Assessment of Self-Reported Health Status among Coronary Heart Disease Patients in Comparison with General Population in Selected Hospitals, Mangaluru

 

Ms. Neena Mariam Jose¹, Dr. (Mrs).Larisa Martha Sams², Aby G Abraham³

¹MSc Nursing, Laxmi Memorial College of Nursing, A.J Towers, Balmatta, Mangalore- 575002,

²Professor and HOD, Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing,

A.J Towers, Balmatta, Mangalore -575 002,

³Adackakulathil, Thirumoolapuram (p.o), Thiruvalla, Pathanamthitta District Kerala,

ABSTRACT:

AIM: The purpose of the study is to assess the self-reported health status among coronary heart disease patients in comparison with general population in selected hospitals at Mangaluru. BACKGROUND: Coronary Heart Disease is now the leading cause of death worldwide. In India, estimated mortality rate from coronary heart disease in 2010 is 2250,378 and the data suggests an increase of 2946,268 in 2015. By 2020, cases of coronary artery disease are expected to rise in India by 120% in women and 137% in men. Coronary artery disease should now be considered as an important public health problem due to epidemiological transition characterized by changing lifestyle and a problem related to interplay of factors with regard to their existence, causality and attributes. METHOD: A quantitative non-experimental research approach was adopted to assess the self-reported health status among coronary heart disease patients in comparison with the general population in selected hospitals, Mangaluru. Purposive sampling technique was adopted to select 40 coronary artery disease patients and 40 general populations. Data was collected by using demographic proforma and EuroQol 5D, a standardized tool. RESULT: There was a very highly significant difference in the self-reported health status (χ₂²= 5.991,p<0.05; Z = 2.00 ,p<0.001) in terms of dimensions and VAS score [EuroQol 5D scores] between CHD patients and general population. There was a very highly significant difference between CHD patients and general population in terms of each dimensions, that is, mobility, self-care, usual activities, pain and anxiety/depression [p<0.001]. CONCLUSION: The findings demonstrated that CHD has a negative influence on patient reported health status. EuroQol 5D scores are impaired in CHD patients which suggest that the self-reported health status among CHD patients is poor when compared to the general population. CHD is associated with significant impairment of health-related quality of life and other patient reported health status.

 

 

 

INTRODUCTION:

Coronary artery disease is characterized by narrowing and blockage of coronary arteries that supplies the heart with blood. includes angina (stable or unstable), myocardial infarction, congestive heart failure and even sudden death.¹ The term “Risk factor” in relation to cardio-vascular disease and especially coronary heart disease was used for the first time in 1961 in a paper on the Framingham study. The WHO expert committee on prevention of Coronary Artery Disease identified a number of lifestyle and environmental factors as the underlying cause of CHD. These risk factors may be conceptualized as modifiable and non-modifiable. Age, sex, smoking, high blood pressure, diabetes, elevated plasma cholesterol/triglycerides, obesity, sedentary lifestyle, personality type and psychological stress are considered some of the major risk factors for CAD.²

In today’ world, most death are attributable to non-communicable disease, 32 million and just over half of these, 16.7 million are a result of CHD. In developed countries heart disease is the first cause of death for adult women and men. Indians have the highest rates of CAD all over the world. It is 2-4 times higher at all ages and 5-10 times higher in those below 40 years of age. The excess burden of CAD in Indians is due to the combination of nature and nurture.³ According to World Health Report 2002, cardiovascular disease will be the largest cause of death and disability by 2020 in India. In 2020 A.D, 2.6 million Indians are predicted to die due to coronary heart disease which constitutes 54.1% of all cardio-vascular disease death.⁴

 

