1st revision3 - 97-03

7/27/2019 1st revision3 - 97-03

1/22

Health-related Quality of Life of Persons with Cardiovascular Diseases1

Table of Contents

Page

INTRODUCTION

Background of the Study

Cardiovascular diseases are illnesses that concerns the involvement of the heart

and the blood vessels. The most common type of which is the coronary artery

disease (CAD) also known as atherosclerotic heart disease, coronary heart disease(CHD), or ischemic heart disease (IHD), which cause heart attacks.

(www.mountsinai.org) Heart attacks or arrest could mean the life of the patient anytime.That is why CHD is one of the leading causes of deaths in adults in developed countries.The overall rate of death in 2009 attributable to CVD was 236.1 per 100 000 (Go et al

2012).

In the USA, CAD accounted for killing more than 385,000 people annually eachyear (American Heart Association, 2008). Every year, still in the USA, almost 600,000

people die of heart disease (Kochanek, Xu, Murphy, Minio, Kung 2011) and about

715,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and190,000 happen in people who have already had a heart attack (Go et al 2012). On this

basis, more than 2150 Americans die of CVD each day, an average of 1 death every 40

seconds (Go et al 2012).

Deaths due to CVD also vary by ethnicity and Asians or Pacific Islanders rank 3rd

among all other races (Heron, M. 2008). In the Philippines, as observed with theassociated fast-paced lifestyle, an increased in number of CHD patients is very likely. By

the year 2001, 9 Filipinos die of cardiovascular illnesses every minute (Philippine Daily

Inquirer- Science/ Health Section). While National Statistics Office (NSO, 2009) Manila

enlisted the top 5 causes of deaths had remained on their posts and that of cardiovascular
http://en.wikipedia.org/wiki/Heart_attackhttp://www.mountsinai.org/http://en.wikipedia.org/wiki/Heart_attackhttp://www.mountsinai.org/

7/27/2019 1st revision3 - 97-03

2/22


diseases is one enlisted there. Latest World Health Organization (WHO) data published

in April 2011 CHD deaths in Philippines reached 57,864 or 13.73% of total deaths. The

age adjusted death rate is 121.63 per 100,000 of population making the Philippines #79 inthe world rank for CHD. In line with this, Philippines top 20 causes of death is CHD

ranking as the top 1 cause of mortality (http://www.worldlifeexpectancy.com/philippines-

coronary-heart-disease).

In the Baguio City alone, Department of Health- Cordillera Administrative

Region (DOH-CAR) statistics 2011 shows that Saint Louis University Hospital of theSacred Heart (SLU-HSH) recorded 792 cases of CAD in the same year as the top 7 cause

of morbidity and on the top 10 leading cause of mortality and as of September to

December 2012 records, CAD ranked 5th both among the top 10 leading cases of

morbidity and mortality in the same institution giving the impression of an increasingtrend. Furthermore, Baguio General Hospital and Medical Center (BGHMC) documented

CAD ranked as 13th on the top 20 leading causes of morbidity and top 4 as a leading

cause of mortality in the year 2011. In the same year, Notre Dame de Chartres Hospital,

the only hospital with a cardiac laboratory in Baguio City, recorded CAD with 275 casesmaking it 3rd on the top 10 leading causes of morbidity and 2nd among the top 10

leading causes of mortality (DOH-CAR, 2011).

CAD in its many forms according to Lee (2010), is a chronic disease with

symptoms that requires constant observation or examination and management to avoidfurther complications such as myocardial infarctions (MIs) and chronic heart failure

(CHF). Having this chronic disease with a high mortality rate, holistic care work-up for

the maintenance of these patients quality of life (QoL) specifically pertaining to their

heart illness is a must. The term QoL references the general well-being of individuals andsocieties. The term is used in a wide range of contexts, including in the field of

healthcare. Standard indicators of the QoL include not only wealth and employment but

also the built environment, physical and mental health, education, recreation and leisuretime, and social belonging (Gregory, Johnston, Pratt, Watts, Whatmore, 2009 and

Nussbaum, M & Sen, A. ed. 1993).

Hence, HRQoL or QoL interchangeably, is a broad multidimensional concept

encompassing self-reported measures of physical and mental health (Beck & Shah 2012).

