Quality of life in cardiac patient research: a meta-analysis

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.

Measurement of Health-Related Quality of Life in Chronic Heart Failure, from a Nursing Perspective—a Review of the Literature

BACKGROUND

Living with chronic heart failure (CHF) is distressful and affects daily life. Because of the lack of a cure for CHF, there has been a progressive interest in using health-related quality of life (Hr-QoL) as an outcome measurement of the treatment in patients with CHF.

OBJECTIVE

The aim of this review was to describe the instruments/questionnaires used in different studies in the measurement of Hr-QoL in patients with CHF, and how they were put into operation as seen from a nursing perspective.

METHOD

MEDLINE and CINAHL databases were searched from January 1995 to June 2002, by using the keywords CHF, heart failure, QoL and Hr-QoL. A total of 33 articles were analysed.

RESULTS

Thirty-two different Hr-QoL questionnaires were found. Generic, disease-specific and battery approaches were different ways used to measure Hr-QoL. To assess/describe Hr-QoL, evaluate the impact of interventions and examine relations/predictors were three main objectives. However, different aspects of the concept Hr-QoL, influencing factors, how to implement the questionnaires and a lack of unified CHF criteria existed.

CONCLUSIONS

To create a guideline for the measurement of Hr-QoL in CHF patients is of great importance for nurses and might generate homogeneity in the measurement methods and promote the scientific approach in the nursing care process.

A Nurse-Managed Discharge Program for Congestive Heart Failure Patients: Outcomes and Costs

This experimental study determined the effect of a structured nurse-managed postdischarge program for congestive heart failure (CHF) patients. The program consisted of telephone calls to participants in the experimental group 72 hours postdischarge, 72 hours later, and then every 2 weeks for 2 months. Patient self-care for CHF was evaluated. Data on unexpected office visits, emergency room visits, and readmissions due to exacerbation of CHF plus costs were collected. No significant differences were found. However, because quality of life did show improvement for the experimental group, this type of nursing intervention can improve outcomes for patients after discharge from the hospital.

Multivariate Meta-Analysis of Preference-Based Quality of Life Values in Coronary Heart Disease

BACKGROUND

There are numerous health-related quality of life (HRQol) measurements used in coronary heart disease (CHD) in the literature. However, only values assessed with preference-based instruments can be directly applied in a cost-utility analysis (CUA).

OBJECTIVE

To summarize and synthesize instrument-specific preference-based values in CHD and the underlying disease-subgroups, stable angina and post-acute coronary syndrome (post-ACS), for developed countries, while accounting for study-level characteristics, and within- and between-study correlation.

METHODS

A systematic review was conducted to identify studies reporting preference-based values in CHD. A multivariate meta-analysis was applied to synthesize the HRQoL values. Meta-regression analyses examined the effect of study level covariates age, publication year, prevalence of diabetes and gender.

RESULTS

A total of 40 studies providing preference-based values were detected. Synthesized estimates of HRQoL in post-ACS ranged from 0.64 (Quality of Well-Being) to 0.92 (EuroQol European"tariff"), while in stable angina they ranged from 0.64 (Short form 6D) to 0.89 (Standard Gamble). Similar findings were observed in estimates applying to general CHD. No significant improvement in model fit was found after adjusting for study-level covariates. Large between-study heterogeneity was observed in all the models investigated.

CONCLUSIONS

The main finding of our study is the presence of large heterogeneity both within and between instrument-specific HRQoL values. Current economic models in CHD ignore this between-study heterogeneity. Multivariate meta-analysis can quantify this heterogeneity and offers the means for uncertainty around HRQoL values to be translated to uncertainty in CUAs.

Health state utility values for diabetic retinopathy: protocol for a systematic review and meta-analysis

BACKGROUND

People with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial for health technology assessment and the development of decision analytic models. A review and synthesis of HSUVs for the different stages of disease progression in diabetic retinopathy has not previously been conducted.

METHODS/DESIGN

We will conduct a systematic review of the available literature that reports HSUVs for people with diabetic retinopathy, in correspondence with current stage of disease progression and/or visual acuity. We will search Medline, EMBASE, Web of Science, Cost-Effectiveness Analysis Registry, Centre for Reviews and Dissemination Database, and EconLit to identify relevant English-language articles. Data will subsequently be synthesized using linear mixed effects modeling meta-regression. Additionally, reported disease severity classifications will be mapped to a four-level grading scale for diabetic retinopathy.

