AJCC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

American Journal of Critical Care. 2004;13: 153-161
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Respond to This Article
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hou, N.
Right arrow Articles by Bennett, S. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hou, N.
Right arrow Articles by Bennett, S. J.

Relationship of Age and Sex to Health-Related Quality of Life in Patients With Heart Failure

By Nan Hou, RN, MSN, Michelle A. Chui, PharmD, PhD, George J. Eckert, MAS, Neil B. Oldridge, PhD, Michael D. Murray, PharmD, MPH and Susan J. Bennett, RN, DNS. From School of Nursing (NH, SJB), School of Medicine (NBO, GJE), and School of Allied Health Sciences (NBO), Indiana University, Indianapolis, Ind; Purdue University School of Pharmacy (MDM), Indianapolis, Ind; Regenstrief Institute (NBO, MDM), Indianapolis, Ind; and Midwestern University College of Pharmacy (MAC), Glendale, Ariz.


   Abstract
Top
 Abstract
Methods
 Results
 Discussion
 Conclusion
 References
 
• Background Although health-related quality of life is diminished among patients with chronic heart failure, few investigators have examined interactions of age and sex with health-related quality of life longitudinally.

• Objectives To examine differences in health-related quality of life among 4 groups of patients with heart failure on the basis of age (<65 years and >65 years) and sex and to evaluate relationships of age and sex to changes in health-related quality of life during 6 months.

• Methods Patients from 2 outpatient clinics in an urban county hospital were interviewed at baseline and 26 weeks later. Health-related quality of life was measured by using the Minnesota Living With Heart Failure Questionnaire and the Chronic Heart Failure Questionnaire.

• Results A total of 165 patients (52% women; mean age, 57.6 years) completed interviews at baseline and 26 weeks later. At baseline, patients younger than 65 years had poorer health-related quality of life scores on total scales and some subscales than did older patients. Women had poorer scores than did men on some scales, particularly the emotional subscales. At 26 weeks, patients younger than 65 had poorer total health-related quality of life on 1 scale than did patients 65 and older, and women had poorer scores than did men on 1 total scale. With demographic and clinical factors controlled for, women younger than 65 had improvements in health-related quality of life on some scales.

• Conclusions Women younger than 65 years had relatively poorer initial health-related quality of life that improved after 26 weeks.

Chronic heart failure is a significant health problem in the United States, and the incidence of newly diagnosed cases of heart failure continues to increase.1 According to the American Heart Association,2 heart failure affects more than 4.9 million persons in the United States, and 550 000 new cases occur annually. Heart failure has a high mortality rate, with a 12-month rate of approximately 15% and a 5-year rate of 50%.2 In addition, a considerable financial burden results from the high rates of hospitalization, readmission, visits to physicians’ offices, and complicated treatment regimens.2 These patients are often admitted to critical care units for stabilization after episodes of acute decompensation. Health-related quality of life (HRQL) is greatly diminished among patients with heart failure. Patients experience a variety of uncomfortable signs and symptoms and reduced physical, psychological, and social function.3–12 Importantly, HRQL is a significant predictor of hospitalization and mortality among chronically ill patients with heart failure.13,14

The incidence of heart failure increases with older age, and the risk factors for heart failure may be different for women and men.2 Additionally, women and men may respond differently to the impact of heart failure.15 However, the relationships of age and sex of patients to HRQL and to changes in HRQL over time are not clear.

Findings from previous studies of the relationship between age and HRQL have been inconsistent, with a suggestion that older patients do not necessarily experience poorer HRQL. Older age in patients with heart failure has been associated with an increase in general life satisfaction,16 better overall life satisfaction and HRQL,8 and worse emotional functioning,17 although Westlake et al18 did not find that age was a significant correlate of physical or emotional components of HRQL.

Investigators have also examined the relationship between sex of the patient and quality of life. Minimal differences in HRQL between women and men were reported in samples of 61 patients (including 16 women)18 and 58 patients (including 23 women).19 On the other hand, Riedinger et al20 reported that women (n = 691) had significantly worse general health and physical function than did men (n = 691) once age, left ventricular ejection fraction, and New York Heart Association (NYHA) class had been controlled for, but they found no differences in emotions between women and men as measured by the Profile of Mood States. These studies suggest that sample sizes may contribute to the inconsistent findings about differences in HRQL between women and men. Small sample sizes may limit the likelihood of findings being statistically significant.

