Health-related Quality of Life of Persons with Cardiovascular Diseases 1

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 each year (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 and 190,000 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 the associated 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

Health-related Quality of Life of Persons with Cardiovascular Diseases 2

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 in the 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/philippinescoronary-heart-disease). In the Baguio City alone, Department of Health- Cordillera Administrative Region (DOH-CAR) statistics 2011 shows that Saint Louis University Hospital of the Sacred 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 increasing trend. 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 cases making 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 avoid further 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 and societies. 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 leisure time, 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 wellbeing. HRQoL consists several domains which includes functional ability, psychological state, 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-life issues 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 and cultural; 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

Health-related Quality of Life of Persons with Cardiovascular Diseases 3

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 therapeutic effects. 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 other variables 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 a successful 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 our patients, advantage of measuring CVD patients HRQoL is worthy looking upon since Lukkarinen (2008) suggested that consideration of patients HRQoL should be taken alongside 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 cardiac interventions. 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 prolong life 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 that patient-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 a patient'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

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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 on related 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 functioning d. Psychological/ spiritual 3. Is there a significant difference in the QoL of persons with CVD according to: a. Age b. Gender c. Educational attainment d. Marital status e. 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 that individuals 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 the insufficiency 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 supportivedevelopmental system. Here, the patient is doing all of the self-care and is able to perform 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 and skills.

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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 of educative 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 the development of an algorithm for CVD patients assessment. The proposed algorithm is attached 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 behavior towards 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 be taught 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 is aim 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 expectations regarding 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 them more productive all throughout despite the disease process.

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METHODS and PROCEDURES Research Design The study will be using descriptive quantitative research. Quantitative research involves 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 old according 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 Cochrane which dictates 385 respondents to be completed.

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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, the researcher 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 various studies 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 better the 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 study of 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 alpha ranges 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 emotional problems; (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 or emotional problems consisted of items number 17- 19 while energy/ fatigue items are randomly 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, general health subscale items are numbers 1, 2 and 33 to 36. Tool (2) Ferrans and Powers Quality of Life Index (QLI) Cardiac Version IV consists 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 1 to 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.

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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 of CVD 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. This procedure 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 the response. 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 the study 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 the respondents 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 be utilized to treat data that will be gathered to answer the research questions. Students ttest and analysis of variance will be used in the statistical analysis. P<0.05 will be considered statistically significant. Scoring systems prescribed for each of the tool will be strictly followed. These guidelines from the authors themselves are downloaded from the same website from which the fully adapted tools are obtained. Input of raw data and statistical computations would be facilitated with the use of Microsoft excel. Interpretation of the QoL of CVD patients thereby follows.

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APPENDICES Tools/Scale Medical Outcomes Study: 36-Item Short Form Survey Instrument 1. In general, would you say your health is: Excellent Very good Good Fair Poor 1 2 3 4 5

2. Compared to one year ago, how would you rate your health in general now? Much better now than one year ago Somewhat better now than one year ago About the same 1 2 3

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Somewhat worse now than one year ago Much worse now than one year ago

4 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 Yes, Limited No, Not a Lot a Little limited at All 3. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports 4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf 5. Lifting or carrying groceries 6. Climbing several flights of stairs 7. Climbing one flight of stairs 8. Bending, kneeling, or stooping 9. Walking more than a mile 10. Walking several blocks 11. Walking one block 12. Bathing or dressing yourself [1] [2] [3]

[1]

[2]

[3]

[1] [1] [1] [1] [1] [1] [1] [1]

[2] [2] [2] [2] [2] [2] [2] [2]

[3] [3] [3] [3] [3] [3] [3] [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? (Circle One Number on Each Line) Yes No 13. Cut down the amount of time you spent on work or other activities 1 2

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14. Accomplished less than you would like 15. Were limited in the kind of work or other activities 16. Had difficulty performing the work or other activities (for example, it took extra effort)

1 1 1

2 2 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)? (Circle One Number on Each Line) Yes No 17. Cut down the amount of time you spent on work or other activities 18. Accomplished less than you would like 19. Didn't do work or other activities as carefully as usual 1 1 1 2 2 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 Slightly 1 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

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Very mild Mild Moderate Severe

2 3 4 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 A little bit Moderately Quite a bit Extremely 1 2 3 4 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 . . . (Circle One Number on Each Line) All of the Most of A Good Bit Some of A Little of None of Time the Time of the Time the Time the Time the Time 23. Did you feel full of pep? 24. Have you been a very nervous person? 25. Have you felt so down in the dumps that nothing could cheer you up? 26. Have you felt calm and peaceful? 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6

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27. Did you have a lot of energy? 28. Have you felt downhearted and blue? 29. Did you feel worn out? 30. Have you been a happy person? 31. Did you feel tired?

