Copyright © eContent Management Pty Ltd. Contemporary Nurse (2014) 47(1–2): 159–167.
Congestive heart failure: Predictors of health-related quality of life in Iranian women ZAHRA RAHNAVARD, ZAHRA HOSSEINI NODEH* AND KHADIJEH HATAMIPOUR Faculty of Nursing and Midwifery, Department of Community Health Nursing, Tehran University of Medical Sciences, Tehran, Iran; *Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
Abstract: Background and Objectives: Identify the factors affecting quality of life (QOL) is one of the major goals for improving the Health-Related Quality of Life (HR-QOL) in patients suffering from Congestive Heart Failure (CHF). Considering the fact that there are few published studies in this regard in Iran, as a developing country, this research was designed to determine the HR-QOL in Iranian CHF patients and its related factors. Methods and Materials: In this cross-sectional study, random sampling was used to select 1840 female CHF patients. After obtaining informed consent, patients’ demographic and disease-related data (using a researcher-made questionnaire which assessed eight dimensions including role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health), and the HR-QOL data (using the SF-36 questionnaire) were assessed and analyzed with SPSS version 15. Results: A high proportion of the participants had an unfavorable HR-QOL in physical functioning (44.56%), rolephysical (49.55%), role-emotional (59.83%), mental health (54.50%), and general health (53.36%) dimensions and a relatively favorable HR-QOL in social functioning (50.57%), vitality (49.26%), and body pain dimensions (52.55%). A significant relationship was found between the HR-QOL and the employment status, level of education, being cared for at home, functional capacity, disease duration, frequency of medical encounter and hospitalization, duration of hypertension and concurrent CHF, presence of edema, presence of disease symptoms and morbidities, intensity of fatigue at the study time and previous months, and the type of medications. Conclusion: According to the results, QOL in CHF patients was unfavorable in the scales of general health, role-emotional, and mental health.
Keywords: health-related quality of life, women, congestive heart failure
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uring the recent 20 years, assessment and improvement of the quality of life (QOL) in patients with chronic diseases has attracted great attention. To this end, daily improvement in the function and QOL of the patients with chronic diseases has been considered a goal. In chronic diseases, the QOL undergoes unfavorable changes. As a result, some aspects of the QOL in many patients with chronic diseases are affected by special conditions of their disease (Ashwill, James, & Droske, 2002). Cardiovascular diseases comprise a group of chronic diseases, among which congestive heart failure (CHF) is the only disease whose incidence and prevalence rates have grown considerably. These results from the higher survival rate of cardiovascular patients (Taylor-Piliae & Molassiotis, 2001). Six to seven percent of 75–84-year old people and 15% of more than 85-year old people have CHF (British Heart Foundation Report, 2005; McQueen, Mittman, & Demakis, 2004). While, cardiovascular diseases are increasingly recognized
as an important cause of morbidity and mortality in developing countries (Mendez & Cowie, 2001). According to the statistics published by the Iranian Center for Disease Management, 3337 out of 100,000 people in Iran had CHF in 2000; the same report states that CHF is one of the most fatal diseases in Iranian women (Shojaei, 2008). It is believed that the QOL in serious diseases is related to personal characteristics. It should be noted that the severity and symptoms might be different in patients with the same disease (Hinds, 1990). In a study on the relationship between age and sex and health-related QOL, it was concluded that younger patients (below 65 years) had a poorer QOL in comparison with their older counterparts (above 65 years). Moreover, in some aspects, particularly the psychological aspects, women had a poorer QOL (Hou et al., 2004). Canam and Acorn reported that economic factors affected QOL. They stated that one’s income was an important factor, relevant to the health status and the individual’s function (Canam & Acorn, 1999).