Individual differences in HRQL over time were reported in 3 studies.21–23 In a study in which NYHA class, age, and ejection fraction were matched in a sample of 640 patients with heart failure (50% women), Riegel et al21 found that women had worse emotional HRQL at baseline, both women and men had significantly improved HRQL during the 3-month study period, and women and men did not differ significantly after 3 months. However, in another study,22 women had worse physical functioning at baseline and less improvement than men in physical function during a 1-year study period with no differences between the sexes in emotional HRQL as measured by the SF-36 Health Survey during the study period. In a study23 of a sample of 227 patients with heart failure, small changes in social support occurred that were nonetheless predictive of HRQL over 12 months. However, age was not related to changes in HRQL, and no difference was found in HRQL between women and men.

Among previous investigations, cross-sectional designs were used in 4 studies8,16,19,20 and generic HRQL measures in 5 studies.8,16,19,20,22 In some studies, the samples included disproportionate numbers of white patients,8,16,19,21,22 men,8,17,18 highly educated patients,8 and patients with end-stage heart failure who were undergoing heart transplantation.8,18

Information on the relationships of patients’ age and sex and the interactions of those 2 factors to HRQL and to changes in HRQL over time is important. Such information can be incorporated into critical care nurses’ assessments, so that realistic goals can be established and appropriate interventions designed for specific, demographic populations. Previous studies provide some information, although results of those studies have been inconsistent. More information would help optimize individualized, effective interventions to improve HRQL among patients with heart failure and primarily among patients in the groups with poorest HRQL scores. Therefore, the specific aims of our study were to examine the differences in HRQL at baseline and after 26 weeks among 4 groups of patients with heart failure, that is, men less than 65 years old, men 65 years and older, women less than 65 years old, and women 65 years and older, and to evaluate interactions of age and sex with the changes in HRQL during 6 months, after controlling for the influence of race, marital status, living status, perceived income, educational level, baseline NYHA class, mental status scores, and baseline HRQL.


Some data show that older patients with heart failure do not experience poorer quality of life than younger patients.

 


   Methods
Top
 Abstract
 Methods
Results
 Discussion
 Conclusion
 References
 
Procedure
As part of a larger study to compare measures of HRQL, patients were recruited from 2 outpatient clinics in an urban county hospital.24 The study protocol was approved by the university’s institutional review board.

The eligible population was determined, and 211 patients with heart failure (a convenience sample) were enrolled in the study. Eligibility criteria for the study are published elsewhere.24 Data were extracted from a computerized medical records system at the study site by a research coordinator. After letters were sent to eligible patients, health professionals trained as research assistants described the study to patients in the adult general medicine and heart clinics. Patients who signed consent forms completed the Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) to assess mental status.25 The SPMSQ is a 10-item screening questionnaire that measures orientation, personal history, remote memory, and calculations. The possible range of the SPMSQ score is from 0 to 10, with a higher score indicating a better mental status, and a score of 6 and over indicating intact mental status.25 Only patients with a SPMSQ score of 6 or higher were enrolled in the study because it was thought that intact mental status was essential for reliable data. Baseline data, including demographics, NYHA class, and HRQL, were collected within 2 weeks of the enrollment date by telephone. Patients were interviewed again about HRQL measures at 4, 8, and 26 weeks after baseline.26

Age 65 years was used as the cutoff point between older and younger adults in this study because it is used by the federal government as a marker for full Social Security and Medicare benefits, and it has been commonly viewed as the age of retirement.

Measures and Instruments
The Chronic Heart Failure Questionnaire (CHQ) and the Minnesota Living With Heart Failure Questionnaire (LHFQ) were used to measure disease-specific HRQL. The CHQ contains 16 items with 7-point response scales ranging from 1 (worst) to 7 (best) and includes subscales for dyspnea (5 items), fatigue (4 items), and emotional symptoms (7 items) in patients with heart failure.27 A mean total score is computed by summing the responses to the 16 items and dividing the sum by 16; a higher score indicates better HRQL. The dyspnea dimension was patient-specific. Five activities important to each patient and causes of shortness of breath in the patient’s daily life were identified at baseline. During baseline and follow-up interviews, patients were asked to rate the shortness of breath they had experienced while doing each of the 5 activities in the past 4 weeks. This instrument has documented validity and reliability and is relatively accurate in detecting changes in dyspnea and fatigue.23,27–29 For the larger sample of 211 patients with heart failure, the internal consistency reliabilities of the total CHQ and its subscales for dyspnea, fatigue, and emotion were 0.93, 0.86, 0.86, and 0.92, respectively. For the responders who completed the 26-week questionnaire, the internal consistency reliabilities were 0.95, 0.91, 0.89, and 0.91, respectively.26