According to recent estimates, cases of CAD in India has increased from about 2.9 crores in 2000 to 6.4 crores in 2015; prevalence rates in rural populations remain lower than that of urban populations. In India, estimated mortality rate from coronary heart disease in 2010 is 2250,378 and the data suggests an increase of 2946,268 in 2015. Previously thought to affect primarily high income countries, Coronary artery disease now leads to more death and disability in low and middle income countries, such as India. The prevalence of coronary artery disease has progressively increased in India during the latter half of the last century. By 2020, cases of coronary artery disease are expected to rise in India by 120% in women and 137% in men.⁵

 

Health related quality of life (HRQL) assessment is an important measure of the impact of the disease, effect of treatment and other variables affecting people’s lives. There has been a rapid and significant growth in the measurement of quality of life as an indicator of health outcome in patients with coronary heart disease. In the clinical course of CHD, there are many aspects where patient’s quality of life may be affected which includes symptoms of angina and heart failure, limited exercise capacity of the symptoms, the physical debility caused and psychological stress associated with chronic stress. Modern treatment nowadays focuses not only on improving life expectancy, symptoms and functional status, but also quality of life. Thus an improvement in the health-related quality of life is considered to be important as a primary outcome and in the determination of therapeutic benefit.⁶

 

PROBLEM STATEMENT:

Assessment of self-reported health status among coronary heart disease patients in comparison with general population in selected hospitals at Mangaluru.

 

OBJECTIVES

·         To measure the self-reported health status among coronary heart patients

·         To determine the self-reported health status among general population

·         To compare the self-reported health status between coronary heart patients and general population

·         To find out the association between self-reported health status among coronary heart patients and general population and the selected demographic variables

 

HYPOTHESES:

·         There will be a significant difference in the self reported health status between coronary heart patients and general population.

·         There will be a significant association between self reported health status of coronary heart disease patients and selected demographic variables.

 

METHODS AND MATERIALS:

A quantitative non-experimental research approach was adopted to assess the self-reported health status among coronary heart disease patients in comparison with the general population in selected hospitals, Mangaluru. Comparative non-experimental research design was adopted for the study. In this study, the self-reported health status among coronary heart disease patients and general population was the research variable, which was observed in natural setting without manipulating them. This study was be conducted in two multi speciality private medical college hospitals namely A.J Hospital and Research Centre, A.J Institute of Medical Science and Fr Muller Medical College Hospital, Mangaluru. 80 samples were selected for the study [40 coronary heart disease patients and 40 general populations]. An official permission for conducting the study was obtained from the director and administrative departments of selected hospitals. Informed consent was obtained from the sample before initiating the study. Data was collected using demographic proforma and EuroQol 5D. Demographic profoma was used for the assessment of demographic and clinical variables. EuroQol 5D questionnaires consists of a descriptive system produced in a standard layout that enables the respondent to classify his/her health according to five dimensions and a VAS to enable the respondent to provide a self-rating of his/her own health. Collected data will be statistically analyzed and compared to find the significance of difference among the coronary heart disease patients and general population.

 

RESULT:

Section A: Description of sample Characteristics:

Majority of CHD patients (57.5%) and general population (65%) were in the age group of 51-65 years. Majority of CHD patients (70%) and general population (77.5%) were males. Highest percentage of CHD patients (37.5%) and general population (37.5%) has an educational status of degree and above. Majority of CHD patients (67.5%) and general population (87.5%) were employed. Majority of CHD patients (97.5%) and general population (92.5%) were married. Highest percentage of CHD patients (22.2%) and general population (46.2%) had hypertension. Majority of CHD patients (85%) and general population (82.5%) were not having any co-morbidity.

 

Section B: Description of self-reported health status among coronary heart disease patients and general population [EuroQol-5D scores].

Majority of CHD patients had some problems in terms of self-care (62.5%) and usual activities (67.5%), highest percentage of CHD patients had some problems in terms of mobility (45%), pain/discomfort (35%) and anxiety/depression (37.5%) [Table 1, Figure 1]. Majority of general population had no problem in terms of mobility (92.5%), self-care (85%), usual activities (80%), pain/discomfort (95%) and anxiety/depression (85%).  [Table 1, Figure 2].

 

Table 1: Distribution of CHD Patients and General Population According to EuroQol 5D Scores N=40+40

 

Figure 1: Bar Diagram Showing Percentage Distribution of CHD Patients According to EuroQol 5D

 

Figure 2: Bar Diagram Showing Percentage Distribution of CHD Patients According to EuroQol 5D

The mean VAS score of general population [94.25] was higher than that of CHD patients [45.25] [Table 2].

 

Table 2: Mean and Standard Deviation of VAS Score of CHD Patients and General Population N=40+40

Section C: Comparison of self-reported health status between coronary heart disease patients and general population.

This section deals with the comparison of self-reported health status between CHD patients and general population.

 

Table 3: Difference in the EuroQol 5D Score between CHD Patients and General Population [in terms of each dimension] N=40+40

Sl No	Groups	Mobility		Self-care		Usual Activities		Pain/Discomfort		Anxiety/ Depression
		χ2 value	p value	χ2 value	p value	χ2 value	p value	χ2 value	p value	χ2 value	p value
1	CHD patients	38.225 <0.001		42.68  <0.001		47.78  <0.001		29.981  <0.001		58.971    <0.001
2	General population

χ₂²= 5.991, p<0.001                                                                                                  ***=very highly significant

 

Table 4: Difference in the EuroQol 5D Score between CHD Patients and General Population [in terms of total dimensions] N=40+40

χ₂²= 5.991,p<0.05                          ***=very highly significant

 

Table 5: Difference in the EuroQol 5D Score between CHD Patients and General Population [in terms of VAS Score] N=40+40

Z = 2.00 , p<0.05                             ***=very highly significant

 

There was a very highly significant difference in each dimensions of EuroQol 5D between CHD patients and general population [p< 0.001] [Table 3]. There was a very highly significant difference in the self-reported health status (χ₂²= 5.991, p<0.05; Z = 2.00, p<0.05) in terms of dimensions and VAS score [EuroQol 5D scores] between CHD patients and general population.[Table 4 and 5]

 

Summary:

This section has dealt with the analysis and interpretation of the results of the study. The data gathered were analyzed using descriptive and inferential statistics. The findings suggest that general population have a better self-reported health status when compared to CHD patients.

 

DISCUSSION:

In this study, majority of CHD patients (57.5%) and general population (65%) were in the age group of 51-65 years. Majority of CHD patients (70%) and general population (77.5%) were males. Highest percentage of CHD patients (37.5%) and general population (37.5%) has an educational status of degree and above. Majority of CHD patients (67.5%) and general population (87.5%) were employed. Majority of CHD patients (97.5%) and general population (92.5%) were married. Highest percentage of CHD patients (22.2%) and general population (46.2%) had hypertension. Majority of CHD patients (85%) and general population (82.5%) were not having any co-morbidity. These findings are supported by a study conducted in Belgium to compare EuroQol-5D (EQ-5D) outcomes in coronary heart disease patients with those from the general population. The study showed that majority of CHD patients [60%] and general population [68%] were in the age group of 50-65 years with the mean age of 62 years, most of them were males, majority of CHD patients [72%] and general population [85%] were employed, most of them were married, majority of CHD patients [68%] and highest percentage of general population [34%] had hypertension, and majority of them were not having any co-morbidities.⁷ The present study showed that majority of CHD patients had some problems in terms of self-care (62.5%) and usual activities (67.5%), highest percentage of CHD patients had some problems in terms of mobility (45%), pain/discomfort (35%) and anxiety/depression (37.5%). It also showed that majority of general population had no problem in terms of mobility (92.5%), self-care (85%), usual activities (80%), pain/discomfort (95%) and anxiety/depression (85%). These findings are supported with a study conducted in Belgium to compare EuroQol-5D (EQ-5D) outcomes in coronary heart disease patients with those from the general population. The study showed that majority of CHD patients had some problems in terms of mobility [55%], self-care [62%], usual activities [68.5%], pain/discomfort [58%] and highest percentage of them had extreme problems in terms of anxiety/depression [72%]. Majority of general population had no problem in terms of mobility (94%), self-care (85%), usual activities (76%), pain/discomfort (85%) and anxiety/depression (82%).⁷ In the present study there was a very highly significant difference in the self-reported health status (χ₂²= 5.991,p<0.05; Z = 2.00 ,p<0.001) in terms of dimensions and VAS score [EuroQol 5D scores] between CHD patients and general population. There was a very highly significant difference between CHD patients and general population in terms of each dimensions, that is, mobility, self-care, usual activities, pain and anxiety/depression [p<0.001]. These findings are supported with a study conducted in Belgium to compare EuroQol-5D (EQ-5D) outcomes in coronary heart disease patients with those from the general population. The result suggest that there was a significant difference in the EuroQol 5D scores [p<0.05] between CHD patients and general population.⁷