This faade refers to how a health condition impacts a persons perception of their well-

being. HRQoL consists several domains which includes functional ability, psychologicalstate, social function, overall life satisfaction and an individuals perception of his own

health. Health is defined by WHO as being not only the absence of disease and infirmity

but also the presence of physical, mental, and social well-being, and so quality-of-lifeissues have become steadily more important in health care practice and research. And by

that definition, health is one of the main components defining the concept of QoL, along

with other aspects of perceptions, social, experiences, expectations, economic andcultural; in which may be referred collectively as perceptions of health according to Testa

& Simonson (1996). An importance of HRQoL measurement according to American

Heart Association (AHA) is that HRQoL measurements can be used in measuring

effectiveness of treatment and predict the long-term mortality after a cardiac event. This
http://www.worldlifeexpectancy.com/philippines-coronary-heart-diseasehttp://www.worldlifeexpectancy.com/philippines-coronary-heart-diseasehttp://en.wikipedia.org/wiki/Martha_Nussbaumhttp://en.wikipedia.org/wiki/Amartya_Senhttp://www.worldlifeexpectancy.com/philippines-coronary-heart-diseasehttp://www.worldlifeexpectancy.com/philippines-coronary-heart-diseasehttp://en.wikipedia.org/wiki/Martha_Nussbaumhttp://en.wikipedia.org/wiki/Amartya_Sen

7/27/2019 1st revision3 - 97-03

3/22


is also in line with the main goals of treating CAD which is prolonging life and

improving HRQoL (Klocek & Kawecka-Jaszcz, 2013). An improvement in HRQoL is

considered to be important as a primary outcome and in the determination of therapeuticeffects. In addition, this could also serve as a means of secondary prevention strategies

(Dempster, Donnelly, & O'Loughlin, 2004). This goal could be attained way through

upon starting of HRQoL determination over CVD patients HRQoL assessment.

As previously described, it is now safe to say that HRQoL assessment is an

important measurement of the impact of the disease, effect of treatment and othervariables affecting peoples lives (Thompson & Yu, 2003). As mentioned earlier, Lee

(2013) discussed that an advantage of QoL is that it not only takes physical health into

consideration but emotional and social aspects of life and that of physicians' perspectives

and patients' perspectives can be very different in which a physician may regard as asuccessful procedure may not be perceived in the same light as the patient or their family.

Furthermore, examining both perspectives may ensure patients and healthcare

professionals setting realistic goals about what to expect following interventions, in

particular after any cardiac interventions including surgery. At this point of caring to ourpatients, advantage of measuring CVD patients HRQoL is worthy looking upon since

Lukkarinen (2008) suggested that consideration of patients HRQoL should be takenalongside with the clinical severity of the disease.

With the presence of a CVD, QoL is directly affected. Sawatzky et al. (2005)observed that those with chronic illness tend to participate in less physical activity which

in turn can worsen their physical QoL and increase problems such as immobility and pain

affecting how their overall HRQoL. The challenge seems to be balancing the symptoms

of chronic illness from comorbidities and maximizing the benefits of cardiacinterventions. CAD is a progressive condition and while procedures only seek to relieve

symptoms, they are not curative. The importance of monitoring and managing other

comorbid conditions is essential to maximize QoL.

Another importance of determination of CVD patients HRQoL is that some of

the studies like that of Xie, Wu, & Zheng (2008) revealed that better treatments prolonglife expectancy of CHD patients but that quality of those extra years may be less than

ideal. In this context, knowledge about patients HRQoL is a vital data for health care

professionals which reflects the appropriateness of their given intervention for these

patients in their attempt to improve HRQoL. Beck & Shah (2012) also agreed thatpatient-centered outcomes which includes HRQoL will become even more important as

individuals adjust to living with chronic conditions such as in CAD.

The challenge for healthcare professionals more importantly to the nurses since

assessment is an innate role of the nurses in the area, is to assess patients QoL, recognize

and manage these potentially confounding variables and ultimately improve apatient's QoL. The aforementioned task can only be done if health care professionals had

a view of cardiac patients HRQoL. Nevertheless, in Baguio City, where as observed

coronary patients are exponentially increasing, no available literature that I came across

that focused on the said aspect of care. As a routine, some if not all of the cardiologists in

7/27/2019 1st revision3 - 97-03

4/22


the country assesses their patients with the different clinical signs and symptoms as

expected from the said medical condition however, these assessments are not quantified

as to per domains of QoL to determine whether they have poor or good QoL. Basing onrelated literatures which has already presented QoL and its importance to persons with

CVD, no studies until at present had been made in Baguio City measuring the QoL of

these specific patients.