The LHFQ contains 21 items with 6-point response scales ranging from 0 to 5. The LHFQ includes sub-scales for physical (8 items) and emotional (5 items) HRQL and 8 additional items that are part of the total LHFQ.30,31 The possible range of the total HRQL score is from 0 to 105; a higher score indicates poorer HRQL.30,31 This instrument has documented validity, reliability, and sensitivity.30–33 In the complete sample of 211 patients with heart failure, the baseline internal consistency reliabilities of the total LHFQ and its physical and emotional subscales were 0.95, 0.94, and 0.89, respectively.26 For the responders who completed the 26-week questionnaire, the internal consistency reliabilities of the total LHFQ and its physical and emotional subscales were 0.95, 0.91, and 0.86, respectively.26

Statistical Analysis
Statistical analyses were conducted by using the SAS version 8.02 (SAS Institute Inc, Cary, NC) computer program. Descriptive statistics by group for the 165 patients who completed the study were used to ascertain the overall mean, SD, SE, and range of scores at baseline and at 26 weeks after baseline and changes in HRQL during the 26 weeks. The change scores were computed by subtracting 26-week scores from baseline scores. Paired t tests (2-tailed) were used to determine differences between baseline HRQL scores and 26-week HRQL scores. In order to accomplish the first goal, 2-way analysis of variance models were used to determine if HRQL total and subscale scores were related to the age and sex of the patient. Tukey honestly significant difference post hoc analyses were applied to detect where the significant differences lay. In order to accomplish the second goal, a series of analysis of variance models and Tukey honestly significant difference post hoc analyses were computed to examine changes in HRQL over 6 months for differences in age and sex, controlling for other demographic (race, marital status, living status, perceived income, and educational level) and clinical (baseline NYHA class, mental status scores, and baseline HRQL) variables. The significance level for the comparisons was .05.


   Results
Top
 Abstract
 Methods
 Results
Discussion
 Conclusion
 References
 
Characteristics of the Sample
Of the 211 patients with baseline data, 165 (78%) also completed the 26-week interviews (Table 1Go). Mean age was 57.6 years old (SD, 11.4; range, 26–85); 52% were women and 48% were men, with 62% of the women and 84% of the men less than 65 years old. More African American patients (61%) than white patients were included in the sample. A total of 78% of the patients had evidence of baseline NYHA class II or III heart failure. Of the 46 patients who did not complete the 26-week interviews, 11 died before the 26-week interview, and 35 did not complete the 26-week interviews because of refusal, illness, or being lost to follow-up. Age, sex, race, education level, SPMSQ score, and baseline NYHA class did not differ significantly between patients who completed the 26-week interview and patients who did not. Patients who did not complete the 26-week interview had significantly poorer baseline total HRQL scores, poorer perceived physical HRQL, and more symptoms of dyspnea than did patients who completed the 26-week interview.


View this table:
[in this window]
[in a new window]
  		Table 1 Demographic and clinical variables*

 

In this study of heart failure, most of the men and women were under age 65.

 

Health-Related Quality of Life
Table 2Go gives the mean scores and SDs of the CHQ and the LHFQ at baseline and at 26 weeks and the change scores in the sample of 165 patients who completed both baseline and 26-week interviews. Overall, patients reported moderate HRQL. On the CHQ, the total scores and the scores for the dyspnea and emotional subscales increased significantly over 26 weeks, indicating fewer symptoms and improved HRQL.26


View this table:
[in this window]
[in a new window]
  		Table 2 Means and SDs for baseline, 26-week, and change scores on the Chronic Heart Failure Questionnaire and the Living With Heart Failure Questionnaire

 
Group Differences in HRQL at Baseline and 26 Weeks Later
Table 3Go shows the mean scores and the results of group comparisons at baseline, and Table 4Go shows the mean scores and the post hoc results by group at 26 weeks after baseline. We found significant differences among the 4 groups of patients on the total CHQ scores and all 3 subscale scores of the CHQ and on the total LHFQ scores and the emotional subscale scores of the LHFQ (Table 3Go). Patients less than 65 years old had significantly worse baseline HRQL scores on the CHQ total scale; the dyspnea, fatigue, and emotional sub-scales of the CHQ; the LHFQ total scale; and the emotional subscale of the LHFQ than did patients 65 years and older. Also, women had significantly poorer baseline CHQ total scores, scores on the dyspnea and emotional subscales of the CHQ, and scores on the emotional subscale of the LHFQ than did men. At 26 weeks, patients less than 65 years old had significantly worse LHFQ total scores than did patients 65 years and older, and women had significantly worse LHFQ total scores than did men (Table 4Go).