Volume 47, Issue 1–2, April/June 2014
CN
159
CN
Zahra Rahnavard, Zahra Hosseini Nodeh and Khadijeh Hatamipour
Two extensive investigations in the USA indicated that CHF, as compared with other chronic diseases, caused more disturbances in the patients’ QOL; and higher levels of disease severity were associated with a lower QOL (Stewart & Blue, 2004). Goldman and Schafer considered symptoms of heart insufficiency as the cause of disturbance in the patients’ functional capacity and QOL; and believed that the disease-related factors decreased the patients’ QOL (Goldman & Schafer, 2012). In a study on 359 patients waiting for heart transplant, the disease symptoms were the most important factors in the prediction of the QOL (Bennett, Cordes, Westmoreland, Castro, & Donnelly, 2000). The increasing prevalence and life expectancy of CHF patients, besides the devastating symptoms of this disease (e.g., fatigue, decrease in functional capacity, dyspnea, etc.) have increased the attentions paid to the importance of Healthrelated quality of life (HR-QOL) in these patients (Jones, O’Connell, & Gray, 2003). Hence, obtaining information about HR-QOL is a guide for more effective interventions. It also helps developing more realistic decisions, supportive programs, and rehabilitation procedures (Bottomley et al., 2005). Although there has been a growing number of investigations regarding HR-QOL in different health complications including heart failure, little is known about HR-QOL in Iranian patients suffering from CHF. Considering that CHF is one of the most fatal diseases in Iranian women (Shojaei, 2008) and women reported significantly poorer HR-QOL in Iran (Tajvar, Arab, & Montazeri, 2008), this study aimed to evaluate HR-QOL in Iranian female CHF patients and to assess the personal and clinical characteristics as factors predictive of future HR-QOL. Methods This cross-sectional study was performed on CHF female patients who were referred to 12 heart clinics affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran between December 2010 and March 2011. So that interviewers went to the clinics and met patients to complete the questionnaires. Exploiting random sampling, first, 6 referral heart clinics were selected 160
CN
from a total of 12. Then a total of 1840 female CHF patients were included in the study. The inclusion criteria were as follows: (1) confirmed diagnosis of CHF, for at least 1 year, by a cardiologist, (2) receiving cardiovascular medications, and (3) lack of other chronic diseases. The reason for excluding these diseases was that chronic condition, can result in extended pain, suffering and impaired QOL (Chen, Baumgardner, & Rice, 2011). Plus, co-morbidities independently affected the hospitalization rate which could worsen the HR-QOL in the patients (Gott et al., 2006). These conditions might lead to biases. Measures Demographic and clinical characteristics A questionnaire was used to assess demographic data (age, marital status, educational level, employment status, family size, body mass index (BMI), being cared for at home, and tobacco use) and disease-related factors (functional capacity, disease duration, frequency of medical encounter, frequency of hospitalization during the past year, duration of hypertension allied with CHF, intensity of fatigue at the moment and during the past month, presence of edema based on the physician’s diagnosis, and the kind of medication used for treatment). The patient’s functional capacity was categorized using four classifications proposed by the American Heart Association (AHA) (Levin, Dolgin, Fox, & Gorlin, 1994). A threepoint verbal rating scale was used to evaluate the patient’s fatigue in a range of 0–10. Health-related quality of life Health-related quality of life was measured using a 36-item, self-administered, short-form (SF36) questionnaire (Ware & Sherbourne, 1992), which assessed role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health. For scoring the SF36 questionnaire, the sum of score points in each subscale was converted to a range of 0–100 and then classified into three distinct levels: (1) favorable HR-QOL: >75 scores, (2) relatively favorable HR-QOL: 25–75 scores, and (3) unfavorable HR-QOL:
Congestive heart failure: Predictors of health-related quality of life in Iranian women ZAHRA RAHNAVARD, ZAHRA HOSSEINI NODEH* AND KHADIJEH HATAMIPOUR Faculty of Nursing and Midwifery, Department of Community Health Nursing, Tehran University of Medical Sciences, Tehran, Iran; *Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
Abstract: Background and Objectives: Identify the factors affecting quality of life (QOL) is one of the major goals for improving the Health-Related Quality of Life (HR-QOL) in patients suffering from Congestive Heart Failure (CHF). Considering the fact that there are few published studies in this regard in Iran, as a developing country, this research was designed to determine the HR-QOL in Iranian CHF patients and its related factors. Methods and Materials: In this cross-sectional study, random sampling was used to select 1840 female CHF patients. After obtaining informed consent, patients’ demographic and disease-related data (using a researcher-made questionnaire which assessed eight dimensions including role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health), and the HR-QOL data (using the SF-36 questionnaire) were assessed and analyzed with SPSS version 15. Results: A high proportion of the participants had an unfavorable HR-QOL in physical functioning (44.56%), rolephysical (49.55%), role-emotional (59.83%), mental health (54.50%), and general health (53.36%) dimensions and a relatively favorable HR-QOL in social functioning (50.57%), vitality (49.26%), and body pain dimensions (52.55%). A significant relationship was found between the HR-QOL and the employment status, level of education, being cared for at home, functional capacity, disease duration, frequency of medical encounter and hospitalization, duration of hypertension and concurrent CHF, presence of edema, presence of disease symptoms and morbidities, intensity of fatigue at the study time and previous months, and the type of medications. Conclusion: According to the results, QOL in CHF patients was unfavorable in the scales of general health, role-emotional, and mental health.
