Cardiac instrument development in a low-literacy population: the revised Chest Discomfort Diary.

OBJECTIVE: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy. DESIGN: The study design was descriptive and correlational. SAMPLE: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. RESULTS: Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of "typical angina." Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy. CONCLUSION: The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients' chronic angina.

Impact of cardiac symptoms on self-reported household task performance in women with coronary artery disease.

PURPOSE: Household tasks are highly salient physical activities for women. Inability to perform household tasks may serve as an important marker of limitations imposed by cardiac symptoms. The purpose of this study was to examine the impact of cardiac symptoms on perceived ability to perform household tasks in women with coronary artery disease and to examine relationships among age, whether the woman lived alone, ability to perform household tasks, and cardiac-related quality of life. METHODS: Forty-one women with confirmed diagnosis of coronary artery disease and a mean age of 66 years (SD 12 years) were interviewed about the impact of their cardiac symptoms and perceived ability to perform household tasks (Household Activities Scale) and cardiac-related quality of life (Seattle Angina Questionnaire). The women were primarily white (89.4%) and retired (65.9%). Forty-six percent were married, and 26.8% lived alone. RESULTS: "Washing dishes" (51.3%) was the only task a majority of the sample could perform without limitation. Household tasks most commonly reported as no longer performed included carrying laundry (24.4%), vacuuming (30.0%), and scrubbing the floor (51.2%). The task most commonly modified because of cardiac symptoms was changing bed linens (60%). Of the 14 household tasks, women performed a mean of 3.39 (SD 3.36) activities without difficulty. Total number of household activities performed without difficulty was associated with better quality of life in the area of exertional capacity (r = 0.50, P = 0.001). Women who lived alone reported greater perceived ability to perform household tasks than women who did not live alone (r = 0.31, P = 0.05). Age was not significantly associated with perceived household task performance (r = -0.22, P = 0.17). CONCLUSION: Women with coronary artery disease (CAD) perceived cardiac symptoms as disrupting their ability to perform household tasks. Future research is needed to determine the independent impact of cardiac symptoms on functional limitations, especially in older women with heart disease, and whether changes in ability to perform household tasks could be a marker for coronary artery disease progression in women.

Knowledge and use of sublingual nitroglycerin and cardiac-related quality of life in patients with chronic stable angina.

Relationships among sublingual nitroglycerin (SLN) knowledge and use, general aspects of angina self-management, and quality of life were investigated in 95 patients with angina (age 63 +/-11 years). Quality of life was measured using a reliable and valid questionnaire, the Seattle Angina Questionnaire. Older age (p = 0. 04), male gender (p = 0.0001), more recent diagnosis with coronary artery disease (p = 0.02), and distant recall of SLN instruction (p = 0.02) predicted poorer SLN knowledge (R(2) = 0.26, p < 0.001). Male gender (p = 0.001) predicted more difficulty with SLN use (R(2) = 0.15, p = 0.005). A "bad" experience with SLN was associated with poorer quality of life (r = -22, p = 0.047). Sixty-five percent lacked knowledge about using SLN to prevent symptoms and 32.6% took SLN for symptoms other than chest pain. Findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use of SLN and side effect management.

Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion.

BACKGROUND: Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion. METHODS: Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status. RESULTS: The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables. CONCLUSIONS: Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.

Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation.