View this table:
[in this window]
[in a new window]
  		Table 3 Group differences in scores on questionnaires measuring health-related quality of life at baseline*

 

View this table:
[in this window]
[in a new window]
  		Table 4 Group differences in health-related quality of life at 26 weeks*

 

Although women less than 65 years old had poorer heath-related quality of life than all other groups at baseline, it did improve over time.

 

Group Differences in HRQL Changes After Controlling for Demographic and Clinical Factors
The effects of patients’ age and sex on longitudinal changes in HRQL after race, marital status, living status, perceived income, educational level, baseline NYHA class, mental status scores, and baseline HRQL were controlled for are presented in Table 5Go. Significant group differences were found on the total CHQ scale and the fatigue and emotional subscales. Post hoc analysis indicated that women less than 65 years old improved their overall HRQL significantly more than men less than 65 years old and women 65 years old and older. Women less than 65 years old also improved significantly more on the fatigue symptoms than did women 65 years old and older and more on the emotional symptoms than did men less than 65 years old. We found no significant differences in the LHFQ.


View this table:
[in this window]
[in a new window]
  		Table 5 Group differences in changes in scores on questionnaires measuring health-related quality of life after controlling for race, marital status, living status, perceived income, educational level, New York Heart Association class, baseline mental status, and baseline health-related quality of life scores*Conclusion

 

   Discussion
Top
 Abstract
 Methods
 Results
 Discussion
Conclusion
 References
 
Two disease-specific instruments were used in this study, and when baseline HRQL was compared among the 4 groups of patients with heart failure (women <65 years old, women >65 years old, men <65 years old, and men >65 years old), age and sex both had significant roles in determining baseline HRQL on both instruments. Women less than 65 years old had the poorest baseline HRQL among the 4 groups. On the other hand, the 2 disease-specific instruments used in this study generated different results about changes in HRQL over time. Women less than 65 years old had significant improvement in HRQL over time as measured by the CHQ, and because the magnitude of change for these women was more than 0.21, this finding may be clinically important.26 Conversely, the LHFQ scores indicated differences in HRQL related to patients’ sex and age at 26 weeks after baseline but did not show significant differences in the changes over time. This finding may be due to a difference in the sensitivity to change between the 2 measures: the CHQ may be more sensitive for detecting individual changes in clinical conditions, particularly in dyspnea and fatigue.26

Results of previous studies suggested differences in HRQL related to patients’ age or sex, but in most studies, the interactions of age and sex were not considered. Relatively worse general health, but not emotional HRQL, was reported for women.20,22 On the contrary, Riegel et al21 found differences, albeit minimal, in emotional HRQL between women and men. In addition, the results of previous studies on age differences in HRQL were inconsistent. In some studies,18,34 no direct associations between age and HRQL were reported, although higher overall life satisfaction was reported in older patients.17 These inconsistencies may be related to differences in the study samples, for example, in the number of subjects recruited, the percentage of women, disease severity (eg, patients with heart failure waiting for a heart transplant vs patients enrolled in clinical trials), comorbid conditions, social support, and quality of marriages.35 The sensitivity of different questionnaires used may also account for the inconsistent findings. In previous studies, age may have been treated as a continuous variable with different age ranges for each sample, and the relationships that we found may not have been evident. Further, the relationship of patients’ age and sex to HRQL may be through association with other variables such as depression or social support. For instance, women may have higher rates of depressive symptoms and may be more susceptible to the stressful effects of life events than are men,36–38 and because younger persons report more stressful life events and more hassles than do elderly persons,39–42 this possibility would be consistent with our findings of poorer HRQL in the younger women.