Objectives of the Study

The objectives of the study are:

To describe the global QoL of CVD patients

To determine the QoL of CVD patients per domains or subscales of QoL

To explore how dependent variables affects QoL of patients with CVD

Research Problems

1. What is the total QoL of persons with CVD in Baguio City?

2. What is the QoL of persons with CVD in Baguio City along:a. Physical functioning

b. Emotional functioning

c. Socioeconomic functioningd. Psychological/ spiritual

3. Is there a significant difference in the QoL of persons with CVD according to:

a. Ageb. Gender

c. Educational attainment

d. Marital statuse. Socioeconomic status

Framework of the Study

Dorothea Orems Self-Care Deficit theory is the principle that guides the study.

Accordingly, in the theory of self-care, the performance or practice of activities thatindividuals initiate and perform or the activities of daily living (ADLs) on their own

behalf to maintain life, health and well-being. If there is a deficit that exists when the

patient cannot carry out his ADLs, it is where the role of the nurses come in to fulfill theinsufficiency in activities of the patient. There are three nursing systems in the theory

which include the supportive-educative nursing system or also known as the supportive-

developmental system. Here, the patient is doing all of the self-care and is able toperform or can and should learn to perform required measures of externally or internally

oriented therapeutic self-care but cannot do so without assistance and so patients require

for help confined to decision making, behavior control and acquiring knowledge andskills.

7/27/2019 1st revision3 - 97-03

5/22


In relation to the study, patients QoL is a dual responsibility by the health care

team and the patient in which CVD clients seek support from the nurses by way ofeducative means when they experience a deficit and so to make-up for that which in turn

can improve CVD patients knowledge on QoL that may contribute to improvement of

QoL (George, 1995).

Significance of the Study

Nursing Practice

This study could provide a foundation in the promotion of a routine heart disease

QoL assessment to our coronary patients with the utilization of some validated

instruments. The interpreted measured QoL may be used for monitoring patient care,improvement of the patient, informing the health care team on patient wellness

throughout the health care process. In the process, this may also contribute to thedevelopment of an algorithm for CVD patients assessment. The proposed algorithm isattached in the appendices.

Nursing Education

This piece of knowledge could be used in discussion of CVD management in

Medical Surgical Nursing as well as on how to handle this patients. Nurses in the

academe acting as clinical instructors as well as the student nurses will have their

knowledge reinforcements regarding QoL, which may lead to their change in behaviortowards QoL of CVD patients therefore acting as a change agent in delivery of care

improving QoL of their specified clients. Utilization of the different tools could also betaught so that proper QoL assessment could be facilitated.

Nursing Research

This study will be the basis of future research.

Respondents

This would be of significant to the patients because measurement of HRQoL isaim to determine the patients own experience of health and illness particularly CVD in a

broad perspective. A persons QoL is greatly affected by his or her expectationsregarding health and their ability to cope with limitations and disability. With this study,

CVD patients will further realize importance and maintenance of QoL despite CVD.

Upon realization, patients would be receptive of their own health status and therefore

may lead to continuous or attitude change towards positive perspective making themmore productive all throughout despite the disease process.

7/27/2019 1st revision3 - 97-03

6/22


METHODS and PROCEDURES

Research Design

The study will be using descriptive quantitative research. Quantitative researchinvolves the systematic collection of numerical information, often under conditions of

considerable control and the analysis of that information using statistical procedure (Polit,

2008).

Locale and Population

The respondents will be residents of Baguio City who seek for a medical

consultation to a cardiologists. The inclusion criteria include those who are diagnose of

any CVD, of legal age or consenting age so they can give their informed consent

specifically those who are considered in their middle adulthood aging 40-65 years oldaccording to Ericksons developmental theory. The respondents will be those who are

ambulatory and not in coma. Total enumeration will be used at the scheduled day of data

gathering in a cardiologists clinic and in the outpatient department of selected hospitals.

The total number of CVD incidence in Baguio City to be obtained in the Baguio

Health Department as well as NSO Baguio City and the sample size is based on Cochranewhich dictates 385 respondents to be completed.

7/27/2019 1st revision3 - 97-03

7/22


Data Gathering Tool

A closed-ended questionnaire will be used to gather data for the study, which is

composed of 2 fully-adapted tools. The Short Form 36 (SF-36) and Quality of Life Index

Cardiac Version IV (QLI) are copyrighted tools and are free for use, nevertheless, theresearcher sent an email to the authors notifying them for the utilization of the said tools

in which they confirmed the permission to use the tool. Both tools are highly-reliable and

valid for measuring QoL of patients with CVD and had been already used in a variousstudies in a wide variety of settings such as in the different countries mentioned earlier.