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 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 Most of the time Some of the time A little of the time None of the time (Circle One Number on Each Line) Definitely True 33. I seem to get sick a little easier than other people 34. I am as healthy as anybody I know 35. I expect my health to get worse 36. My health is excellent 1 Mostly True 2 Don't Know 3 Mostly False 4 Definitely False 5 1 2 3 4 5

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

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

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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.

Moderately Satisfied 5 5 5

Slightly Dissatisfied

Very Dissatisfied

HOW SATISFIED ARE YOU WITH:

Moderately Dissatisfied

Slightly Satisfied

1. Your health? 2. Your health care? 3. The amount of chest pain (angina) that you

1 1 1

2 2 2

3 3 3

4 4 4

Very Satisfied 6 6 6

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have? 4. Your ability to breathe without shortness of breath? 5. The amount of energy you have for everyday activities? 6. Your ability to take care of yourself without help? 7. The amount of control you have over your life? 8. Your chances of living as long as you would like? 9. Your familys health? 10. Your children? 11. Your familys happiness? 12. Your sex life? 13. Your spouse, lover, or partner? 14. Your friends? 15. The emotional support you get from your family? 16. The emotional support you get from people other than your family? 17. Your ability to take care of family responsibilities? 18. How useful you are to others? 19. The amount of worries in your life? 20. Your neighborhood? 21. Your home, apartment, or place where you live? 22. Your job (if employed)? 23. Not having a job (if unemployed, retired, or disabled)? 24. Your education? 25. How well you can take care of your financial needs? 26. The things you do for fun? 27. Your chances for a happy future? 28. Your peace of mind? 29. Your faith in God? 30. Your achievement of personal goals? 31. Your happiness in general? 32. Your life in general? 33. Your personal appearance? 34. Yourself in general? 35. The changes in your life that you have had to make because of your heart problem

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

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(for example, changes diet, physical activity, and/or smoking?)

PART 2. For each of the following, please choose the answer that best describes how important 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: Moderately Unimportant

Moderately Important 5 5 5 5 5 5

Slightly Unimportant

Slightly Important

Very Unimportant

1. Your health? 2. Your health care? 3. Having no chest pain (angina)? 4. Having no shortness of breath? 5. Having enough energy for everyday activities? 6. Taking care of yourself without help?

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

Very Important 6 6 6 6 6 6

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7. Having control over your life? 1 8. Living as long as you would like? 1 9. Your familys health? 1 10. Your children? 1 11. Your familys happiness? 1 12. Your sex life? 1 13. Your spouse, lover, or partner? 1 14. Your friends? 1 15. The emotional support you get from your 1 family? 16. The emotional support you get from 1 people other than your family? 17. Taking care of family responsibilities? 1 18. Being useful to others? 1 19. Having no worries? 1 20. Your neighborhood? 1 21. Your home, apartment, or place where 1 you live? 22. Your job (if employed)? 1 23. Having a job (if unemployed, retired, or 1 disabled)? 24. Your education? 1 25. Being able to take care of your financial 1 needs? 26. Doing things for fun? 1 27. Having a happy future? 1 28. Peace of mind? Specific diagnostic1 work-ups for 29. Your faith in God? 1 Negative establishment of CVD 30. Achieving your personal goals? 1 31. Your happiness in general? 1 32. Being satisfiedas with life? 1 Not managed CVD patients 33. Your personal appearance? 1 34. Are you to yourself? 1 35. The changes in your life that you have 1 had to make because of your heart problem (for example, changes diet, physical activity, and/or smoking?) ALGORITHM
Various domains affecting QoL (physical, emotional, socioeconomic, psychological/ spiritual)

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

2 3 4 2 3 4 2 3 4 2 3 4 Positive 2 3 4 2 3 4 2 Managed 3as CVD 4 patients 2 3 4 2 3 4 2 3 4

Follow-up check ups

SF-36 & QLI cardiac v. IV administration

QoL interpretation and classification according to

Determination of QoL according to preferred scales

Improvement of QoL

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

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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 monitored thereafter. 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.

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