The significant differences between the sexes and between age groups at baseline as measured by the CHQ were diminished by 26 weeks after baseline. This result is consistent with the findings of Riegel et al.21 However, we also found that the significant differences for sex and age on the LHFQ total score were still apparent at 26 weeks. In previous work,26 the minimal clinically important difference was 5 points for the LHFQ total score. The statistically significant differences in our analyses were greater than this 5-point clinically important level, suggesting that the differences in our study are clinically meaningful. Previously, among hospitalized patients with heart failure, Chin and Goldman22 found that women had relatively less improvement in HRQL and still had poorer HRQL for all dimensions except mental function 1 year after baseline. The difference in findings of HRQL improvement over time may be related to sensitivity of the measurements, different study periods, and samples of outpatients with stable heart failure versus hospitalized patients with heart failure.

Several factors may have contributed to our finding that in women less than 65 years old, total HRQL improved over time. The risk factors for heart failure may differ between younger and older patients and between women and men. For instance, hypertension and diabetes play a greater role in women, whereas ischemic heart disease plays a greater role in men.43 Women and men may also respond differently to the impact of heart failure, and disease severity may play a more important role on physical HRQL in women than in men.15 Because age itself is a major risk factor for heart diseases and other chronic diseases,44 older patients may have more comorbid conditions that contribute to decreased HRQL over time and larger numbers of sicker patients may have been lost to follow-up. Alternatively, the young, without many comorbid conditions, may have a greater potential for improvements in HRQL over time.

A post hoc power analysis was performed for the CHQ total and LHFQ total scales. For the observed SDs and sample sizes, the study had approximately 80% power to detect the minimal clinically important difference for the CHQ total for comparisons of either age or sex. The study had 80% power to find differences of 8 to 13 points for the LHFQ total, depending on the comparison (age or sex) and on the specific outcome (baseline, 26-week, or change). Thus, although we found some differences, the study was underpowered to detect the 5-point minimal clinically meaningful difference for the LHFQ.

Limitations
This study has several limitations. First, it was limited to patients who completed both baseline and 26-week interviews, and the patients who did not complete the interview at 26 weeks because they had died or for other reasons were not included in the analyses. Although neither baseline NYHA class nor demographics except for SPMSQ differed significantly between the 2 groups, patients who completed the 26-week interview had significantly better baseline HRQL on some of the measures. Second, in our sample of 165 patients with heart failure, overall HRQL, physical HRQL, and emotional HRQL improved and symptoms decreased over time. These results differ from the results of a previous study among hospitalized patients45 and may be due to the sicker patients who were enrolled in the previous study or the number of patients in our study who did not complete the 26-week interview. Third, in our sample, a disproportionate number of patients were men less than 65 years old and women less than 65 years old; this difference may limit the generalizability of the study. The number of men older than 65 years is small; this small sample size is a limitation in finding statistically significant differences. The convenience sample in our study was recruited from an urban county hospital and included a high percentage of African Americans, a characteristic that may not be representative of the heart failure population in general but may be representative of patients with heart failure at similar urban centers. Fourth, regression toward the mean may have contributed to the significant change scores for women less than 65 years old (eg, those who had poor scores at baseline tended to have better scores at 26 weeks, and those who had good scores the first time tended to have slightly lower scores at 26 weeks).


   Conclusion
Top
 Abstract
 Methods
 Results
 Discussion
 Conclusion
References
 
Women less than 65 years old with heart failure in this study reported poorer HRQL than did other groups of patients and showed more improvement over 26 weeks. Future studies should be directed at explaining why the women less than 65 years old were experiencing poorer HRQL at baseline than were older women or younger and older men and how this disparity should be addressed. The longitudinal changes in HRQL among women less than 65 years old are important and should be examined in more detail specifically to address the needs and problems of younger women with heart failure.


   ACKNOWLEDGMENTS
 
Funding for this study was provided by the Agency for Health Care Research and Quality (AHRQ R03 HS09822-01). We thank Phyllis Dexter, RN, PhD, for editorial assistance; Ms Sherry Browning, RN, MSN, for assistance with the project; and Ms Laura L. Parker, for manuscript preparation.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.