The utilization of the said tools would be enough to measure or answer the research

questions. The scores are directly related to QoL whereas the higher the scores, the betterthe QoL and lower scores signifies poor QoL.

Tool (1) Medical Outcomes Study Short Form-36 is a generic tool, meaning not a

disease specific tool, was from a longer instruments which were completed by the

patients who were participating in the Medical Outcomes Study, an observational studyof the different practice styles by the physicians and in different systems of health care

delivery in relation with the patient outcomes and turned out to had a Cronbachs alpharanges between 0.64-0.92 (Thompson & Yu, 2003). This scale contains 36-item which

has eight subscales namely: (1) Physical functioning; (2) bodily pain; (3) role limitations

due to physical health problems; (4) role limitations due to personal or emotionalproblems; (5) emotional well-being; (6) social functioning; (7) energy/fatigue; and (8)

general health perceptions. The scores are directly proportional to the Health-related

Quality of Life wherein the higher the scores are, the better HRQL is.

Physical functioning includes item numbers 3 to 12 while role limitations due to

physical health problems are numbered 13 to 16. Role limitations due to personal oremotional problems consisted of items number 17- 19 while energy/ fatigue items arerandomly numbered as 23, 27, 29 and 31. Emotional well-being subscale has items

number 24 to 26, 28 and 30. Social functioning subscale has items number 20 and 32

while bodily pain or simply pain subscale is items number 21 and 22. Lastly, generalhealth subscale items are numbers 1, 2 and 33 to 36.

Tool (2) Ferrans and Powers Quality of Life Index (QLI) Cardiac Version IVconsists 70 items. These 70 items were divided into 2 parts equally. Part 1 measures the

patients satisfaction in relation with the different life domains, and Part 2 measures the

significance of these domains to the patient. The QLI cardiac version-IV has domains

of 4 namely health and functioning, socioeconomic, psychological and spiritual, family)and global QoL or total QoL. The scales and items have satisfactorily reliable and valid

(Durmaz, Ozdemir, Keles, Akar Bayram, & Bozkuri, 2009). These subscales consisted of

respective items. In the health and functioning subscale, this consisted of items number 1to 8, 12, 17 to 19, 26-27 and 35. Socioeconomic subscale included items number 14, 16,

and 20 to 25. Items numbered 28 to 34 belongs to psychological and spiritual subscale

and the remaining items numbered 9 to 11, 13 and 15 consisted the family domain.

7/27/2019 1st revision3 - 97-03

8/22


Computation of the

Data-Gathering Procedure

The researcher will make a communication letter to the BHD and NSO to be

noted by the research adviser for the procurement of numerical data of incidences ofCVD in Baguio City. The researcher will also make a request letter to be shown to the

different cardiologists, still to be noted by the research adviser, for the doctors

permission for the researcher to be able to float the questionnaires to their patients. Thisprocedure would be repeatedly done until the required number of respondents are

completed. The researcher may also go back again in a particular clinic to gather other

CVD patients in a different occasion providing that the doctors have given permission.

Upon face to face with the CVD patients, the researcher will establish rapport

with the respondents and will give a consent letter asking for their approval to answer the

questionnaire. They will be instructed to put a check mark on the boxes and encircle the

numbers provided for their choice. The researcher will check the consent letter for theresponse. If the respondents agreed to participate, the administration of the questionnaire

then follows. The researcher will explain the purpose of the research, the nature of thestudy and the likely risks and benefits that would be incurred. The respondents will be

informed that their answers will be treated anonymously and confidentially. During the

collection of the questionnaires, the researcher will maintain a distance enough for therespondents to approach if there would be some questions or clarifications regarding the

research or the tool itself. After answering, the questionnaires will be check for the

completeness of the answers before leaving the area. The data will then be tallied and will

be organized for interpretation.

Statistical Treatment

After meeting- up the sample size, descriptive and inferential statistics will beutilized to treat data that will be gathered to answer the research questions. Students t-

test and analysis of variance will be used in the statistical analysis. P

7/27/2019 1st revision3 - 97-03

9/22


APPENDICES

Tools/ScaleMedical Outcomes Study: 36-Item Short Form Survey Instrument

1. In general, would you say your health is:

Excellent 1

Very good 2

Good 3

Fair 4

Poor 5

2. Compared to one year ago, how would you rate your health in general now?

Much better now than one year ago 1

Somewhat better now than one year ago 2

About the same 3

7/27/2019 1st revision3 - 97-03

10/22


Somewhat worse now than one year ago 4

Much worse now than one year ago 5

The following items are about activities you might do during a typical day. Does your

health now limit you in these activities? If so, how much?