DISCUSSION

The systematic review and meta-analysis will provide important evidence for future model-based economic evaluations of technologies for diabetic retinopathy. The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will also highlight where the design of the study and HSUV instrument have influenced the reported utility values. We believe this protocol to be the first of its kind to be published.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014012891.

Deriving input parameters for cost-effectiveness modeling: taxonomy of data types and approaches to their statistical synthesis

BACKGROUND

The evidence base informing economic evaluation models is rarely derived from a single source. Researchers are typically expected to identify and combine available data to inform the estimation of model parameters for a particular decision problem. The absence of clear guidelines on what data can be used and how to effectively synthesize this evidence base under different scenarios inevitably leads to different approaches being used by different modelers.

OBJECTIVES

The aim of this article is to produce a taxonomy that can help modelers identify the most appropriate methods to use when synthesizing the available data for a given model parameter.

METHODS

This article developed a taxonomy based on possible scenarios faced by the analyst when dealing with the available evidence. While mainly focusing on clinical effectiveness parameters, this article also discusses strategies relevant to other key input parameters in any economic model (i.e., disease natural history, resource use/costs, and preferences).

RESULTS

The taxonomy categorizes the evidence base for health economic modeling according to whether 1) single or multiple data sources are available, 2) individual or aggregate data are available (or both), or 3) individual or multiple decision model parameters are to be estimated from the data. References to examples of the key methodological developments for each entry in the taxonomy together with citations to where such methods have been used in practice are provided throughout.

CONCLUSIONS

The use of the taxonomy developed in this article hopes to improve the quality of the synthesis of evidence informing decision models by bringing to the attention of health economics modelers recent methodological developments in this field.

What is the methodological and reporting quality of health related quality of life in chronic heart failure clinical trials?

BACKGROUND

Although the number of clinical trials assessing health related quality of life (HRQoL) in chronic heart failure (CHF) has increased exponentially over the last decade, little is known about the quality of reporting. The purpose of this review was to assess the methodological and reporting rigor of HRQoL in RCTs of pharmacological therapy in CHF.

METHODS

The electronic data bases, Medline and EMBASE were searched from 1990 to 2009 using the key search terms 'heart failure' combined with 'quality of life', 'pharmacological therapy' and 'randomized controlled trials'. A total of 136 articles were identified and evaluated according to the "Minimum Standard Checklist (MSC) for Evaluating HRQoL Outcomes".

RESULTS

According to the MSC criteria, 26 (19.1%) studies were considered 'very limited', 91 (66.9%) were 'limited' and only 19 (14.0%) studies were considered to be of a 'probably robust' in terms of methodological and reporting rigor. In fact, the quality of HRQoL reporting has not improved over time.

CONCLUSION

HRQoL is a critical consideration in CHF management, yet reporting is highly variable. There is a need to develop a standardized method for measuring and reporting HRQoL measures in clinical trials to aid in the interpretation and application of findings.

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.

Preparing for the worst while hoping for the best: the relevance of hope in the heart failure illness trajectory

BACKGROUND

Patients with heart failure have higher mortality rates than those with most malignant diseases. The heart failure illness trajectory is one of gradual decline characterized by unpredictable events such as acute decompensation of heart failure or a sudden cardiac death. Health professionals have an obligation to give patients and their families concise and honest information concerning their prognosis. The challenge exists to give what ostensibly may seem a bleak prognosis within a context of hope and optimism.

AIM

To explore the role of hope in heart disease and the potential utility of this construct in the development of nursing interventions.

METHODS

The electronic databases CINAHL, MEDLINE, EmBASE, and PSYCHlit were searched from 1982 to August 2004 using the key words "hope," "hopelessness," "heart disease," and "heart failure." Articles were subsequently sorted to meet the inclusion criteria of (1) a philosophical discussion of the construct of hope and/or (2) investigation of hope in heart disease.

