the impact of heart disease on quality of life

Question 1

what is quality of life?

Answer 1

a combination of a person physical, mental and social well being, not merely the absence of disease

Question 2

what are the determinants of quality of life in heart disease?

Question 3

what is the relationship between depression and heat disease?

Answer 3

• loss of self worth
• loss of confidence
• loss of independence
• persistent severe reaction to health problem = depression

Question 4

what are 3 different ways to measure the health of individuals and populations?

Answer 4

• mortality rates
• morbidity rates
• measures of function

Question 5

describe QOL as a concept?

Answer 5

it is a concept that aims to capture the well being, (wether a population or individual), regarding both positive and negative elements within the entirely of their existence at a specific point in time.

Question 6

describe the bio physiological model of QOL?

Answer 6

biological = often associated with the relationship of disease and bodily health

social = interpersonal factors such as social interactions and community activities

psychological = the aspects of mental and emotional wellness that also relate to behaviour

Question 7

QALYS?

Answer 7

It is a measure used in. health care and health economics to assess the value and effectiveness of different medical treatments and interventions.
- they are used to quantify the impact of a medical condition or treatment on a persons overall quality of life and life expectancy.

Question 8

how does QALYs work?

Answer 8

• measured on a scale of 0 to 1
• 0= a state equivelant to death
  1= perfect health
• between them represents varying degrees of health degrees
• considers the amount of time a persons spends in a particular health state.

Question 9

calculation for QALY?

Answer 9

quality of life x time

Question 10

what are the different measure types for QOL?

Answer 10

uni-dimensional
multidimensional (generic or disease specific)

Question 11

uni dimensional?

Answer 11

general health question
- mental wellbeing

Question 12

multideminsional generic?

Answer 12

medical outcomes study 36 item short survey.
eg - in general, how would you say your health is?
compared to one year ago, how would you are your health now?

Question 13

multidimensional disease specific ?

Answer 13

Seattle angina questionare (5 dimensions)

Question 14

what are the 5 determinants of QOL in heart disease?

Answer 14

1- physical functioning
2- physiological functioning
3- social functioning
4- occupational functioning
5- perception of health status

Question 15

what 2 diseases have the greatest impact on QOL?

Answer 15

cardiac and gastrointestinal disease

Question 16

physical functioning

Answer 16

positive impact if:
- minimal/no physical symptoms
- able to carry out usual physical activities
- healthy sexual relationships

Question 17

psychological functioning

Answer 17

-impacts on disease processes
- may also impact treatment concordance
- patients subject to long period of stress, coping strategies
- impacts on the ability to retain and understand information
- psychological stress is a predictor of hispitilsation
- physiological stress = poor QOL

Question 18

what is the relationship between psychological functioning and relationships?

Answer 18

• psychological functioning is important in building a rapport
• psychological distress can impede social support
• psychological distress can impair personal relationships
• it can create problems with relationships with health professionals

Question 19

what is the psychological distress following MI/CABG a risk factor for?

Answer 19

• early mortality
• low return to work
• difficulty making lifestyle changes
• problems with concordance in medical care
• increased use of health services
• PTSD
• readmission to hosp

Question 20

what things might cause a cardiac patient to become anxious?

Answer 20

• being away from partner
• fear of further event
• chest sensations
• returning to activities
• being in hospital

Question 21

first stage of psychological challenges of cardiac disease?

Answer 21

• fear
• anxiety
• depression
• loss of control
• loss of independence
• denial

Question 22

second stage of psychological challenges of cardiac disease?

Answer 22

• anger
• hopelessness
• sense of failure
• potential impaired cognitive function impacting on memory and confidence

Question 23

what are key symptoms of anxiety?

Answer 23

• excessive anxiety and worrying
• difficulty controlling the worrying

Question 24

what are associated symptoms of anxiety ?

Answer 24

• restlessness
• being easily fatigued
• irritability
• muscle tension
• difficulty concentrating
• disrupted sleep

Question 25

describe how there is a viscous cycle of anxiety post cardiac event?

Answer 25

- worrying thoughts can produce adrenaline - when there is no danger to run away from: physical effects = dizziness, dry mouth, shortness of breathe, heart racing, butterflies In stomach, hyperventilation cognitive effects = racing thoughts, anxious thoughts, preoccupation with catastrophising about bodily sensations.

Question 26

social functioning?

Answer 26

this has a positive effect on QOL - goof friends and family support - meaningful role in society

Question 27

occupational functioning?

Answer 27

- ability to return to work - rerunning to work and performing well - financial reward - significant positions and roles outside of work = improved QOL

Question 28

perception of health status

Answer 28

very variable = patients with the same pathophysiology will perceive their health differently

Question 29

what is perception of health influenced by?

Answer 29

- individual experience as a child, family relationships, occupational status - previous experience of health services -mental health and depression - personal understanding of the illness - denial

Question 30

what is illness behaviour?

Answer 30

evaluating symptoms, seeking medical help to bring relief and seeking support from family - defines a social role with expectations for both the sick and the healer

Question 31

describe the impact of illness behaviour?

Answer 31

- it can bring about secondary gains through sick role (increased sympathy and attention, special favours) - can prolong illness behaviour and negatively impact on perception of health status and therefore on QOL - patient perception cannot undertake normal activities

Question 32

epidemiology of depression and heart disease?

Answer 32

- estimated 15-45% affected after MI - 41% higher health care costs than in non depression patients - poor mortality and social/functional outcomes - depression is the most common feature of QOL - major risk factor for relapse

Question 33

key symptoms of depression?

Answer 33

- persistent sadness or low mood - marked loss of interest or pleasure

Question 34

what are sub threshold depression symptoms?

Question 35

symptoms of mild depression?

Answer 35

few if any symptoms in excess of the 5 required to make a diagnosis, and symptoms will result in only minor functional impairment

Question 36

symptoms of moderate depression?

Answer 36

symptoms or functional impairment are between mild and severe

Question 37

symptoms of severe depression?

Answer 37

most symptoms, and they will markedly interfere with functioning

Question 38

what is HADS assessment tool for depression?

Answer 38

- hospital anxiety and depression scale - not a diagnostic tool - informed self report - gives an indication as to a level of psychological distress

Question 39

how do you treat depression following a cardiac event?

Answer 39

there will be a likely combination of interventions that will depend on the severity, consider: - psychological therapy - lifestyle advise and self help - maximising physical health/status - drug treatments - specialist mental health services CARDAIC REHABILITATION

Question 40

describe the impact of cardiac rehabilitation?

Answer 40

positive impact on psychological health/adjustment of QOL

Question 41

what are the reduced rates after cardiac rehabilitation?

Answer 41

- 20% reduction in all cause mortality - 27% reduction in cardiac mortality - reduced health care costs

Question 42

what are the positive effects following a cardiac event that is aided by cardiac rehabilitation?

Answer 42

- relationships improve - low anxiety - motivated to change - high internal locus of control - sex life improves

Question 43

what are the challenges to using QALYs?

Answer 43

- been critiques on technical and ethical grounds - a salient problem relies on the numerical nature of its constituent parts - the appropriateness of the arithmetical operation is compromised by the essence of the utility scale: while life years are expressed as 0 means good and the interval scale where 0 is an arbitrary value for death. - you are assigning a numerical value to a persons quality of life and making difficult decisions about resources allocation in health care.