(Circle One Number on Each Line)

Yes, Limited

a Lot

Yes, Limited

a Little

No, Not

limited at All

3. Vigorous activities, such as running, lifting

heavy objects, participating in strenuous sports

[1] [2] [3]

4. Moderate activities, such as moving a table,

pushing a vacuum cleaner, bowling, or playinggolf

[1] [2] [3]

5. Lifting or carrying groceries [1] [2] [3]

6. Climbing several flights of stairs [1] [2] [3]

7. Climbing one flight of stairs [1] [2] [3]

8. Bending, kneeling, or stooping [1] [2] [3]

9. Walking more than a mile [1] [2] [3]

10. Walking several blocks [1] [2] [3]

11. Walking one block [1] [2] [3]

12. Bathing or dressing yourself [1] [2] [3]

During the past 4 weeks, have you had any of the following problems with your work or

other regular daily activities as a result of your physical health?


Yes No

13. Cut down the amount of time you spent on work or other activities 1 2

7/27/2019 1st revision3 - 97-03

11/22


14. Accomplished less than you would like 1 2

15. Were limited in the kind of work or other activities 1 2

16. Had difficulty performing the work or other activities (for example, it took

extra effort)

1 2

During the past 4 weeks, have you had any of the following problems with your work or

other regular daily activities as a result of any emotional problems (such as feeling

depressed or anxious)?


Yes No

17. Cut down the amount of time you spent on work or other activities 1 2

18. Accomplished less than you would like 1 2

19. Didn't do work or other activities as carefully as usual 1 2

20. During the past 4 weeks, to what extent has your physical health or emotional

problems interfered with your normal social activities with family, friends, neighbors, or

groups?

(Circle One Number)

Not at all 1

Slightly 2

Moderately 3

Quite a bit 4

Extremely 5

21. How much bodily pain have you had during the past 4 weeks?

(Circle One Number)

None 1

7/27/2019 1st revision3 - 97-03

12/22


Very mild 2

Mild 3

Moderate 4

Severe 5

Very severe 6

22. During the past 4 weeks, how much did pain interfere with your normal work

(including both work outside the home and housework)?

(Circle One Number)

Not at all 1

A little bit 2

Moderately 3

Quite a bit 4

Extremely 5

These questions are about how you feel and how things have been with you during the

past 4 weeks. For each question, please give the one answer that comes closest to the way

you have been feeling.

How much of the time during the past 4 weeks . . .


All of theTime

Most ofthe Time

A Good Bitof the Time

Some ofthe Time

A Little ofthe Time

None ofthe Time

23. Did you feel full of

pep?

1 2 3 4 5 6

24. Have you been a very

nervous person?

1 2 3 4 5 6

25. Have you felt so down

in the dumps that nothingcould cheer you up?

1 2 3 4 5 6

26. Have you felt calm

and peaceful?

1 2 3 4 5 6

7/27/2019 1st revision3 - 97-03

13/22


27. Did you have a lot of

energy?

1 2 3 4 5 6

28. Have you felt

downhearted and blue?

1 2 3 4 5 6

29. Did you feel wornout?

1 2 3 4 5 6

30. Have you been a

happy person?

1 2 3 4 5 6

31. Did you feel tired? 1 2 3 4 5 6

32. During the past 4 weeks, how much of the time has your physical health or emotional

problems interfered with your social activities (like visiting with friends, relatives, etc.)?

(Circle One Number)

All of the time 1

Most of the time 2

Some of the time 3

A little of the time 4

None of the time 5

How TRUE or FALSE is each of the following statements for you.


Definitely

True

Mostly

True

Don't

Know

Mostly

False

Definitely

False

33. I seem to get sick a

little easier than other

people

1 2 3 4 5

34. I am as healthy as

anybody I know

1 2 3 4 5

35. I expect my health toget worse

1 2 3 4 5

36. My health is excellent 1 2 3 4 5

7/27/2019 1st revision3 - 97-03

14/22


Ferrans and Powers QUALITY OF LIFE INDEX CARDIAC VERSION - IV

PART 1. For each of the following, please choose the answer that best describes how

satisfied you are with that area of your life. Please mark your answer by circling the

number. There are no right or wrong answers.