Keywords: health-related quality of life, women, congestive heart failure
D
uring the recent 20 years, assessment and improvement of the quality of life (QOL) in patients with chronic diseases has attracted great attention. To this end, daily improvement in the function and QOL of the patients with chronic diseases has been considered a goal. In chronic diseases, the QOL undergoes unfavorable changes. As a result, some aspects of the QOL in many patients with chronic diseases are affected by special conditions of their disease (Ashwill, James, & Droske, 2002). Cardiovascular diseases comprise a group of chronic diseases, among which congestive heart failure (CHF) is the only disease whose incidence and prevalence rates have grown considerably. These results from the higher survival rate of cardiovascular patients (Taylor-Piliae & Molassiotis, 2001). Six to seven percent of 75–84-year old people and 15% of more than 85-year old people have CHF (British Heart Foundation Report, 2005; McQueen, Mittman, & Demakis, 2004). While, cardiovascular diseases are increasingly recognized
as an important cause of morbidity and mortality in developing countries (Mendez & Cowie, 2001). According to the statistics published by the Iranian Center for Disease Management, 3337 out of 100,000 people in Iran had CHF in 2000; the same report states that CHF is one of the most fatal diseases in Iranian women (Shojaei, 2008). It is believed that the QOL in serious diseases is related to personal characteristics. It should be noted that the severity and symptoms might be different in patients with the same disease (Hinds, 1990). In a study on the relationship between age and sex and health-related QOL, it was concluded that younger patients (below 65 years) had a poorer QOL in comparison with their older counterparts (above 65 years). Moreover, in some aspects, particularly the psychological aspects, women had a poorer QOL (Hou et al., 2004). Canam and Acorn reported that economic factors affected QOL. They stated that one’s income was an important factor, relevant to the health status and the individual’s function (Canam & Acorn, 1999).
Volume 47, Issue 1–2, April/June 2014
CN
159
CN
Zahra Rahnavard, Zahra Hosseini Nodeh and Khadijeh Hatamipour
Two extensive investigations in the USA indicated that CHF, as compared with other chronic diseases, caused more disturbances in the patients’ QOL; and higher levels of disease severity were associated with a lower QOL (Stewart & Blue, 2004). Goldman and Schafer considered symptoms of heart insufficiency as the cause of disturbance in the patients’ functional capacity and QOL; and believed that the disease-related factors decreased the patients’ QOL (Goldman & Schafer, 2012). In a study on 359 patients waiting for heart transplant, the disease symptoms were the most important factors in the prediction of the QOL (Bennett, Cordes, Westmoreland, Castro, & Donnelly, 2000). The increasing prevalence and life expectancy of CHF patients, besides the devastating symptoms of this disease (e.g., fatigue, decrease in functional capacity, dyspnea, etc.) have increased the attentions paid to the importance of Healthrelated quality of life (HR-QOL) in these patients (Jones, O’Connell, & Gray, 2003). Hence, obtaining information about HR-QOL is a guide for more effective interventions. It also helps developing more realistic decisions, supportive programs, and rehabilitation procedures (Bottomley et al., 2005). Although there has been a growing number of investigations regarding HR-QOL in different health complications including heart failure, little is known about HR-QOL in Iranian patients suffering from CHF. Considering that CHF is one of the most fatal diseases in Iranian women (Shojaei, 2008) and women reported significantly poorer HR-QOL in Iran (Tajvar, Arab, & Montazeri, 2008), this study aimed to evaluate HR-QOL in Iranian female CHF patients and to assess the personal and clinical characteristics as factors predictive of future HR-QOL. Methods This cross-sectional study was performed on CHF female patients who were referred to 12 heart clinics affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran between December 2010 and March 2011. So that interviewers went to the clinics and met patients to complete the questionnaires. Exploiting random sampling, first, 6 referral heart clinics were selected 160
CN
from a total of 12. Then a total of 1840 female CHF patients were included in the study. The inclusion criteria were as follows: (1) confirmed diagnosis of CHF, for at least 1 year, by a cardiologist, (2) receiving cardiovascular medications, and (3) lack of other chronic diseases. The reason for excluding these diseases was that chronic condition, can result in extended pain, suffering and impaired QOL (Chen, Baumgardner, & Rice, 2011). Plus, co-morbidities independently affected the hospitalization rate which could worsen the HR-QOL in the patients (Gott et al., 2006). These conditions might lead to biases. Measures Demographic and clinical characteristics A questionnaire was used to assess demographic data (age, marital status, educational level, employment status, family size, body mass index (BMI), being cared for at home, and tobacco use) and disease-related factors (functional capacity, disease duration, frequency of medical encounter, frequency of hospitalization during the past year, duration of hypertension allied with CHF, intensity of fatigue at the moment and during the past month, presence of edema based on the physician’s diagnosis, and the kind of medication used for treatment). The patient’s functional capacity was categorized using four classifications proposed by the American Heart Association (AHA) (Levin, Dolgin, Fox, & Gorlin, 1994). A threepoint verbal rating scale was used to evaluate the patient’s fatigue in a range of 0–10. Health-related quality of life Health-related quality of life was measured using a 36-item, self-administered, short-form (SF36) questionnaire (Ware & Sherbourne, 1992), which assessed role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health. For scoring the SF36 questionnaire, the sum of score points in each subscale was converted to a range of 0–100 and then classified into three distinct levels: (1) favorable HR-QOL: >75 scores, (2) relatively favorable HR-QOL: 25–75 scores, and (3) unfavorable HR-QOL:
