Chronic heart failure is an increasingly prevalent condition associated with high mortality and a heavy burden on patients, families, and society. Despite evidence that psychosocial variables are associated with the clinical evolution of other forms of cardiac disease, little is known about the prognostic impact of these factors for patients with asymptomatic left ventricular dysfunction (LVD) or overt heart failure. The purpose of this study was to evaluate social isolation, mood (anxiety, depression, and vigor), low socioeconomic status, non-White ethnicity (in U.S. patients), life stress, and poor self-rated health as possible correlates of health outcomes for patients with systolic LVD. / A secondary analysis was performed on clinical and psychosocial data for 4991 (of 6797) American, Canadian and Belgian patients aged 21 to 80 with left ventricular ejection fractions ≤35% enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) clinical trials. Psychosocial correlates of mortality, clinical deterioration, arrhythmias, hospitalizations, and quality of life (functional status, life satisfaction, and symptom levels) were examined using logistic and Cox proportional hazards model regressions, before and after adjustment for patient clinical characteristics. / Results showed that some measures of social isolation (being unmarried, making visits to and receiving visits from others infrequently) were associated with the majority of the negative health outcomes studied. Contrary to expectations, neither high depression, nor high anxiety predicted risk of either cardiac-related mortality or ventricular arrhythmias. However, both depression and anxiety were linked with measures of clinical deterioration, hospitalizations for any cardiac cause, as well as poor quality of life at 1 year. Low vigor, low socioeconomic status, non-White ethnicity, and low self-rated health were all consistently associated with poor quality of life and heightened risk of all of the adverse events studied except arrhythmias. / Psychosocial factors appear to be independent predictors of mortality and morbidity in advanced cardiac disease characterized by moderate to severe LVD. This suggests that it is worth evaluating these parameters in patients with, or at risk for, heart failure and tailoring clinical interventions to address the impacts these factors may have on different health outcomes.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.34930 |
| Date | January 1998 |
| Creators | Clarke, Sean Patrick. |
| Contributors | Frasure-Smith, Nancy (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (School of Nursing.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001635663, proquestno: NQ44386, Theses scanned by UMI/ProQuest. |
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