   REFERENCES
Top
 Abstract
 Methods
 Results
 Discussion
 Conclusion
 References
 

  1. Ansari M, Massie BM. Heart failure: how big is the problem? Who are the patients? What does the future hold? Am Heart J. 2003;146:1–4.[Medline]
  2. American Heart Association. Heart Disease and Stroke Statistics: 2003 Update. Dallas, Tex: American Heart Association; 2002.
  3. Ekman I, Fagerberg B, Lundman B. Health-related quality of life and sense of coherence among elderly patients with severe chronic heart failure in comparison with healthy controls. Heart Lung. 2002;31:94–101.[Medline]
  4. Cline CM, Willenheimer RB, Erhardt LR, Wiklund I, Israelsson BY. Health-related quality of life in elderly patients with heart failure. Scand Cardiovasc J. 1999;33:278–285.[Medline]
  5. Berry C, McMurray J. A review of quality-of-life evaluations in patients with congestive heart failure. Pharmacoeconomics. 1999;16:247–271.[Medline]
  6. Bennett SJ, Pressler ML, Hays L, Firestine LA, Huster GA. Psychosocial variables and hospitalization in persons with chronic heart failure. Prog Cardiovasc Nurs. 1997;12:4–11.[Medline]
  7. Friedman MM. Stressors and perceived stress in older women with heart disease. Cardiovasc Nurs. July-August 1993;29:25–29.[Medline]
  8. Grady KL, Jalowiec A, White-Williams C, et al. Predictors of quality of life in patients with advanced heart failure awaiting transplantation. J Heart Lung Transplant. 1995;14(1 pt 1):2–10.[Medline]
  9. Dracup K, Walden JA, Stevenson LW, Brecht L. Quality of life in patients with advanced heart failure. J Heart Lung Transplant. 1992;11:273–279.[Medline]
  10. Jaarsma T, Halfens R, Abu-Saad HH, Dracup K, van Ree J. Quality of life in older patients with systolic and diastolic heart failure. Eur J Heart Fail. 1999;1:151–160.[Medline]
  11. Bennett SJ, Baker SL, Huster, GA. Quality of life in women with heart failure. Health Care Women Int. 1998;19:217–229.[Medline]
  12. Freedland KE, Carney RM, Rich MW, et al. Depression in elderly patients with congestive heart failure. J Psychiatr Gerontol. 1991;24:59–71.
  13. Stull DE, Clough LA, Van Dussen D. Self-report quality of life as a predictor of hospitalization for patients with LV dysfunction: a life course approach. Res Nurs Health. 2001;24:460–469.[Medline]
  14. Konstam V, Salem D, Pouleur H, et al. Baseline quality of life as a predictor of mortality and hospitalization in 5025 patients with congestive heart failure. SOLVD Investigations. Studies of Left Ventricular Dysfunction Investigators. Am J Cardiol. 1996;78:890–895.[Medline]
  15. Murberg TA, Bru E, Aarsland T, Svebak S. Functional status and depression among men and women with congestive heart failure. Int J Psychiatry Med. 1998;28:273–291.[Medline]
  16. Riedinger MS, Dracup KA, Brecht ML. Predictors of quality of life in women with heart failure. SOLVD Investigators. Studies of Left Ventricular Dysfunction. J Heart Lung Transplant. 2000;19:598–608.[Medline]
  17. Juenger J, Schellberg D, Kraemer S, et al. Health-related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002;87:235–241.[Abstract/Free Full Text]
  18. Westlake C, Dracup K, Creaser J, et al. Correlates of health-related quality of life in patients with heart failure. Heart Lung. 2002;31:85–93.[Medline]
  19. Beery TA, Baas LS, Fowler C, Allen G. Spirituality in persons with heart failure. J Holist Nurs. 2002;20:5–30.[Abstract/Free Full Text]
  20. Riedinger MS, Dracup KA, Brecht M, Padilla G, Sarna L, Ganz PA. Quality of life in patients with heart failure: do gender differences exist? Heart Lung. 2001;30:105–116.[Medline]
  21. Riegel B, Moser DK, Carlson B, et al. Gender differences in quality of life are minimal in patients with heart failure. J Card Fail. 2003;9:42–48.[Medline]
  22. Chin MH, Goldman L. Gender differences in 1-year survival and quality of life among patients admitted with congestive heart failure. Med Care. 1998;36:1033–1046.[Medline]
  23. Bennett SJ, Perkins SM, Lane KA, Deer M, Brater DC, Murray MD. Social support and health-related quality of life in chronic heart failure patients. Qual Life Res. 2001;10:671–682.[Medline]
  24. Bennett SJ, Oldridge NB, Eckert GJ, et al. Discriminant properties of commonly used quality of life measures in heart failure. Qual Life Res. 2002;11:349–359.[Medline]