RESULTS

This search retrieved 768 articles, and 24 met the inclusion criteria. Key findings from the review indicate that "hope" and "hopelessness" are underdeveloped, yet important constructs and conceptually linked with depression and spirituality. Intriguing findings from descriptive, observational studies have demonstrated the positive impact of expression of hope on cardiovascular outcomes. These findings need to be validated in randomized controlled trials.

CONCLUSIONS

This critical literature review has determined that "hope" is strongly associated with the individual's future orientation. Increased understanding of this concept may assist in refining patient-focused interventions and developing therapeutic strategies to enhance hope.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

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

OBJECTIVE

The study objective was to compare coping, social support, and quality of life in Swedish women and men 1 month after myocardial infarction.

DESIGN

The study design was cross-sectional and descriptive-comparative.

SETTING

The study took place in 1 hospital service area in the middle of Sweden.

SUBJECTS

The sample consisted of 74 women and 97 men.

INSTRUMENTS

The Jalowiec Coping Scale, the Social Network and Social Support Questionnaire, the Short Form-36 Health Survey, and the Quality of Life Index-Cardiac Version were used.

RESULTS

Compared with men, women used more evasive and supportive coping and rated psychologic aspects of the heart disease as more problematic to manage. More women perceived available support from friends and grandchildren, and more men perceived available support from their partner. Women rated lower levels in physical and psychologic dimensions of quality of life.

CONCLUSION

The first month after myocardial infarction is a susceptible period especially for women. They used more evasive and supportive coping and experienced a lower quality of life compared with men.

Improving Quality of Life in Patients With Heart Failure

Nurses play a major role in assisting patients with chronic diseases manage their symptoms, adhere to treatment, and change behavior. This article describes an innovative behavioral intervention for patients with heart failure. The rationale and theoretical basis for the intervention, implementation, and evaluation of the intervention and its implications for use in clinical practice and further research are presented.

Patient-centered Needs Assessment

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Quality of Evidence

BACKGROUND

In 1998, the Committee on Health Care Quality in America was created and given the charge of devising a strategy to achieve substantial improvement in the quality of health care for all Americans. One strategy to move the quality agenda forward is the use of evidence by both providers of health care and consumers of health care. One feature of this agenda, evidence-based practice, refers to a hierarchy of evidence ranging from individual randomized, controlled trials to expert opinion.

OBJECTIVES

The purposes of this article are to describe the evidence base in nursing, discuss the quality and strength of nursing's evidence, illustrate the application of the Quality Health Outcomes Model, and present recommendations for practice, research, and policy to increase nursing's contribution to quality health care.

RESULTS AND RECOMMENDATIONS

Nurses everywhere must use innovative solutions to operationalize the "evidence" in evidence-based nursing. The Quality Health Outcomes Model (QHOM) provides a useful way of advancing research and evidence about the quality of health care in America. In concert with the conceptual framework for the National Health Care Quality Report, the QHOM provides a map for identifying evidence gaps and research questions arising from the model and conceptual framework, as well as evidence synthesis (integrating methodologic quality) driven by theoretical understanding.

Self-care Resources and Activity as Predictors of Quality of Life in Persons After Myocardial Infarction

An ex post facto correlational study was conducted to examine predictors of quality of life in persons 3 to 6 months after a myocardial infarction. Self-care resources, self-care knowledge (needs), activity level, and selected demographic variables were examined as predictor variables. A convenience sample of 86 subjects with a mean age of 61 years, was recruited for participation in this study. The study that explained 35% of the variance in quality of life included self-care resources available, activity level, and self-care needs. Modeling and Role Modeling Paradigm provided a useful explanation of how self-care resources and self-care knowledge can be applied to persons recovering from myocardial infarction.

Psychosocial factors and their association with clinical outcomes in patients with heart failure: why clinicians do not seem to care

Poor quality of life, social isolation, depression and anxiety all have been linked to increased risk of rehospitalization and mortality in patients with heart failure. Yet, despite evidence of their importance to outcomes in heart failure patients, psychosocial factors are assessed and treated infrequently in clinical practice. Potential reasons for this include: (1) inadequate dissemination of research about the link between psychosocial factors and outcomes; (2) insufficient training in heart-mind interactions that precludes clinicians from taking advantage of what is known; (3) perceived problems with interventions or with the science of heart-mind interactions that interfere with acceptance of what is known; (4) concerns about how to measure psychosocial factors in clinical practice; and (5) lack of curiosity from clinicians about the role of psychosocial factors in their patients. In this article, each of these possible explanations is explored and recommendations suggested.