HOW SATISFIED ARE YOU WITH:

VeryD

issatisfied

ModeratelyDissatisfied

SlightlyDissatisfied

SlightlySatisfied

ModeratelySatisfied

Very

Satisfied

1. Your health? 1 2 3 4 5 6

2. Your health care? 1 2 3 4 5 6

3. The amount of chest pain (angina) that you 1 2 3 4 5 6

7/27/2019 1st revision3 - 97-03

15/22


have?

4. Your ability to breathe without shortness

of breath?

1 2 3 4 5 6

5. The amount of energy you have for

everyday activities?

1 2 3 4 5 6

6. Your ability to take care of yourselfwithout help?

1 2 3 4 5 6

7. The amount of control you have over your

life?

1 2 3 4 5 6

8. Your chances of living as long as youwould like?

1 2 3 4 5 6

9. Your familys health? 1 2 3 4 5 6

10. Your children? 1 2 3 4 5 6

11. Your familys happiness? 1 2 3 4 5 6

12. Your sex life? 1 2 3 4 5 6

13. Your spouse, lover, or partner? 1 2 3 4 5 6

14. Your friends? 1 2 3 4 5 615. The emotional support you get from your

family?

1 2 3 4 5 6

16. The emotional support you get from

people other than your family?

1 2 3 4 5 6

17. Your ability to take care of family

responsibilities?

1 2 3 4 5 6

18. How useful you are to others? 1 2 3 4 5 6

19. The amount of worries in your life? 1 2 3 4 5 6

20. Your neighborhood? 1 2 3 4 5 6

21. Your home, apartment, or place where

you live?

1 2 3 4 5 6

22. Your job (if employed)? 1 2 3 4 5 6

23. Not having a job (if unemployed, retired,or disabled)?

1 2 3 4 5 6

24. Your education? 1 2 3 4 5 6

25. How well you can take care of your

financial needs?

1 2 3 4 5 6

26. The things you do for fun? 1 2 3 4 5 6

27. Your chances for a happy future? 1 2 3 4 5 6

28. Your peace of mind? 1 2 3 4 5 6

29. Your faith in God? 1 2 3 4 5 6

30. Your achievement of personal goals? 1 2 3 4 5 6

31. Your happiness in general? 1 2 3 4 5 6

32. Your life in general? 1 2 3 4 5 6

33. Your personal appearance? 1 2 3 4 5 6

34. Yourself in general? 1 2 3 4 5 6

35. The changes in your life that you havehad to make because of your heart problem

1 2 3 4 5 6

7/27/2019 1st revision3 - 97-03

16/22


(for example, changes diet, physical activity,

and/or smoking?)

PART 2. For each of the following, please choose the answer that best describes howimportant that area of your life is to you. Please mark your answer by circling the

number. There are no right or wrong answers.

HOW SATISFIED ARE YOU WITH:

VeryUnimportant

ModeratelyUnimportant

SlightlyUnimportant

SlightlyImportant

ModeratelyImportant

VeryImportant

1. Your health? 1 2 3 4 5 62. Your health care? 1 2 3 4 5 6

3. Having no chest pain (angina)? 1 2 3 4 5 6

4. Having no shortness of breath? 1 2 3 4 5 6

5. Having enough energy for everyday

activities?

1 2 3 4 5 6

6. Taking care of yourself without help? 1 2 3 4 5 6

7/27/2019 1st revision3 - 97-03

17/22


7. Having control over your life? 1 2 3 4 5 6

8. Living as long as you would like? 1 2 3 4 5 6

9. Your familys health? 1 2 3 4 5 6

10. Your children? 1 2 3 4 5 6

11. Your familys happiness? 1 2 3 4 5 6

12. Your sex life? 1 2 3 4 5 613. Your spouse, lover, or partner? 1 2 3 4 5 6

14. Your friends? 1 2 3 4 5 6

15. The emotional support you get from your

family?

1 2 3 4 5 6

16. The emotional support you get from

people other than your family?

1 2 3 4 5 6

17. Taking care of family responsibilities? 1 2 3 4 5 6

18. Being useful to others? 1 2 3 4 5 6

19. Having no worries? 1 2 3 4 5 6

20. Your neighborhood? 1 2 3 4 5 6

21. Your home, apartment, or place whereyou live?

1 2 3 4 5 6

22. Your job (if employed)? 1 2 3 4 5 6

23. Having a job (if unemployed, retired, or

disabled)?

1 2 3 4 5 6

24. Your education? 1 2 3 4 5 6

25. Being able to take care of your financialneeds?

1 2 3 4 5 6

26. Doing things for fun? 1 2 3 4 5 6

27. Having a happy future? 1 2 3 4 5 6

28. Peace of mind? 1 2 3 4 5 6

29. Your faith in God? 1 2 3 4 5 6

30. Achieving your personal goals? 1 2 3 4 5 6

31. Your happiness in general? 1 2 3 4 5 6

32. Being satisfied with life? 1 2 3 4 5 6

33. Your personal appearance? 1 2 3 4 5 6

34. Are you to yourself? 1 2 3 4 5 6

35. The changes in your life that you have

had to make because of your heart problem(for example, changes diet, physical activity,

and/or smoking?)

1 2 3 4 5 6

ALGORITHM

Specific diagnostic

work-ups forestablishment of CVDNegative Positive

Not managed as CVD

patients

Managed as CVD

patients

SF-36 & QLI

cardiac v. IV

administratioFollow-up check ups

Various domains affectingQoL (physical, emotional,socioeconomic,

psychological/ spiritual)

QoL interpretation

and classificationaccording to

Determination of QoL

according to preferredscales

Health teaching provision or reinforcement of knowledge asnecessary depending upon which domain of QoL results in low

QoL

Improvement of QoL

7/27/2019 1st revision3 - 97-03

18/22


A patient should be fully established of any CVD diagnosis and have already sought for

treatment or management and the assessment of QoL should be administered upon

follow-up check-up in using the SF-36 and QLI cardiac version IV and be monitoredthereafter. Classification of QoL will then be facilitated using the preferred scaling. The

degree for the need of educative function of nurses in the various QoL domains can be

initiated depending from the patients QoL results.

7/27/2019 1st revision3 - 97-03

19/22


REFERENCES

American Heart Association, 2008

Asadi-Lari, M., Packham, C., & Gray, D. (2003). Patient's Satisfaction and Quality of

Life in Coronary Artery Disease.Health and Quality of Life Outcomes .

Beck, C., & Shah, S. (2012). Research on Health-related Quality of Life and Cardiac

Conditions.Medline .

Brown, N., Melville, M., Gray, D., Young, T., Munro, J., & Skene, A. (1999). Quality of

Life Four Years After Acute Myocardial Infarction: Short Form 36 Scores Compared

with a Normal Population.Heart.

Constitution of the World Health Organization. In: World Health Organization.

Handbook of basic documents. 5th ed.

Dempster, M., Donnelly, M., & O'Loughlin, C. (2004). The Validity of the New Quality

of Life in Heart Disease Questionnaire.Health and Quality of Life Outcomes .

Dunderdale K, T. D. (2005). Quality-of-life measurement in chronic heart failure: do we

take account of the patient perspective?European Journal of Heart Failure , 572-582.

Durmaz, T., Ozdemir, O., Akyunak Ozdemir, B., Keles, T., Akar Bayram, N., & Bozkurt,

E. (2009). Factors Affecting Quality of Life in Patients with Coronary Heart Disease.Turk J Med Sci.

George, JB (1995), Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton

& Lange.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM,

Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA,

Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth

LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS,

Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, ViraniSS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee

and Stroke Statistics Subcommittee. Heart disease and stroke statistics2013 update: a

report from the American Heart Association. Circulation. 2013 Jan 1;127(1):e6-e245.

doi: 10.1161/CIR.0b013e31828124ad. Epub 2012 Dec 12. Retrieved from HYPERLINK

"http://circ.ahajournals.org/content/127/1/e6.long"

http://circ.ahajournals.org/content/127/1/e6.long

7/27/2019 1st revision3 - 97-03

20/22


HYPERLINK "http://en.wikipedia.org/wiki/Derek_Gregory" \o "Derek Gregory"

Gregory, Derek ; Johnston, Ron; Pratt, Geraldine; HYPERLINK

"http://en.wikipedia.org/wiki/Michael_Watts" \o "Michael Watts" Watts, Michael

; Whatmore, Sarah, eds. (June 2009). "Quality of Life". Dictionary of Human

Geography (5th ed.). Oxford: Wiley-Blackwell. Retrieved from: pwias.ubc.ca. 2013

Kiessling, A. (2005). Quality of Care anf Quality of Life in Coronary Artery Disease.

Karolinska, Institutet at Danderyd University Hospital, Department of Internal Medicine,

Stockholm, Sweden.

Klocek, M., & Kawecka-Jaszcz, K. (2013). Quality of Life in Patients with Coronary

Artery Disease. Springer-Verlag Italia .

Kochanek KD, Xu JQ, Murphy SL, Minio AM, Kung HC.(2011) HYPERLINK

"http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf" \t "_blank" Deaths:

final data for 2009. National vital statistics reports.

Lalonde, L., Clarke, A., Joseph, L., MacKenzie, T., & Grover, S. (2001). Health-related

Quality of Life with Coronary Heart Disease Prevention and Treatment. Journal of

clinical Epidemiology.

Lau-Walker, M., Cowie, M., & Roughton, M. (2008). Coronary Heart Disease Patients'

Perception of their Symptoms and Sense of Control are Associated with their Quality of

Life Three Years Following Hospital Discharge.Journal of Clinical Nursing.

Lee, G. (2010). Coronary Artery Disease and Quality of Life. Center for International

Rehabilitation Research Informaion and Exchange (CIRRIE) .

Lukkarinen, H. (2008). Assessment of Quality of Life with the Nottingham Health Profile

among Patients with Coronary Heart Disease.Journal of Advanced Nursing.

Mhaila, E. (2010). The Role of Avoidable Mortality in Health Assessment . Management

in Health.

HYPERLINK "http://en.wikipedia.org/wiki/Martha_Nussbaum" \o "Martha

Nussbaum" Nussbaum, M and HYPERLINK

"http://en.wikipedia.org/wiki/Amartya_Sen" \o "Amartya Sen" Sen, A. ed.

(1993). The Quality of Life, Oxford: Clarendon Press. Retrieved fromhttp://www.oxfordscholarship.com

Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., & Almahmeed, W.

(2004). INTERHEART study: Control Study.Lancet.

7/27/2019 1st revision3 - 97-03

21/22


Rumsfeld, J., MaWhinney, S., McCarthy, M. J., Shroyer, A., VillNueva, C., O'Brien, M.,

et al. (1999). Health-Related Quality of ife as a Predictor of Mortality Following

Coronary Artery Bypass Grafty Surgery.American Medical Association .

Spertus, J., Jones, P., McDonnel, M., Fan, V., & Fihn, S. (2002). Health Status Predicts

Long-Term Outcome in Outpatients with Coronary Disease. Circulation .

Stafford, L., Berk, M., & Jackson, H. (2009). Are Illness Perceptions about Coronary

Artery Disease Predictive of Depresssion and Quality of Life Outcome? Journal of

Psychosomatic Research .

Stafford, L., Berk, M., & Jackson, H. (2013). Tobacco Smoking Predicts Depression and

Poorer Qualoty of Life in Heart Disease.BMC Cardiovascular Disorders .

Staniute, M., & Brozaitiene, J. (2010). Changes in Health- Related Quality of Life among

Patients with Coronary Artery Disease: A 2-year Follow-up.Medicina (Kuanas) .

Tavella, R., & Beltrame, J. (2012). Cardiac Rehabilitation may not Provide a Quality of

Life Benefit in Coronary Artery Disease Patients.BMC Health Services Research .

Testa, M., & Simonson, D. (1996). Assessment of Quality of Life Outcomes. The New

England Journal of Medicine .

Thompson, D., & Yu, C. (2003). Quality of Life in Patients with Coronary Heart Disease-

I: Assessment tools.Health and Quality of Life Outcomes .

Tofighi, S., Kiadaliri, A., Sadeghifar, J., Raadabadi, M., & Mamikhani, J. (2012). Health-

Related Quality of Life among Patients with Coronary Artery Disease: A Post-TreatmentFollow-Up Study in Iran. Cardiology Research and Practice .

Ware, J. (2003). Conceptualization and Measurement of Health-Related Quality of Life:

Comments on an Evolving Field.American Congress of Rehabilitation Medicine .

Westin, L., Carlsson, R., Israelsson, B., Willenheimer, R., Vline, C., & McNeil, T.

(1997). Quality of Life in Patients with Ischemic Heart Disease: A Prospective

Controlled Study.J Intern Med.

Xie, J., Wu, E., & Zheng, Z. (2008). Patient-reported Health Status in Coronary Heart

Disease in the United States. Age, Sex, Racial and Ethnic Differences. Circulation.

7/27/2019 1st revision3 - 97-03

22/22


1st revision3 - 97-03

Documents