 

LIMITATIONS:

·         The study was conducted only in a few hospitals at Mangaluru which imposed restrictions on generalization of findings.

·         Sample size was limited to 80 because of time constraints.

·         The study was conducted only on the coronary artery disease patients.

 

RECOMMENDATIONS:

Keeping in view the present research study findings, the following recommendations have been made.

·         The study can be repeated in large sample size to generalize the findings

·         A similar study can be conducted in different hospitals.

·         Similar studies can be done for longer duration of follow ups to note the improvement in health status.

·         A study can be done to determine various alternative approaches to improve the health status among CHD patients.

·         A similar study can be conducted with other major disease conditions.

·         A similar study can be done with experimental research approach having a control group.

 

CONCLUSION:

Self-reported health status differs among CHD patients and general population. CHD is associated with significant impairment of health-related quality of life and other patient reported health status. CHD has a negative influence on patient reported health status. EuroQol 5D scores are impaired in CHD patients which suggest that the self-reported health status among CHD patients is poor when compared to the general population.

 

CONFLICT OF INTEREST:

There were no conflicts of interest reported.

 

ACKNOWLEDGMENTS:

The author would like to express heartfelt thanks with deep sense of gratitude and respect to my guide Dr. (Mrs.) Larissa Martha Sams, M.Sc. (N), M. Phil.(N), Ph.D.(N), HOD, Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing, for her guidance, constant encouragement, personal interest, valuable advice and utmost patience in helping me to complete the study successfully.

 

REFERENCE:

1.         Coronary Herat Disease. Available from URL: http://www.nlm.nih.gov/medilineplus/ency/presentation/1001605.

2.         Deedwarnia P. Global risk assessment in pre-symptomatic patient. American Journal of Cardiology. 2008; 88:17-22.

3.         Deepa R.K., Aravind K., Mohan V. Risk factors for coronary artery disease. Current Science. 2002 Dec; 83(12): 1497-1505.

4.         Urmimala S., Ali S., Mary H. Self efficacy and health status in patients with coronary heart disease- findings from heart and soul study. Psychosom Med. May 2007; 69(4): 306-312.

5.         Reddy K.S. India wakes up to the threat of cardio-vascular disease. J Am Coll Cardiol.2007; 50:1370-1372.

6.         Steven P.S., Claudine T., David S.G., Jeffery D., Marcin D., William E. Health status and quality of life in patients with coronary artery disease. American Journal of Cardiology. September, 2013; 34(6):213-219.

7.         Smelt D. Clayst, Annemans L., Pardaens L., Kotseva K., Bacquer D. Self reported health status in coronary heart disease patients- a comparison with general population. International Journal of Cardiology. September 2013; 168 (2): 898-903.

 

 

 

Received on 13.12.2016          Modified on 25.12.2016

Accepted on 21.01.2017         © A&V Publications all right reserved