The impact of angina and cardiac history on health-related quality of life and depression in coronary heart disease patients.

OBJECTIVE: To prospectively examine the contribution of angina and cardiac history to health-related quality of life (HRQoL) and depression in cardiac patients, over 6 months post-hospitalization. METHODS: Participants were myocardial infarction (MI), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) outpatients under the age of 70 years. One hundred and seventy-one patients consented to participate, with 121 patients being retained 6 months later (71% response rate). The impact of the patient's cardiac history and the presence of angina on physical, social and emotional HRQoL and depression was examined. RESULTS: At baseline, cardiac history was not significantly related to any of the dimensions of HRQoL or depression. At 6-month follow-up, cardiac history significantly predicted a higher level of depression, and angina was predictive of a significantly worse emotional, physical and social HRQoL and a higher level of depression. DISCUSSION: The presence of a cardiac history is associated with depression 6 months post-cardiac event, and angina is associated with both an adverse HRQoL and higher levels of depression. As past research has demonstrated that depression is a risk factor for mortality in patients with established heart disease, it is important from both a clinical and a research perspective to address these issues.

Self-efficacy and overprotection are related to quality of life, psychological well-being and self-management in cardiac patients.

This repeated-measures study explores how self-efficacy and overprotection relate to psychological well-being, health-related quality of life and self-management. Eighty-two cardiac patients, suffering from congestive heart failure (CHF) or myocardial infarction (MI), completed questionnaires at T1 and three months later. Perceived overprotection is associated with concurrent levels of anxiety and depression, and lowered quality of life. Self-efficacy is related to psychological well-being in both patient groups, but only associated with quality of life in CHF patients. In addition, self-efficacy predicts MI patients' self-management behaviours in the medium term. Findings have implications for cardiac rehabilitation, where attention may usefully be focused on enhancing self-efficacy and dealing with issues of support and overprotection by the partner.

Effects of a behavioural intervention on quality of life and related variables in angioplasty patients: results of the EXhaustion Intervention Trial.

OBJECTIVES: The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI). METHODS: Seven hundred ten patients were randomized into an intervention group and a usual care control group. The group intervention focused on stressors leading to exhaustion and on support of recovery. HRQL (measured by the MacNew questionnaire), exhaustion [measured by the Maastricht Questionnaire and the Maastricht Interview Vital Exhaustion (MIVE)], anxiety (measured by the State-Trait Inventory), and depression (measured by the structured clinical interview for DSM-IV) were assessed at intake and at 6 and 18 months. Presence of anginal complaints was assessed at 18 months. RESULTS: The intervention had a significant beneficial effect on all psychological factors except hostility and on the presence of anginal complaints. The effect of the intervention on exhaustion, as assessed by the MIVE, was modified by a previous history of coronary artery disease (CAD). Gender modified the effect of the intervention on exhaustion and on anxiety, the strongest effect being observed in women. CONCLUSIONS: The behavioural intervention improved HRQL and related psychological factors. Somatic comorbidity and a history of CAD limited the effect of the intervention.

Attachment in families with Huntington's disease. A paradigm in clinical genetics.

OBJECTIVE: Based on the premise that attachment experiences lead to a working model for social relationships throughout life, this study investigates if there is a difference between adult attachment representations in individuals who were brought up by a parent with Huntington's disease (HD), compared to a non-clinical population. Specific events in the parents' disease process, especially those leading to trauma and loss will receive attention. METHODS: Using the Adult Attachment Interview, adult attachment representations were investigated in 32 unaffected adults at 50% risk for HD who were raised by an affected parent. RESULTS: We found a lower percentage of secure attachment representations, a higher percentage of preoccupied representations, and a higher percentage of unresolved/disorganized representations in our sample, compared to a non-clinical population. A relatively late start of the parent's HD career was associated with a secure adult attachment representation. Death of the HD parent before the child's 18th birthday was associated with an unresolved/disorganized adult attachment representation. CONCLUSION: Growing up in a family where one of the parents has Huntington's disease appears to affect the offspring's adult attachment representation. PRACTICE IMPLICATIONS: This study can be of relevance for genetic counselling, as well as for counselling and intervention in childrearing matters.

