Quality of life with heart failure: psychosocial determinants to be considered by cardiologists.

BACKGROUND: Independent determinants of QOL (quality of life) with heart disease have been recognised and include factors such as severity of medical condition, comorbidity, and concomitant medication. Psychosocial factors, as 'ability to cope with the unpleasantness of the medical condition', 'want of information', and 'social identification' have an important influence on self-perceived wellbeing, but their influence on health-related QOL domains and self-perceived QOL in patients with heart failure has not been systematically studied.
OBJECTIVE: To assess correlation between such psychosocial factors and QOL in patients with heart failure.
METHODS: Patients from the outpatient heart failure clinic of the Martini Hospital, a 1000-bed community hospital in the city of Groningen, the Netherlands, were included if their ejection fractions were <40% and their medical diagnosis according to their cardiologists was stable chronic congestive heart failure. The following QOL estimators were applied: Pearlin's Mastery Scale, Stewart's Short Form 36 Quality of Life Questionnaire, Dupuy's Index of Wellbeing, Cantrill's Self-perceived Quality of Life Scale, Mester's Want of Information Scale. Internal consistency of the multi-item scales was estimated by Cronbach's alphas. Linear and multiple linear regression analyses were performed of the data.
RESULTS: Sixty patients were enrolled, 41 males and 19 females, average age 68 years (range 51 to 84 years). 'Ability to cope with the unpleasantness of the medical condition' was not only an independent determinant of self-perceived and health-related QOL (both p<0.001), but also of each domain of health-related QOL separately (p<0.001 for each domain). Lack of 'adequate medical information' and 'negative social identification' (identification with fellow-sufferers who are doing worse) were negative predictors of 'ability to cope' (p<0.01 and <0.001 respectively). 'Negative social identification' was also an independent determinant of self-perceived QOL, both unadjusted and after adjustment for 'ability to cope' and 'adequate medical information'.
CONCLUSION: Relevant recommendations from this paper to be considered by cardiologists during everyday office hours could include: 1. Patients who express having difficulties in coping with the unpleasant aspects of their underlying heart condition have low health-related QOL as well as low self-perceived QOL. 2. Providing adequate medical information is a significant contributor to both better 'ability to cope' and better self-perceived QOL. 3. Avoiding identifying with fellow-sufferers who are doing worse and, instead, starting to identify with those who are doing better, are significant contributors to both better 'ability to cope' and better self-perceived QOL.