Determinants of quality of life changes among long-term cardiac transplant survivors: results from longitudinal data

BACKGROUND

Cross-sectional analyses have identified significant associations between quality of life (QOL), and comorbidities and adverse effects in cardiac transplant recipients. However, little is known about factors that influence changes in QOL over time. This study examines both cross-sectional and longitudinal data from long-term survivors to identify factors that affect differences in QOL among recipients and individual changes in QOL during a 1-year period.

METHODS

Self-selected enrollees completed questionnaires, including QOL scales, at 3-month intervals. Repeated measures multiple regression analysis was used to examine the association between the QOL scales and comorbidities, adverse effects, and compliance measures, controlling for other factors.

RESULTS

We included 569 participants in the analysis, with a mean time since transplantation of 8.6 years. Cross-sectional results showed that the number of comorbidities, treatment non-compliance, and several adverse effects were associated with low QOL. In longitudinal results, waiting to take medications and taking less medication because of lifestyle restrictions were associated with decreases in QOL over time. Hair loss, changes in face shape, and decreased sexual interest or ability also had the largest adverse effects on changes in QOL.

CONCLUSIONS

These findings provide new opportunities for interventions to address factors related to decreases in QOL. Clinicians should actively solicit information about compliance with medication regimens. In addition, information about the adverse effects of medications should be considered when making therapeutic decisions.

Meta-analysis and decision analysis bridge research and practice

Research synthesis methods provide meaningful quantitative data through systematic review of the research literature and translation of these findings into practice implications. Meta-analysis has been the gold standard for translation of research findings into practice. Decision analysis has emerged as an alternative to and extension of meta-analysis. Examples, contrasting the application of meta-analysis and decision analysis, are presented and discussed in relation to its relevance in providing clinical direction. The methods are points along the continuum of translating research findings into practice. Meta-analytic studies provide an essential foundation for estimating and assigning the probabilities used in decision analysis, whereas the outcomes of decision analysis provide data for estimating the cost effectiveness of different interventions or treatment options. Decision analysis can assist in bridging the research-practice gap. Nurse researchers are urged to collaborate with other disciplines that have used these methods to refine translation and use of research findings in practice.

Interventions to increase physical activity among aging adults: a meta-analysis

OBJECTIVES

This review applied meta-analytic procedures to integrate primary research findings that test interventions to increase activity among aging adults.

METHODS

We performed extensive literature searching strategies and located published and unpublished intervention studies that measured the activity behavior of at least five participants with a mean age of 60 years or greater. Primary study results were coded, and meta-analytic procedures were conducted.

RESULTS

The overall effect size, weighted by sample size, was d(w) = .26 +/- .05. Effect sizes were larger when interventions targeted only activity behavior, excluded general health education, incorporated self-monitoring, used center-based exercise, recommended moderate intensity activity, were delivered in groups, used intense contact between interventionists and participants, and targeted patient populations. Effect sizes were larger for studies that measured exercise duration and studies with a time interval of less than 90 days between intervention and behavior measurement.

CONCLUSIONS

These findings suggest that group-delivered interventions should encourage moderate activity, incorporate self-monitoring, target only activity, and encourage center-based activity. Findings also suggest that patient populations may be especially receptive to activity interventions. Primary research testing interventions in randomized trials to confirm causal relationships would be constructive.

A meta-analysis of quality-of-life estimates for stroke

BACKGROUND

Researchers performing cost-effectiveness analyses often incorporate quality-of-life (QOL) estimates.

OBJECTIVE

To aid analysts, we performed a meta-analysis to estimate quality of life for minor, moderate, and major stroke and assessed the relative importance of study design characteristics in predicting the quality of life of patients with stroke.

METHODS

Through a systematic search we identified 20 articles reporting 53 unique QOL weights for stroke. Each article was read and QOL weights and study characteristics were recorded. We used a hierarchical linear model (HLM) to perform a meta-regression. The model included severity of stroke, elicitation method, respondents, and QOL scale bounds as explanatory variables.

RESULTS

Severity of stroke (p < 0.0001) and the bounds of the scale (p = 0.0015) were significant predictors of quality of life, while the elicitation method and respondents were not. Pooling QOL weights using the HLM model, we estimated a quality of life of 0.52 for major stroke, 0.68 for moderate stroke, and 0.87 for minor stroke if the time trade-off method is used to assess quality of life from community members when the scale bounds range from death to perfect health.

CONCLUSIONS

We found no systematic difference in stroke QOL weights depending on elicitation method or respondents. However, quality of life is sensitive to the bounds of the scale. Because the pooled QOL estimates reported here are based on a comprehensive review of the QOL literature for stroke, they should be of great use to researchers performing cost-utility analyses of interventions designed to prevent or treat stroke, or where stroke is a possible side effect of therapy.

The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension

BACKGROUND

Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase quality of life and prolongation of life. Hypertension affects a large number of people. It is important that those affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson's Caring Model is one nursing approach consistent with needs of persons with hypertension, and was used in this study to guide both research and practice.

AIM

To determine the effectiveness of a nurse's caring relationship according to Watson's Caring Model on the blood pressure and the quality of life of patients with hypertension.

METHODS

The design of the study was a one-group pretest and post-test. The study included 52 patients with hypertension in four health care units in Erzurum, Turkey in 2000. These patients had been diagnosed with hypertension and invited to participate in a research project involving nursing care. After acceptance, patients were given questionnaires consisting of demographic characteristics; their blood pressure was measured, and a quality of life scale was administered. Each of the participating nurse researchers was prepared in the use of Watson's Theory and Model of Caring (and the 10 Carative Factors). This training formed the basis of the caring process used by the nurse researchers who then visited the patients and their families once a week for blood pressure measurement for a 3-month period. At the end of care, the quality of life scale was applied to patients, and blood pressures were measured as the post-test.

RESULTS

There were statistically significant differences between mean scores of general well-being (t = 3.097, d.f. = 51, P = 0.003), physical symptoms and activity (t = 2.994, d.f. = 51, P = 0.004), medical interaction (t = 2.127, d.f. = 51, P = 0.035). There were also significant differences between blood pressure (systolic: t = 4.830, d.f. = 51, P = 0.000; and diastolic: t = 3.51, d.f. = 51, P = 0.001) in pre- and post-test.

CONCLUSION

This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.

A meta-analysis of utility estimates for HIV/AIDS

The authors performed a meta-analysis to derive pooled utilities for HIV/AIDS and to assess the relative importance of study design characteristics in predicting utilities. Twenty-five articles were identified reporting 74 unique utilities elicited from 1956 respondents. The authors used a hierarchical linear model to perform the meta-analysis, with disease stage, elicitation method, respondent type, and the upper-bound and lower-bound labels for the utility scale as the independent variables. Disease stage (P = 0.016) and respondent type (P = 0.014) were significant predictors of utility. Elicitation method was of marginal significance (P = 0. 052). Bounds were not significant. Pooling utilities, the authors estimate a utility of 0.70 for AIDS, 0.82 for symptomatic HIV and 0.94 for asymptomatic HIV when the time tradeoff method is used to elicit utilities from patients and the scale ranges from death to perfect health. The pooled utilities reported here should be of great use to researchers performing cost-utility analyses of interventions for HIV/AIDS.

Anxiety, depression and functional capacity in older women with mitral valve stenosis

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.

Evaluation of 3 quality of life measurement tools in patients with chronic heart failure

OBJECTIVE

The objectives of this study are to (1) Address issues related to selecting a quality of life (QOL) measuring tool; and (2) Present data from a pilot test comparing 3 QOL tools (Medical Outcomes Study Short Form-36 [SF-36], the Minnesota Living with Heart Failure Questionnaire [LHFQ], and a visual analogue scale).

DESIGN

Descriptive comparative.

SETTING

A Southern university-affiliated tertiary medical center outpatient heart failure clinic.

PATIENTS

Thirty adults, randomly selected from those treated in a multidisciplinary, nurse practitioner-managed heart failure clinic.