Goal disturbance predicts health-related quality of life and depression 4 months after myocardial infarction.

OBJECTIVES: The aim of this longitudinal study was to determine whether the event of a myocardial infarction (MI) would lead to a disturbance in important higher-order goals, and whether goal disturbance could predict health-related quality of life (HRQL) and depression 4 months later, in addition to baseline scores, demographic characteristics, presence of anginal complaints (AP) or chest pain, coping strategies and social support. METHOD: A total of 113 MI patients completed questionnaires shortly after hospitalization (T1) and 4 months later (T2), assessing (an impact of the event on) important higher-order goals (T1), disease-related coping strategies (T1), perceived adequacy of social support (T2), AP (T2), HRQL, and depression (T2). Two separate hierarchical regression analyses were performed with HRQL and depression at T2 as dependent variables. RESULTS: The results suggest that the experience of an MI has an impact on the attainment of higher-order goals. Goal disturbance is an independent predictor of both HRQL and depression after MI. CONCLUSION: A goal theory perspective can provide additional insights into HRQL outcomes after an MI.

Quality of life after myocardial infarction: translation and validation of the MacNew Questionnaire for a Dutch population.

A wide range of instruments have been used in health-related quality of life (HRQL) assessment of patients with coronary artery disease. The MacNew heart disease health-related quality of life questionnaire (MacNew) is a disease-specific measure of HRQL, that has been found to have both good discriminative and evaluative properties. The objective of the present study was to translate the MacNew for a Dutch population, and assess its reliability and validity. Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac event, participated in the study. Questionnaires were filled out at baseline, at 3 months, and at 12 months. A clinically relevant three-factor solution, reflecting an emotional, physical, and social domain of HRQL, allowed us to explain 55% of variance. Angina pectoris was consistently found to be significantly associated with worse HRQL. The pattern of correlations between the subscales of the MacNew on the one hand, and between the subscales of the MacNew and two other, related questionnaires on the other hand, indicated only modest convergent and discriminant validity. The internal consistency was found to be fair to (very) good (ranging between 0.78 and 0.95). Finally, the Dutch MacNew was demonstrated to be substantially more responsive than two other instruments measuring physical and psychological well-being.

Development, content, and process evaluation of a short self-management intervention in patients with chronic diseases requiring self-care behaviours.

Many patients with asthma, diabetes, and heart failure do not succeed in integrating the required self-management behaviours into their lives, and fail to attain optimal disease control. The purpose of this study was to describe the development of a theory-driven intervention to enhance self-management that would be appreciated and accepted by participants and providers. Based on self-regulation theory and proactive coping, the program emphasised goal-setting and the planning of behaviour. In five 2h group sessions, participants first decided upon their own goal and behaviours they wanted to change. Next, they wrote an action-plan to implement these behavioural intentions. Behavioural rehearsal and self-monitoring took place between the sessions. Participants and nurse providers evaluated the intervention positively. Evaluations were unrelated to patients' health at baseline, or to feelings of self-efficacy regarding self-management. But patients of older age, lower education, or no current employment responded best to the intervention.

Modeling predictors of quality of life after coronary angioplasty.

Psychological predictors of quality of life in patients undergoing coronary angioplasty were investigated using a prospective model based on self-regulation and stress-coping theories. Predictors (chest pain, disturbance of personal goals, stress perception, approach coping, avoidant coping, and optimism) and three quality of life indicators (disease-specific quality of life, positive affect, and negative affect) were measured with questionnaires in 158 patients both when they were admitted on the waiting list for angioplasty and 3 months after angioplasty. The results were congruent with expectations based on the theories and indicated that the models predicting disease-specific quality of life and negative affect fit the data well. Avoidant Coping and Stress Perception predicted all quality of life indicators. Goal Disturbance predicted only negative quality of life variables, and Approach Coping predicted only positive quality of life variables. Chest Pain predicted Disease-Specific Quality of Life and Positive Affect. Optimism served as a coping resource. Individualized behavior modification interventions were recommended, but the data suggest that patients may not be easily persuaded to engage in health behavior.