BACKGROUND: Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device. OBJECTIVES: The purpose of this study was to examine the association of emotional status after internal cardioverter defibrillator (ICD) implantation and subsequent arrhythmia events. METHODS: An analysis of data obtained in a prospective longitudinal study of responses to the ICD measured mood disturbance (Profile of Mood States; POMS) before implant and at 1, 3, 6, and 9 months postoperatively. Subjects included 144 men and 32 women with a mean age of 60 +/- 13 years and a mean left ventricular ejection fraction (LVEF) of 33 +/- 12%. Arrhythmia events were measured by self-report of shocks and by ICD device interrogation to obtain the number and type (defibrillation, cardioversion, and antitachycardia pacing) of therapies delivered by the ICD. For each time point, POMS scores of subjects who had arrhythmia events were compared with those who did not. For subjects who had ICD shocks, pre-event and post-event POMS scores were also compared. Multiple logistic regression was used at each time point to determine if clinical, demographic and psychological data could predict arrhythmia events. RESULTS: Patients with arrhythmia events had higher POMS scores throughout the 9 months of follow-up. Higher level of mood disturbance (specifically anxiety, fatigue, and confusion) at 1 and 3 months were independent predictors of subsequent arrhythmia events at 3 and 6 months after controlling for LVEF, the presence of coronary artery disease, pre-implant arrhythmia history, and the use of amiodarone and beta-blocking agents. There were no differences in POMS scores before and after ICD shocks, reinforcing the notion that negative emotions were a cause, rather than a consequence, of arrhythmia events. CONCLUSIONS: Mood disturbances, such as anxiety, may increase the risk for arrhythmia events after ICD insertion.

Cognitive appraisal and cardiac risk reduction behavior following coronary angioplasty.

Clinicians express concern that because percutaneous transluminal coronary angioplasty (PTCA) is minimally invasive and yields rapid symptom relief, patients with successful PTCA may be too optimistic about their future health status, may no longer perceive heart disease as a threat to health, and thus, may view cardiac risk-reduction behaviors as unnecessary. This study examined the relationship between patients' cognitive appraisal of PTCA (treatment appraisal and heart disease threat) and subsequent participation in cardiac risk-reduction behavior 2 weeks following hospital discharge. The sample included 58 subjects with successful PTCA. The majority were older, married, Caucasian men who reported participation in cardiac risk-reduction behavior (not smoking, exercising regularly, and following a low fat/low sodium diet) following PTCA. Although heart disease threat was a significant negative predictor of psychological well-being, it did not predict self-reported participation in cardiac risk-reduction behavior.

Perceived side effects and benefits of coronary angioplasty in the early recovery period.

OBJECTIVE: To examine patients' perceptions of the side effects and the treatment benefit of percutaneous transluminal coronary angioplasty (PTCA) in the early postdischarge recovery period, and to determine whether selected demographic and clinical variables were associated with perceptions of side effects and treatment benefit. DESIGN: Descriptive, correlational study. SAMPLE: Convenience sample of 62 subjects, with a mean age of 62 years (SD 11 years), 77% of whom were men, who had undergone successful, elective PTCA. RESULTS: Fifty-two percent of subjects reported side effects 2 weeks after PTCA. The most frequently reported side effect (22.5%), was discomfort in the groin site. Seventy-nine percent of subjects reported PTCA made things better, and 5% reported that PTCA made things worse. The most commonly reported benefit of PTCA was relief of chest pain. Age, sex, and a history of previous PTCA were not related to reported side effects or reported benefits. Subjects who experienced chest pain since the time of hospital discharge were less likely to report that PTCA was beneficial. CONCLUSION: More emphasis should be placed on helping patients who are candidates for a PTCA to predict and to manage treatment side effects and to have realistic expectations concerning the trajectory of recovery from PTCA. Further research is needed to examine the impact of patients' uncertainty concerning treatment benefit or perceptions of no treatment benefit in the early recovery period on intermediate and long-term PTCA recovery outcomes.

Optimism, coping and long-term recovery from coronary artery surgery in women.

Optimism, coping strategies, and psychological and functional outcomes were measured in 55 women undergoing coronary artery surgery. Data were collected in-hospital and at 1, 6, and 12 months after surgery. Optimism was related to positive moods and life satisfaction, and inversely related to negative moods. Few relationships were found between optimism and functional ability. Cognitive coping strategies accounted for a mediating effect between optimism and negative mood. Optimists were more likely to accept their situation, and less likely to use escapism. In turn, these coping strategies were inversely related to negative mood and mediated the relationship between optimism and this outcome. Optimism was not related to problem-focused coping strategies; this, these coping strategies cannot explain the relationship between optimism and outcomes.