RESULTS

Significant correlations were found among the global or broader measures of QOL (visual analog scale and LHFQ Total score) and the component scores (LHFQ Emotional, LHFQ Physical, SF-36 Mental [MCS], and SF-36 Physical [PCS]), with the only exception being that of the LHFQ Total and the SF-36 PCS. Mental and physical components of QOL were not related within the SF-36 or between the SF-36 PCS and the LHFQ Emotional score. However, the emotional and physical scores were highly and significantly related within the LHFQ and between the SF-36 MCS and the LHFQ Physical score.

CONCLUSIONS

The SF-36 was better able to differentiate physical and emotional aspects of QOL in this sample. The LHFQ subscales may be less useful in QOL assessment than the total score.

Factors influencing quality of life in older women with heart disease

BACKGROUND

Better understanding of factors influencing the quality of life (QOL) of cardiac patients can guide treatment decisions.

OBJECTIVES

To describe the impact of clinical and psychosocial factors on the QOL of older women with heart disease.

RESEARCH DESIGN

Baseline and 12-month data from women participating in an intervention study.

SUBJECTS

Eligible participants, identified from medical records, were female, > or = 60 years of age, and diagnosed with cardiac disease. A volunteer sample of 570 women (87% white) completed baseline interviews, with 485 women completing the 12-month assessment.

MEASURES

Utilizing Wilson and Cleary's conceptual framework (1995), measures of clinical, psychosocial, and functional status were examined for their associations with QOL.

RESULTS

At baseline, General Health Perceptions and Symptom Status accounted for 38% and 26%, respectively, of the variation in the QOL rating. Using logistic regression models, seven measures were significant predictors (P < 0.05) of maintenance/improvement versus decline in QOL over 12 months: baseline QOL rating; baseline value and change in satisfaction with social activities over 12 months; change in satisfaction with physical activities; change in satisfaction with mental activities; and baseline value and change in perceived stress. For women who maintained or improved their satisfaction with social activities, the odds for also maintaining or improving QOL were 4.5 times the odds for women whose satisfaction with social activities deteriorated.

CONCLUSIONS

Satisfaction with social activities and perceived stress are important predictors of subsequent QOL. Consideration of the impact of treatments on these factors may help to prevent deterioration of QOL among older female cardiac patients.

Predictors of quality of life in rural patients with cancer

Quality of life (QOL) as an outcome for cancer treatment has been studied primarily in urban populations. Yet, descriptions of rural dwellers suggest that their perception of QOL may differ from that of their urban counterparts. The purpose of this study was to examine QOL in people with a cancer diagnosis of at least 1 month duration in two similar rural northeastern states. The Functional Assessment of Cancer Therapy General (FACT G) scale was completed by 344 respondents. The mean QOL score was 89.41 +/- 16.55. State of residence, gender, known recurrence, and marital status were significant predictors of QOL, explaining 18.3% of the variance in this study. Age, education level, income, type of cancer, living arrangements, and time since diagnosis were not predictive. The QOL scores in this rural sample were higher than those reported earlier for predominantly urban dwellers. Future research is needed to understand these differences.

Caregiving and care receiving among a technologically dependent heart failure population

This descriptive study investigated health-related quality of life (HRQOL) and caregiving/care receiving among 20 end stage heart failure patients receiving community-based inotropic infusions and among their 18 family caregivers. The analysis revealed that care recipients perceived considerable impairment from their disease process and poor HRQOL despite the use of inotropic infusions. Perceived powerlessness was identified as a predictor of the recipients' mental health status, while caregiver esteem adversely affected recipient HRQOL. Although insufficient preparation to care and caregiving tasks significantly contributed to the negative aspects of care provision. the esteem and mental health of the caregiver significantly enhanced HRQOL among caregivers.

Gender differences in sarcoidosis: symptoms, quality of life, and medical consumption

The aim of this study was to examine gender differences in quality of life (QOL) and in constitutional symptoms that coincide with sarcoidosis. The study population included 1026 sarcoidosis patients--all members of the Dutch Sarcoidosis Society--who completed the WHOQOL-100 and a symptom checklist. Women experienced more symptoms than men. With regard to QOL, male and female patients who suffered from symptoms differed in the broader domains of Physical Health and Psychological Health. Specific facets reflected pain, sleep, positive affect, appearance, mobility, and activities of daily living. Future studies should focus on the different experience of the disease between male and female patients more extensively. Studies are needed to evaluate whether the differences in the present study between male and female sarcoidosis patients are caused by a subject selection bias or life style differences; have a genetic, hormonal or biological base; or just are an epiphenomenon.

Effect of psychosocial factors on physiologic outcomes in patients with heart failure

Despite advances in its treatment, the epidemic of heart failure continues unabated in the United States and is escalating worldwide. The extremely high morbidity and mortality seen with heart failure demand creative approaches to this problem. Attention to nontraditional risk factors for rehospitalization and mortality, in addition to traditional medical risk factors, may yield improved outcomes. Psychosocial factors, particularly lack of social support and depression, are associated with poorer outcomes in cardiac patients. However, few studies have been conducted among patients with heart failure. In this article, the evidence relating poor quality of life, social isolation and lack of emotional support, anxiety and depression, and morbidity and mortality in patients with heart failure is discussed. Also explored are possible mechanisms for the association between psychosocial variables and physical outcomes and related clinical and research implications.

Facilitating the work of a meta-analyst

Meta-analysis facilitates the transfer of knowledge from nurse researchers to clinicians. In this article, the benefits and criticisms of meta-analysis for nursing are identified along with the specific problems a meta-analyst may encounter in conducting a quantitative analysis and synthesis of the literature. Problems in data retrieval from the primary studies for a quantitative literature review can plague a meta-analyst. These problems can include insufficient data such as inexact p-values, incomplete descriptions of samples or experimental and control groups, and errors in tables in research reports. Suggestions for removing some of these roadblocks are addressed along with recommendations to authors, editors, and manuscript reviewers. An example of a suggestion for authors is to focus on reporting exact statistical values and p-levels. Also, sample characteristics and methodological variables are deserving of detailed descriptions in research reports. Editors can consider including a summary table of basic descriptive and inferential statistics. Another recommendation for editors is to develop a reviewer's checklist to ensure the author has included all relevant statistical information and study characteristics a meta-analyst needs.

Quality of life in coronary artery disease

BACKGROUND

Coronary artery disease (CAD) constitutes a considerable financial burden on society in Finland; it is the cause of death of approximately 7,500 men and 6,500 women annually in a population of 5 million.

OBJECTIVES

The purpose of this study was to assess the changes in the quality of life (QOL) of patients with CAD treated by medication, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABS) during 1 year.

METHOD

The study population consisted of 280 patients with CAD. One hundred patients had been referred to CABS and another 100 to PTCA, whereas 80 patients were on drug therapy. The patients assessed their health status and QOL in terms of functional capacity and aspects of distress using self-completed questionnaires with the Nottingham Health Profile (NHP) instrument before the operation and 6and 12 months afterwards.

RESULTS

The QOL of the patients who had undergone CABS and PTCA was significantly better on the dimensions of energy, pain, and mobility 1 year after the intervention. In the medication group, the only improvement took place on the dimension of social isolation, whereas both energy and mobility deteriorated.

CONCLUSIONS

The results on QOL obtained in this study support the notion that patients continue to have many problems even after medical treatment with a good outcome. The problems occur in different areas compared with the pretreatment situation as on the dimensions of social isolation and emotional reaction. The rehabilitation of CAD patients is therefore important because the new problems are manifested differently from those seen before the illness or the treatment. The patient's QOL and personal preference for a treatment modality should be important criteria in the choice of treatment.

Discoverer, teacher, friend: a tribute to Marguerite Kinney

This tribute to Dr Marguerite Kinney, a transformational leader in cardiovascular nursing, highlights her influence on the lives and careers of previous students and those she has mentored. Examples of Dr Kinney's excellence in teaching, leadership, scholarship and research, and creative thinking within the discipline of nursing are provided.

Health-related quality of life as an outcome in organizational research

This article discusses the conceptual and methodological issues that continue to plague health-related quality of life (HRQOL) research. The current conceptualizations of the construct are reviewed to make explicit the issues of diversity and lack of consensus in definitions, validity of the conceptual unity of multiple domains, and lack of attention to the integration of the HRQOL construct into a theoretical meaningful model. Inadequately addressed conceptual issues have resulted in the proliferation of scales to measure HRQOL the measurement issues to a need to focus on precision and sensitivity of measures. The author offers a new conceptualization of HRQOL, which encompasses both health-care provider and patient perspectives.