and after CR. Somatic and cognitive symptoms differed as a function of anhedonia over time, but health status did not. Anhedonia might provide a new avenue for secondary prevention in CAD.

Beyond Type D personality: reduced positive affect (anhedonia) predicts impaired health status in chronic heart failure

Objective

Type D personality has been associated with impaired health status in chronic heart failure (CHF), but other psychological factors may also be important.

Aim

To determine whether non-Type D patients with low positive affect and Type D patients report lower health status, compared with non-Type D patients with high positive affect at 12-month follow-up in chronic heart failure.

Methods

Consecutive CHF outpatients (n = 276) filled out the Short Form-12 (health status) and Health Complaints Scale (disease-specific complaints) at inclusion and 12-month follow-up, and the DS14 (Type D personality) and positive affect (Global Mood Scale) at inclusion. Three groups were composed: non-Type D patients without anhedonia, non-Type D patients with anhedonia, and Type D patients.

Results

After controlling for demographic and clinical confounders, and scores at inclusion, anhedonic non-Type D patients reported lower mental health status (β = –.19, P < .004), and more feelings of disability (β = .10, P = .04), marginally lower physical health status (β = −.11, P = .07), and equal levels of cardiac symptoms (β = .04, P = .43), when compared with non-Type D’s without anhedonia. Type D patients reported lower levels of impaired mental health status, more cardiac symptoms and feelings of disability (−.31 < β < .17, all Ps < .05). A trend was shown for physical health status (β = −.11, P = .09).

Conclusion

Non-Type D patients low on positive affect and Type D patients report lower levels of health status in CHF, compared with non-Type D patients with high positive affect. Future studies need to determine whether lack of positive affect is associated with impaired clinical outcome.

Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months

OBJECTIVE

To study the prospective effects of post-myocardial infarction (MI) depressive disorder on health status, including self reported cardiac symptoms, disability, and health related quality of life, at 12 months after MI while controlling for cardiac condition and health status at three months after MI.

METHODS

Longitudinal study of a cohort of 468 adults with MI recruited from four hospitals in the north of The Netherlands between September 1997 and September 2000. Assessment of depressive disorder in the year after MI according to International classification of disease, 10th revision criteria. Assessment of health status at three and 12 months by the RAND 36 item health survey, the health complaints scale, self rated cardiac complaints, and disability.

RESULTS

Patients with post-MI depressive disorder were more likely than those without to have poor quality of life, more health complaints, more cardiac complaints, and more disability at 12 months' follow up. In multivariate analyses adjusted for cardiac condition, health status at three months, age, sex, and pre-MI depression, the prospective association of post-MI depression with poor health status remained for most of the indicators. Severity of the post-MI depression further contributed to aspects of poor health status.

CONCLUSIONS

In a prospective study design, post-MI depression had strong effects on poor health status exceeding the effects of cardiac condition and its short term consequences. Efforts to improve health status after MI should therefore include standard assessment and guideline based treatment of post-MI depressive disorder.

The effect of low social support on short-term prognosis in patients following a first myocardial infarction

The objectives of the current study were (1) to assess adjustment in patients following a first myocardial infarction (MI) at 9 months compared with 4-6 weeks post-MI, (2) to examine the availability of and satisfaction with social support over time, and (3) to determine separate baseline psychosocial predictors of recurrent cardiac events. A questionnaire assessing post-traumatic stress disorder, anxiety, depression, health complaints, and social support, was distributed to consecutive patients 4-6 weeks and 9 months post-MI. Prior to assessment at follow-up, 8 (7%) of 112 patients had dropped out, and two had died due to cardiac causes. Objective clinical measures were obtained from medical records. There was an improvement in somatic and cognitive symptoms at follow-up, but no change in symptoms of arousal, depression, and anxiety. Half of the patients were afraid of a recurrent MI. There was a significant decrease in social support between baseline and follow-up, and lower social support at baseline was associated with a 10% increased risk of recurrent cardiac events at follow-up (OR: 0.90; 95% CI: 0.84 to 0.97) adjusting for all other variables. Some patients still experienced difficulties with psychosocial adjustment 9 months post-MI despite a reduction in somatic and cognitive symptoms. Social support decreased over time, which may have serious prognostic implications; lower social support at baseline was an independent predictor of recurrent events at 9 months. An important step for future research will be to investigate how social support can be enhanced in patients at risk.

Validity of the Type D personality construct in Danish post-MI patients and healthy controls

OBJECTIVE

Type D personality has been associated with increased risk of depression, vital exhaustion, social alienation, a higher number of reinfarctions, and higher mortality rates in patients with established coronary artery disease (CAD) independent of traditional biomedical risk factors. The construct was developed in Belgian cardiac patients, but little is known about its applicability in other nationalities. The objectives of the present article were to cross-validate the Type D Personality Scale-16 (DS16) in a Danish sample of patients with a first myocardial infarction and a random sample of healthy controls, and to investigate whether Type D is associated with posttraumatic stress disorder (PTSD).

METHODS

A questionnaire was given to 112 consecutive patients with a first myocardial infarction 4 to 6 weeks post infarction, and to 115 healthy controls selected randomly from the general population.

RESULTS

The two-factor structure of the DS16 and the internal consistency of the Negative Affectivity (alpha=.83) and Social Inhibition (alpha=.76) subscales were confirmed. The construct validity of the DS16 was confirmed against scales that measure similar constructs, and the discriminant validity of the DS16 against measures of psychopathology. In a pooled sample of patients and healthy controls, comparison of both groups confirmed that Type D may be conceptualised as a marker of general emotional distress, with Type D persons scoring higher on depression, anxiety, and the PTSD symptom clusters arousal and avoidance compared with non-Type D persons. A regression analysis run in two steps showed that the inclusion of Type D in the model lead to an improvement in the level of prediction of PTSD above and beyond a model that included gender, age, MI, neuroticism, and extroversion. Type D (OR=4.46; 95% CI: 1.36 to 14.64), diagnosis of MI (OR=4.03; 95% CI: 1.43 to 11.35), and neuroticism (OR=1.32; 95% CI: 1.13 to 1.53) were independently associated with PTSD, adjusting for all other variables.

CONCLUSION

These findings indicate that the Type D construct is equally applicable in Danish patients with CAD, and that Type D is associated with PTSD.