  25. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23:433–441.[Medline]
  26. Bennett SJ, Oldridge NB, Eckert GJ, et al. Comparison of quality of life measures in heart failure. Nurs Res. 2003;52:207–216.[Medline]
  27. Guyatt GH, Nogradi S, Halcrow S, Singer J, Sullivan MJ, Fallen EL. Development and testing of a new measure of health status for clinical trials in heart failure. J Gen Intern Med. 1989;4:101–107.[Medline]
  28. Guyatt GH, Sullivan MJ, Fallen EL, et al. A controlled trial of digoxin in congestive heart failure. Am J Cardiol. 1988;61:371–375.[Medline]
  29. Wolinsky FD, Wyrwich KW, Nienaber NA, Tierney WM. Generic versus disease-specific health status measures: an example using coronary artery disease and congestive heart failure patients. Eval Health Prof. 1998; 21:216–243.[Abstract/Free Full Text]
  30. Rector TS, Francis GS, Cohn JN. Patients’ self-assessment of their congestive heart failure, I: patient perceived dysfunction and its poor correlation with maximal exercise tests. Heart Fail. 1987;3:192–196.
  31. Rector TS, Kubo SH, Cohn JN. Patients’ self-assessment of their congestive heart failure, II: content, reliability, and validity of a new measure, the Minnesota Living With Heart Failure Questionnaire. Heart Fail. 1987; 3:198–209.
  32. Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota Living With Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J. 1992;124:1017–1025.[Medline]
  33. Rector TS, Kubo SH, Cohn JN. Validity of the Minnesota Living With Heart Failure questionnaire as a measure of therapeutic response to enalapril or placebo. Am J Cardiol. 1993;71:1106–1107.[Medline]
  34. Rosen RC, Contrada RJ, Gorkin L, Kostis JB. Determinants of perceived health in patients with left ventricular dysfunction: a structural modeling analysis. Psychosom Med. 1997;59:193–200.[Abstract/Free Full Text]
  35. Rohrbaugh MJ, Cranford JA, Shoham V, Nicklas JM, Sonnega JS, Coyne JC. Couples coping with congestive heart failure: role and gender differences in psychological distress. J Fam Psychol. 2002;16:3–13.[Medline]
  36. Kessler RC, McGonagle KA, Nelson CB, Hughes M, Swartz M, Blazer DG. Sex and depression in the National Comorbidity Survey, II: cohort effects. J Affect Disord. 1994;30:15–26.[Medline]
  37. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.[Abstract]
  38. Weissman MM, Olfson M. Depression in women: implications for health care research. Science. 1995;269:799–801.[Abstract/Free Full Text]
  39. Aranda MP, Castaneda I, Lee P, Sobel E. Stress, social support, and coping as predictors of depressive symptoms: gender differences among Mexican Americans. Soc Work Res. 2001;25:37–48.
  40. House JS, Kessler RC, Herzog AR. Age, socioeconomic status, and health. Milbank Q. 1990;68:383–411.[Medline]
  41. Paykel ES. Methodological aspects of life events research. J Psychosom Res. 1983;27:341–352.[Medline]
  42. Aldwin CM. Does age affect the stress and coping process? Implications of age differences in perceived control. J Gerontol. 1991;46:174–180.
  43. Johnson MR. Heart failure in women: a special approach? J Heart Lung Transplant. 1994;13:S130–S134.[Medline]
  44. Premen AJ. Research recommendations for cardiovascular aging research. NIA Cardiovascular Aging Advisory Panel. J Am Geriatr Soc. 1996; 44: 1114–1117.[Medline]
  45. Castle JE. Patients With Advanced Heart Failure: A Description of the Disease Trajectory in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment in Critically Ill Adults (SUPPORT) [dissertation]. Boston, Mass: Boston College; 2000.



This article has been cited by other articles:


Home page
 Qual Health ResHome page
L. Nordgren, M. Asp, and I. Fagerberg
Living With Moderate-Severe Chronic Heart Failure as a Middle-Aged Person
Qual Health Res, January 1, 2007; 17(1): 4 - 13.
[Abstract] [PDF]

Home page
 Eur Heart JHome page
M.J. Lenzen, W.J.M. Scholte op Reimer, and M. Komajda
Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey: reply
Eur. Heart J., March 1, 2005; 26(5): 526 - 526.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Respond to This Article
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hou, N.
Right arrow Articles by Bennett, S. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hou, N.
Right arrow Articles by Bennett, S. J.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS